Effectiveness of self-help integrative body-mind-spirit techniques in reducing women’s anxiety during in-vitro fertilization result awaiting period : a randomized controlled trial

Abstract

Background: In-vitro fertilization (IVF) treatment is an assisted reproductive technology that is commonly adopted by couples experiencing infertility to pursue their dream of parenthood. IVF is known as a physically and psychologically demanding treatment, and most women experience high levels of anxiety during the course of treatment, particularly during the two-week wait (2WW)between embryo transfer and pregnancy testing.

Objectives: The aim of this study was to develop self-help intervention techniques for use by women during the 2WW of IVF treatment to alleviate anxiety and promote holistic well-being. The self-help intervention was designed under the framework of the Integrative Body-Mind-Spirit holistic intervention model, with the rationale of promoting a dynamic balance among the physical, psychological and spiritual.

Methods: The study sample consisted of 201 women undergoing IVF treatment. They were randomly assigned to three arms: (i)an intervention group with a behavioral and spiritual intervention component (SB group; n=3), (ii)an intervention group with only a spiritual component (S group; n=4) and (iii)a control group (n=4).

The women in SB group received a self-help booklet outlining 14 daily instructions on physical exercise, relaxation skills, and spiritual stories and messages for personal reflection, whereas those in S group received a different self-help booklet with spiritual stories and messages alone. The women in control group received health education materials. All of the participants were asked to complete self-administered questionnaires at three time points: on the day of the briefing session (T0), on the day of the embryo transfer (T1) and on the day of the pregnancy test (T2). Outcomes were assessed using the Chinese State-Trait Anxiety Inventory, Bodily Distress Scale, Fertility Quality of Life Tool, Fertility Problem Inventory, Importance of Childbearing Index, Body-Mind-Spirit Well-being Inventory and Gratitude Scale.

Results: The results revealed a significant increase in state anxiety from T1 to T2 in both SB group (p<0.05,2=0.20) and control group (p<0.05,2=0.20), whereas there was no such change in S group. SB group also exhibited a significant reduction in the mind-body domain (p<0.01,2=0.25), social domain (p<0.05,2=0.03) and total score (p<0.01,2=0.25) of the Fertility Quality of Life Tool, whereas control group showed a significant reduction only in the mind-body domain (p<0.01,2=0.23) and total score (p<0.05,2=0.18) of that instrument and S group a significant reduction only in the total score (p<0.05,2=0.22). However, no significant difference among the three groups was found for any of the variables during the 2WW period.

Discussion: The results of this study confirm the 2WW to be a stressful period for women. The participants experienced deterioration in psychosocial, physical and spiritual well-being throughout the course of IVF treatment, but particularly during the 2WW. Unfortunately, the self-help intervention was found to exert no significant effect in alleviating women’s anxiety or psychosocial and bodily distress.

Significance: This study suggests an alternative way of supporting women undergoing IVF treatment during the 2WW. It inspires the intervention modality of counseling services for Hong Kong women experiencing infertility, as it provides a new perspective on a form of psychological support that is low in cost, readily accessible and flexible.