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.