Online Intervention May Reduce Stress, Increase Pregnancy Rates in Women With Infertility

woman online holding a pregnancy test
Shot of a young woman using a laptop and pregnancy test on the sofa at home
An internet-based cognitive therapy intervention for women with infertility may reduce anxiety, depression, and stress and increase the likelihood of pregnancy.

An internet-based version of a cognitive therapy intervention for women with infertility called The Mind/Body Program for Fertility may reduce anxiety, depression, and stress, while increasing the likelihood of pregnancy, according to study results of a randomized controlled feasibility trial published in PLoS One.

As emotional distress may negatively affect adherence to fertility treatments, it is important to mitigate anxiety and depression in women seeking reproductive medical treatments. Studies have shown internet-based psychotherapeutic interventions to be an effective alternative to in-person treatment, especially for individuals experiencing infertility.

This study aimed to examine the efficacy of an internet-based version of the empirically tested in-person The Mind/Body Program for Fertility in its ability to recruit participants to volunteer for a randomized trial and to engage in fertility-specific interventions. Rates of anxiety and pregnancy in the intervention group were also studied.

A total of 71 women were eligible and willing to participate. Participants were eligible if they were ≥18 years of age, were nulliparous, had internet access, spoke English, had no change in their psychotropic medications in the month prior to the start of the study, had not previously completed or were currently enrolled in a Mind/Body Program for Fertility, did not have any suicidal ideation/intent, were never diagnosed with a psychotic disorder or eating disorder, and did not engage in substance abuse or dependence.

Eligible participants were randomly assigned to either the internet-based intervention group (mean age, 32.83±3.56 years) or a wait-list group (mean age, 33.49±3.97 years), which served as a quasi-control group. Questionnaires regarding general anxiety, depression, and infertility-related stress were completed at baseline, during the experimental period, and at the end of the intervention or wait-list period. The time between when the baseline and final questionnaires were taken differed significantly between the intervention (233.97±143.5 days) and wait-list groups (90.73±32.71 days; P <.001).

Most participants (84%) in both the intervention (75.0%) and wait-list (94.3%) groups were retained, defined by completion of the middle assessment. In addition, most participants (61%) were adherent, defined by the completion of ≥5 of the 10 online modules. The majority of women (82%) who completed the treatment were satisfied with the intervention overall.

Related Articles

Women in the intervention group had significantly greater reductions in anxiety (β=-4.86; P <.01), depression (β=-7.98; P =.01), perceived stress (β=-4.15; P =.08), fertility-related social stress (β=-5.12; P =.02), and fertility-related sexual stress (β=-6.13; P =.01) and a 4.47-fold increased likelihood of becoming pregnant (95% CI, 1.56-12.84; P =.005) when compared with the wait-list group.

The high rates of satisfaction and adherence suggest that the research design and program specific to this population are feasible and acceptable. The results regarding anxiety, depression, and instances of pregnancy suggest the program may benefit women experiencing infertility. Reproductive medical specialists may be able to use such programs to offer convenient and low-cost emotional support care during treatment for infertility.

Future studies replicating these findings with a larger sample size and more stringent methodologic considerations are warranted. Additional studies with an active control group are also needed to verify this study’s distress reduction and conception promotion findings.


Clifton J, Parent J, Seehuus M, Worrall G, Forehand R, Domar A. An internet-based mind/body intervention to mitigate distress in women experiencing infertility: a randomized pilot trial. PLoS ONE. 2020;15(3)