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This blog addresses various emotional aspects of experiencing infertility. It is written by a clinical psychologist who specializes in infertility counseling. Thank you for reading, and best of luck with your journey!

Thursday, March 3, 2011

Can psychological support groups really double your chance of conception during infertiity treatment?

My father was in town last weekend, and was very excited about a clip he had recently seen on the Today show about infertility, which can be found here. He was very impressed to learn that if a woman participates in an infertility-related social support group, it doubles her chance of conception in a given treatment cycle. When I expressed skepticism, he was adamant. "They proved it at Harvard," he exclaimed! How could I argue with that?

And really, why would I want to argue with that? No one would like to believe that providing people with emotional support would fix their infertility problems more than me. Not only is this a problem I could actually do something about, but given my line of work, it would be financially lucrative if this were true. And yet, I had a sinking suspicion that unfortunately, this was just too good to be true.

Thus, I took myself took a look at the study referred to in the Today show interview. (For those of you who are interested, here is the citation: Domar, A. Clapp, D.,Slawsby, E., Dusek, J., Kessel, B., Freizinger, M., (2000). Impact of group psychological interventions on pregnancy rates in infertile women: Presented at the Annual Meeting of the American Society of Reproductive Medicine, October 5, 1998, San Francisco, California. Fertility and Sterility, Vol. 73 (4), 805-811.) And indeed, the study was performed at Harvard Medical School. The lead author, Alice Domar, Ph.D., is a very well-known psychologist in the area of infertility. And yes, the results did show the women who participated in one of two types of support groups had a conception rate of 54 and 55 percent, respectively, versus only 20 percent in the control group.

However, as is so often the case with psychological research, the results are not the whole story. As the authors of the study themselves explain, this study had some serious methodological issues that call into question the veracity and applicability of its results. The researchers had difficulty recruiting subjects for the study, and thus the sample size involved was very small--too small to conduct powerful statistical analyses or to make sweeping generalizations to the population in general. The researchers made no attempt to control for the type of diagnoses with with the women in the study were struggling--so there was no way to tell whether or not the severity of the diagnosis was a factor in treatment success. Further, because they had difficulty recruiting enough subjects, the researchers were unable to randomly assign women into the three groups (cognitive-behavioral treatment, social support group, and no treatment). In addition, they had such large rate of dropout in the control group (which received the 20% success rate) they decided to not run any statistical analyses on the results because they would not be representative or accurate. The authors concluded that it may be that psychological interventions could increase pregnancy rates, but they could not definitively prove it on the basis of this study--further research was needed to clarify the issue. And by the way, further study has not uniformly supported this finding. Dr. Domar's later studies in this area have shown that while being in support groups or mind-body treatment may increase coping skills, quality of life, and a sense of well-being during infertility treatment, it does not appear to significantly increase, much less double, pregnancy rates.

Needless to say, none of the above limitations mentioned in the study were mentioned in the Today show interview. Rather, the results of this study were presented as Harvard-endorsed gold-plated facts. I don't think there was any malice in this, but rather a good dose of naivete. It does underscore, however, how you really can't believe everything you read, hear, or see on television. As infertility patients, it is imperative for us to all become educated consumers of research. That way, we can go to the studies ourselves and evaluate them critically in order to make the best treatment decisions possible. With the internet, scientific journals and studies are now easier to obtain than ever. Although I did take several research and statistics classes in graduate school, anyone can read and understand the author's descriptions of the problems with the study in question.

I must add that I am a big fan of support groups for infertility. I think that they can provide a great deal of information, camaraderie, and support and I would encourage everyone struggling with infertility to consider joining, creating, or leading one. I just don't think we can expect that in doing so, pregnancy rates among the group members will double. As I've said before, I have a sneaking suspicion that your reproductive system, unless under extremely stressful conditions, doesn't care too much about your unconscious conflicts or how you feel. That doesn't mean that you shouldn't care either, though--and that's where getting enough emotional support is so important, whether it helps you get pregnant or not.

11 comments:

  1. Thank you for this. I saw that Today show clip and thought it seemed a little too good to be true. As a scientist, I'm always a little skeptical of those sorts of blanket statements -- especially when people justify them by saying "they studied it at HARVARD!!!"

    I agree that support groups are incredibly helpful emotionally, though. And, I also think that being part of one has helped me know when it was time to look for medical help and to realize that it was OK to do so. Without that support, it may have taken me longer to look for help so I think I would necessarily be less successful.

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  2. Hi Lisa, this is an interesting post.

    What is your opinion on emotional blockages to fertility and in your opinion how much can a negative mindset influence someone who is confronting fertility issues?

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  3. @baby hopes...I actually have a older blog post on this topic, and here is the link:

    http://theinfertilitytherapist.blogspot.com/2010/09/negatives-of-positive-thinking-denial.html

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  4. I agree with the show. I've been attending a Resolve group for over 2 years and I've seen a few women come in and take away resources that I believe contributed to their success. I'm always on the wrong side of the stats so I'm still attending and hoping for my Resolve!

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  5. 'I have a sneaking suspicion that your reproductive system, unless under extremely stressful conditions, doesn't care too much about your unconscious conflicts or how you feel' Funny, I believe the opposite and have proven it in my own life and observed it in the lives of others.
    Taking control of your situation and your fertility is the best thing you can do for improving your chances of pregnancy.Once you jettison the experts, consultants, specialists,treatments tests and so on you eliminate most of the stress plus the dangerous and invasive drugs and interventions.A support group never hurts either.

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  6. Considering the ammount of blogs in the infertility world, a lot of them posting occasionally about feeling isolated during treatment. having more support groups easily accessable would be fantastic. too many of us seek support through the internet.even if they don't increase success rates ( which they could well do), they would ease a lot of suffering.

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  7. As above, I was going to post here to say I wonder if the difference with online support and actual real life support has any difference? Because I don't know anyone irl going through infertility, I'm not massively sociable and out there at the best of times, but still have a need to be amongst likeminded.

    I enjoyed reading this post, thank you

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  8. I just saw the segment on Today show and frantically googled what this "harvard study" was. Its funny how people will pick up on one study and discuss one misleading result without giving the entire picture, and then conclude that this one study is sufficient to negate all past research in this area.

    That being said, I am sure women who attend support groups don't attend just to "double" their chances, but rather to find emotional support and meet people who are going through what they are. If this has a positive outcome, then even better!

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  9. New to blogging and love your blog... as a doctor myself struggling with secondary infertility after a stillbirth, I've looked for all sorts of answers to fix my problem and agree that the evidence needs to be critically analysed before it can be sited as a treatment/help for infertility. We're just all so desperate sometimes that we'll try anything. Thank you so much for all the valuable information available on your site and look forward to following you :))

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  10. This is a really well-written and thought-out post. And your conclusions seem very true to me. I started doing yoga a year ago because of studies saying it could help increase chances of pregnancy. Turns out, my doing yoga didn't much help my husband's mild MFI (which was our only diagnosis). But it did help me center and relax over those difficult months, and that was a definite emotional benefit.

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  11. Thanks Lisa, for the link to your previous blog post.

    I don't know if what I was referring to is the same as thinking negatively/thinking positively.

    I am talking more along the lines of past emotional or physical traumas (such as recurrent miscarriages, abandonment, sexual abuse etc) and how they manifest as emotional blockages in our bodies which are then interpreted by our brains as a threat (flight/fight/freeze response).

    My area of interest is Emotional Freedom Technique and I want to learn more about it to help myself and others suffering from fertility issues.

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