Effectiveness of non-pharmacological interventions on pregnancy rates in infertile individuals undergoing IVF/ICSI: a systematic review and network meta-analysis.

AIM: To assess the impact of various non-pharmacological interventions on the likelihood of achieving pregnancy in individuals undergoing IVF/ICSI.

BACKGROUND

Despite significant advancements in assisted reproductive technology, the strategic utilization of non-pharmacological interventions to enhance clinical outcomes continues to pose a significant challenge in the field of reproductive medicine.

METHODS

Relevant studies published in English or Chinese were comprehensively selected from databases including CNKI, Wanfang Data, VIP Database, PubMed, Web of Science, and Embase up to December 2023. Studies that examined various non-pharmacological interventions during IVF/ICSI treatment, and reported subsequent pregnancy outcomes, were included. The control group received standard treatment. Study quality was assessed based on the methodology and criteria outlined in the Cochrane Collaboration Handbook. This review protocol was registered with PROSPERO (CRD42023414729).

RESULTS

Out of the initial 28,688 studies identified, 43 trials involving 5,779 women were included. When compared to the control treatment, cognitive-behavioral therapy, acupuncture, lifestyle intervention, health education, and music therapy were associated with a significantly increased likelihood of clinical pregnancy (OR 1.44, 95% CI 1.21 to 1.72; 1.89, 1.46 to 2.43; 1.75, 1.18 to 2.57; 2.10, 1.57 to 2.80; 1.52, 1.08 to 2.13, respectively). Among the non-pharmacological treatments studied, cognitive-behavioral therapy and lifestyle intervention were associated with the highest number of oocytes retrieved (OR 0.31, 95% CI 0.11 to 0.86; 0.15, 95% CI 0.04 to 0.58, compared to controls). No significant differences were observed among non-pharmacological interventions and the control group. Cognitive-behavioral therapy and health education led to the highest rate of high-quality embryos (OR 0.41, 95% CI 0.20 to 0.84; 0.52, 95% CI 0.28 to 0.97, compared to controls).

CONCLUSIONS

Non-pharmacological treatments such as cognitive-behavioral therapy, health education, lifestyle intervention, acupuncture, and music therapy showed trends suggesting better clinical outcomes in terms of pregnancy achievement compared to the control group. More high-level RCT studies are clearly necessary for future meta-analyses to better guide clinical practice.

IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: Policymakers should promote non-pharmacological programs for infertile population and develop standard guidelines. This will ensure that non-pharmacological interventions are implemented responsibly, protecting patient rights and enhancing healthcare outcomes.