The impact of emotional health on assisted reproductive technology outcomes: a systematic review and meta-analysis

Abstract

This systematic review and meta-analysis has addressed ongoing controversy surrounding the association between pre-treatment anxiety, stress and depression and assisted reproductive technology (ART) outcomes. Medline, Embase and PsycINFO were searched up to November 2019. The eligibility criterion was observational studies reporting the association between pre-treatment anxiety, stress or depression and ART outcomes in men, women or couples undergoing ART. The association between pre-treatment anxiety, stress and depression and ART outcomes were extracted, and meta-analyses carried out if ≥3 studies assessed the same outcome over the same number of cycles and reported results homogeneously. The review reports a potential association between decreased sperm motility and increased male state anxiety, but no significant association between women’s pre-treatment emotional health and ART outcomes in terms of live birth, clinical pregnancy, chemical pregnancy, oocyte retrieval, embryos transferred or fertilization. Meta-analyses showed no significant standardized mean difference (SMD) for anxiety/stress and clinical or chemical pregnancy, or depression and clinical or chemical pregnancy.

Keywords:

• Infertility
• assisted reproductive technology
• mental health
• anxiety
• depression

Acknowledgements

Thank you to King’s Fertility and MRC Centre for Transplantation.

Disclosure of interest

The authors report no conflict of interest.

Additional information

Funding

No specific funding sought. We were supported by MRC Centre for Transplantation and King’s Fertility. Kamran Ahmed acknowledges research funding from the Pelican Group, and KMRT (King’s Health Partners).