In a study of infertility patients, two group psychological interventions were compared with routine care. The two groups who received group support and cognitive behavioral therapy had fertility rates of 54% and 55%, respectively, compared with the control group, which had a pregnancy rate of 20%. There were large and disparate dropout rates, which complicate the interpretation of these results (52). In Austria, physicians are required to prescribe psychotherapeutic therapy for every patient undergoing assisted reproductive techniques. These approaches include psychotherapy, hypnotherapy, relaxation, and physical perception exercises. A review of its success associated with pregnancy rates found that of the 1,156 women, the cumulative pregnancy rate of those who utilized the mind–body techniques was 56% and in those who intended to use these approaches were 41.9%, higher than those who refused (53). In a case control study examining the impact of hypnosis on pregnancy rate in in vitro fertilization (IVF), the pregnancy rate in those cycles where hypnosis was used was 53% versus 28% in the controls, and the implantation rate 30% versus 14% (54).
Mind–body therapies, such as relaxation techniques and hypnosis, are reasonable to recommend to relieve a wide variety of issues that can arise with infertility patients.
The use of acupuncture was studied in the treatment of infertility and overall shows promise. Auricular acupuncture was studied as an alternative therapy for female infertility secondary to oligomenorrhea or luteal insufficiency, and the authors concluded it was a valuable therapy (55). Another study used electroacupuncture in anovulatory women with polycystic ovarian syndrome and found that regular ovulation was induced in more than one-third of the women. After early positive results, there were several recent studies on acupuncture and IVF. In a study of 228 women examining acupuncture and IVF, while the difference did not reach statistical significance, the pregnancy rate in the acupuncture arm was 31% versus 23% in the control arm, and ongoing pregnancy rates at 18 weeks gestation was 28% versus 18% (56). In a randomized controlled trial of 225, women undergoing IVF or intracytoplasmic sperm injection (ICSI) with acupuncture had clinical pregnancy rates of 33.6% versus 15.6% in the control group, and ongoing pregnancy rates of 28.4% versus 13.8% (57). In a trial of 182 women comparing usual care versus acupuncture 25 minutes before and after embryo transfer versus acupuncture before and after transfer and 2 days after the transfer, there was again a significant increase in pregnancy rates with acupuncture, but no additional benefit was found in the patients who also received acupuncture 2 days after transfer. The clinical pregnancy rates in the acupuncture group were 39% versus 26% in the controls, and the ongoing pregnancy rate was 36% versus 22% (58).