O-080 The effect of psychosocial support on motivation for assisted reproductive treatments
Authors: Szigeti F. J , Kazinczi C , Szabó G , Sipos M , Ujma P P , Purebl G 
Published: July 2024

Abstract

Study question
Does psychosocial intervention targeting better psychological adjustment increase the likelihood of treatment continuation among women pursuing assisted reproductive technologies (ART)?

Summary answer
After a psychosocial intervention, a robust amelioration occurred in distress levels, yet no notable change was detected in motivational levels for treatment continuation.

What is known already
Approximately 20% of patients stop ART treatments prematurely, often after three unsuccessful cycles, even in countries with a public funding of ART, despite a 15% success rate increase per recommended cycle. Emotional distress, poor prognosis, and financial burden are risk factors for early cessation. Since depression has been shown to predict ART discontinuation, it is logical to expect that an alleviation of depression is accompanied by a strengthening of the intention for treatment continuation.

Study design, size, duration
A prospective, pre-post design, single-centre, interventional cohort study was performed between December, 2019 and October, 2022 (start and end of recruitment, respectively). 2636 patients were approached for study purposes, 610 were assessed for eligibility, and 168 were included in the intervention. With a 8.3% attrition rate, data of 154 patients were analysed in this study, originally a randomized controlled trial, whose data were pooled for the present purposes.

Participants/materials, setting, methods
Women scoring in mild-to-moderate impairment ranges on four psychological tests were invited to take part in a 10-week, 135-minute/week intervention at the assisted reproduction centre of a large university hospital. Psychological data were collected pre- and post-intervention, alongside demographic and fertility specifics. Perceived probability of treatment continuation in the event of an unsuccessful ART cycle was assessed with a Likert-scale single question at both time points. Multivariate linear models were utilized for statistical analysis.

Main results and the role of chance
In comparison with baseline values, significant changes in the expected direction occurred in depressive symptoms, anxiety values, infertility-specific stress and fertility-related quality of life (t-values ranging from 6.559 to 7.949; all p-values&lt;0.001). However, neither treatment-related quality of life (t = 0.718; p = 0.474), nor motivational levels for treatment continuation changed significantly (t = 1.058; p = 0.292). Age, however, had a significant main effect on perceived probability of treatment continuation (t = 2.864; p = 0.004).

Limitations, reasons for caution
Limitations include potential inter-group differences, unmeasured motivational factors, and no male partner data. Biological factors other than age, aetiology and duration of infertility may have confounded study results. Another limitation is the lack of long-term follow-up, given that perceived probability of treatment continuation may not coincide with actual behaviour.

Wider implications of the findings
Psychosocial interventions are efficient in alleviating distress but these improvements may not directly impact motivational changes. Biological factors such as age may have a more accentuated effect on ART treatment continuation than psychological aspects. Alternative hypotheses on precise determinants and modifiable factors influencing motivation need testing.

Trial registration number
Not applicable