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PLOS ONE: Online program more than doubled pregnancy rate for women with infertility

March 18, 2020

For women being treated for infertility, studies show that in-person counseling decreases anxiety, depression and stress and leads to higher rates of pregnancy.

But for a variety of reasons -- including stigma, skepticism about efficacy, cost, travel challenges and difficulty scheduling appointments -- many women in treatment don't seek additional psychological help and often give up on their dream of having a child.

In a study published March 18 in PLOS ONE, researchers at the University of Vermont demonstrated that an internet version of a highly respected clinical program achieved results similar to its in-person equivalent, both in reducing distress and in promoting pregnancy.

Women experiencing infertility issues who took the online program -- the Mind/Body Program for Fertility, developed at the Domar Center at Harvard -- experienced medium to large decreases in depression and anxiety and in stress related to sexual and social concerns, compared with a control group, and were two-and-a-half times more likely to become pregnant.

The results are comparable to studies gauging the impact of the in-person version of the Mind/Body Program.

"Offering this highly effective program online removes the barriers to counseling that prevent so many women in fertility treatment from getting the help they need," said the study's lead author, Jessica Clifton, a faculty scientist at the University of Vermont.

"It could enable women across the country, no matter where they live or what their circumstances, to reduce their distress and increase their chances of conceiving."

Clifton and her colleagues at the University of Vermont developed the online version of the Mind/Body Program over a three-year period in collaboration with the program's founder and director, Alice Domar, associate professor of Obstetrics, Gynecology and Reproductive Biology at the Harvard Medical School. Domar is a co-author of the PLOS ONE study.

The online program mirrors the in-person version, offering ten hour-long modules of instruction that include video, audio and text. Materials cover the relationship between stress, lifestyle and fertility; relaxation techniques, including diaphragmatic breathing and Hatha Yoga; mindfulness; cognitive/behavioral therapy; stress reduction strategies; listening and communication skills; strategies for emotional expression and effective coping with anger; and assertiveness training and goal-setting skills.

As with the in-person program, the online version also offers feedback from a trained therapist to participants' homework assignments. The therapist was available remotely as needed throughout the online program.

The study recruited 71 women who were experiencing infertility issues, about half took the online program right away while the other half were placed on a wait list.

Both groups took a pre- and post-assessment. Those taking the program right away reported measurable reductions in anxiety, depression and stress, while the control group reported a near-zero change. The self-reported pregnancy rate at the study's close was 53 percent for the group that took the program and 20 percent for the wait-list group. Women who took the online program also became pregnant more quickly compared to the wait-list group, in an average of 79 days compared with 97 days.

The study also demonstrated that women experiencing infertility were willing to take an online program and were largely satisfied with it, according the pre- and post-assessment.

"The results suggest we could change the way reproductive medicine is provided," Clifton said. "Medical practices could implement quick and easy screening to identify distressed patients. We could then offer a convenient, effective and affordable internet-based intervention for these patients that would measurably reduce their distress and help them achieve their dream of conceiving a child."
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University of Vermont

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