Solutions-focused therapy improves mental health in IVF patients

Solutions-focused therapy improves mental health in IVF patients | Image Credit: © Chinnapong - © Chinnapong - stock.adobe.com.

Introduction

Anxiety and depression symptoms, sleep quality, and reproductive health quality can be improved by a solution-focused approach (SFA) among women receiving in vitro fertilization-embryo transfer (IVF-ET), according to a recent study published in PLOS One.¹

Infertility presents in 3.5% to 16.7% of women in developed countries and 6.9% to 9.3% in developing countries.² This leads many women to seek Assisted Reproductive Technology (ART) to achieve fertility.¹ However, the success of ART declines with advancing maternal age, potentially leading to negative emotions and reduced quality of life.

“The negative emotions, such as anxiety and depression, that may exist in advanced maternal age infertility patients could further impact their quality of life and sleep quality, and even have adverse effects on pregnancy outcomes and fetal development,” wrote investigators.

SFA intervention process

An SFA promotes holistic personal development to improve outcomes in patients. The stages of SFA include problem description, goal setting, exploring expectations, providing feedback, and evaluating progress. According to investigators, this approach has proven effective in multiple populations.

Investigators conducted a clinical trial to evaluate the efficacy of SFA toward improving the psychological status in women of advanced age, defined as 35 years and older, receiving IVF-ET. Depression and anxiety were reported as primary outcomes, while secondary outcomes included sleep quality, reproductive life quality, and clinical pregnancy rate.

Study participants and methodology

Participants included women aged at least 35 years receiving IVF-ET with a self-rated anxiety scale of 50 or higher and self-rated depression scale score of 53 or higher. Those with severe acute or chronic illness, male partners with severe oligozoospermia, or receiving psychological treatment within the last 2 months were excluded from the analysis.

Baseline self-reported questionnaires were administered to patients to obtain demographic, clinical characteristics, and outcome variable data. Following this assessment, SFA patients immediately received their first intervention session.

On the day of embryo transfer, participants underwent subsequent evaluations and reported depression, anxiety, sleep quality, reproductive quality of life, and satisfaction with the intervention. Clinical pregnancy rates after 28 to 30 days were also obtained.

Control vs intervention groups

Routine nursing care was provided to patients in the control group, including day of treatment initiation, ovulation induction period, human chorionic gonadotropin (HCG) trigger day, oocyte retrieval day, and embryo transfer day. In the SFA group, SFA interventions were included alongside this care.

During SFA interventions, patients were encouraged to discuss the events causing their anxiety and depression. These sessions lasted 30 to 60 minutes and were performed at treatment initiation, ovulation induction, HCG trigger day, oocyte retrieval day, and embryo transfer day.

Measurement tools

There were 5 steps to the SFA process: problem description, goal construction, exploration of expectations, positive feedback, and progress evaluation. Anxiety was measured through the 20-item self-rating anxiety scale (SAS), and depression through the 20-item self-rating depression score (SDS).

Scores ranged from 1 to 4, with total raw scores of 20 to 80. Higher scores indicated more severe symptoms. Additional measures included the Pittsburgh sleep quality index scale (PSQI), Fertility Quality of Life (FertiQoL) scale, and a satisfaction questionnaire developed by researchers.

Study results

There were 112 patients randomized, 56 to the intervention group and 56 to the control group. Of these patients, 4 and 3, respectively, were lost to follow-up. A mean age of 41.12 ± 4.12 years was reported, and 28.6% of patients had a body mass index under 18.5 kg/m², 46.6% from 18.5 to 23.9 kg/m², and 24.8% of 24 kg/m² or higher.

No baseline differences in SAS, SDS, PSQI, or FertiQoL scores were reported between groups. However, the intervention group reported significantly reduced SAS and SDS scores vs the control group following the intervention, with differences of -10.348 and -5.087, respectively. These patients also had a lower PSQI score with a difference of -5.087.

When evaluating FertiQoL, a higher score was reported in the intervention group vs the control group, with a difference of 2.389. Most patients in the IVF-ET group also reported high satisfaction, though 2 were dissatisfied with the number and total duration of intervention. Clinical pregnancy rates did not differ between groups.

“This study confirms the positive effects of SFA on anxiety and depression in advanced age women undergoing IVF-ET, as well as its improvement on sleep quality and quality of life,” wrote investigators. “The study also validates the effectiveness and applicability of the intervention plan in psychological nursing for advanced age infertile women.”

References

1. Tang N, Xie L, Pei M, Wang J, Hu J, Gao Y. Effect of solution focused approach on women aged 35 or over with in vitro fertilization-embryo transfer: A quasi-experimental trial. PLOS One. 2025. doi:10.1371/journal.pone.0316771
2. Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021;326(1):65–76. doi:10.1001/jama.2021.4788