Abstract
ObjectiveOur study examined the psychological outcomes associated with failed ART treatment outcomes in men and women.Search StrategyA systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases.Inclusion CriteriaStudies were included if they contained data on psychosocial outcomes taken pre and post ART treatment.Data Extraction and SynthesisA standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies.Main ResultsBoth depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure.ConclusionLinking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making.
Highlights
Assisted reproductive technologies (ART) have become an important option for those seeking help to conceive [1] and are well-established [2,3,4] with increasing utilisation [5,6]
Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies. Both depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 for depression and 0.21
Studies included in the narrative synthesis confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure
Summary
Assisted reproductive technologies (ART) have become an important option for those seeking help to conceive [1] and are well-established [2,3,4] with increasing utilisation [5,6]. Despite increases in treatment usage, ART success rates, conventionally defined and measured as the rate of live births per cycle initiated [6] improving are still modest [7]. In Australia, the live birth rate per treatment cycle was 17.9% in 2012 [5] with international data reporting rates approximately 2% higher [6]. There is a distinction in the reporting of success rates associated with frozen versus fresh autologous cycles. In Australia rates per live delivery are 2% higher for women undergoing autologous thaw cycles than for autologous fresh cycles [5]. With increasing women’s age the live delivery rate per thawed embryo declines; this is similar if using autologous fresh embryos [12, 5]
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