Examining the Effectiveness of a Self-Help Integrative Body-Mind-Spirit Intervention for Women Receiving Fertility Treatment: A Prospective Three-Arm Randomized Trial

Background and Purpose: In vitro fertilization (IVF) is increasingly used by couples diagnosed with infertility to achieve biological parenthood. Yet, IVF is associated with significant physical and psychological demands that may go on to hamper individuals’ well-being. Evidence suggests that women tend to experience elevated levels of anxiety during the course of treatment, particularly during the 14-day period leading up to the pregnancy test in an IVF cycle. Despite significant burden on the body and the mind, female patients often face substantial psychological and logistical barriers in seeking professional support. The purpose of this study was to test the effectiveness of a self-administered intervention among women receiving IVF treatment. The intervention was developed based on the Integrative Body-Mind-Spirit (I-BMS) social work practice model, which emphasized the interconnectedness of physical, psychological and spiritual well-being. Specifically, we compared the effectiveness of three variations of the I-BMS intervention in order to examine which of the component(s) effect the most desired changes.

Methods: This study was a prospective three-arm randomized trial. Participants were women about to begin fertility treatment at a public hospital in Hong Kong. A total of 356 women were recruited and randomized to receive either spiritual reflection only (S), spiritual reflection and relaxation exercise (SR), or body-mind exercise (BM) in the form of self-help booklets. Participants completed a questionnaire battery at baseline (T0), on the day of embryo transfer (T1) and on the day before taking the pregnancy test. Measures included state and trait anxiety, gratitude, physical distress, holistic well-being, infertility-related stress and fertility-related quality-of-life. Group and time effects were explored using repeated-measures ANOVAs and by specifying a time x group interaction term. Post-hoc within-group comparisons were conducted for each outcome variable assessed at T1 and T2.

Results: After randomization, 149 participants dropped out from the study, yielding a final sample of 207 women. Repeated-measures ANOVAs revealed significant time x group interaction for general physical health [F(2, 194) = 3.27, p<.05] and life satisfaction [F(2, 194) = 4.10, p<.05], suggesting worsening of general physical health from T1 to T2 in the SR group only, and reduced life satisfaction in the SR group and S group. Post-hoc comparisons revealed that in the period between T1 and T2, women in the S group and SR group reported significant deterioration in physical, psychological and spiritual well-being, whereas women who received body-mind exercise (BM group) reported no significant change in physical, psychological and spiritual well-being other than significant increases in state anxiety [t(64) = 4.00, p<.001].

Conclusions and Implications: Findings suggested that simple body-mind exercises have the potential to protect women against significant deterioration in physical, psychological and spiritual well-being during the 14-day waiting period in IVF treatment. Another finding is that state anxiety remains high throughout the waiting period regardless of type of intervention given, highlighting the importance of providing timely support and equipping women with an awareness of own emotional needs and capacity for anxiety relief at critical treatment stages.