Abstract
BACKGROUND:
The lengthy and multi-stage nature of assisted reproductive technology (ART) can impose financial and social burdens on couples while also affecting their psychological well-being. Mindfulness-based stress reduction techniques help individuals cope effectively and cultivate inner calm. Additionally, lifestyle choices can impact fertility outcomes. In this study, we investigated the effects of mindfulness and health-promoting lifestyles on in vitro fertilization outcomes in infertile couples.
MATERIALS AND METHODS:
We conducted a randomized controlled clinical trial involving 300 infertile couples who were candidates for ART. The block randomization method randomly assigned participants to the intervention or control groups. The intervention group received an educational program of eight weeks of face-to-face interactive sessions supplemented by social media support. The control group received standard care. We compared the number of clinical pregnancies, health-promoting lifestyle scores, and anxiety levels between the two groups using Chi-square tests and independent t-tests.
RESULTS:
The clinical pregnancy rate in the intervention group (39.3%) was significantly higher than that in the control group (22%) (P < 0.001). After the intervention, the mean health-promoting lifestyle scores were significantly higher in the intervention group compared to the control group (P < 0.001). Additionally, anxiety scores were significantly lower in the intervention group (P < 0.001).
CONCLUSION:
Simultaneously improving lifestyle choices, cultivating awareness of body and soul, and maintaining a non-prejudiced attitude toward the environment can lead to better outcomes in achieving the desire for a child.
Keywords: Anxiety, infertility, lifestyle, mindfulness, technology-assisted reproductive
Introduction
Infertility has been classified as a disease by the World Health Organization, a designation endorsed by several professional societies, including the American Medical Association, the European Society of Human Reproduction and Embryology, the International Committee for Monitoring Assisted Reproductive Technologies, and the American Society for Reproductive Medicine. The US Centers for Disease Control and Prevention emphasize that infertility is not merely a quality-of-life issue but also a functional disorder that can lead to disability.[1]
Assisted reproductive technology (ART), including techniques like intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF), has a success rate of approximately 30%. However, individuals undergoing ART may encounter psychological and emotional challenges alongside physical discomfort. Couples who are emotionally vulnerable may be mainly influenced by family members and medical professionals, leading to strained interpersonal relationships. These negative experiences can impact their desire for future conception, self-care practices, perceptions of parenthood, and professional lives.[2,3]
Mindfulness is a technique for reducing stress and achieving peace in everyday life. It involves being attentive and aware of current events without judgment.[4,5] Several techniques can enhance mindfulness, including four well-defined and practical methods: Mindfulness-Based Stress Reduction (MBSR) by Kabat-Zinn, Mindfulness-Based Cognitive Therapy (MBCT) by Segal, Dialectical Behavior Therapy by Linehan, and Acceptance and Commitment Therapy by Hayes.[6]
Jon Kabat-Zinn, a leader in the American mindfulness movement, developed the MBSR program in 1994. This program incorporates hatha yoga, meditation, and other Buddhist- and yogic-inspired practices.[7] Individuals who practice MBSR learn to view situations and their thoughts in an accepting, non-judgmental, and non-reactive way. Formal mindfulness exercises include relaxed yoga poses, sitting or lying down meditation, and body scanning. The goal of mindfulness is to alter one’s behavior and exposure to stressful thoughts and events by adjusting emotional reactions and improving cognitive evaluation.[8]
The standard MBSR program consists of eight structured sessions, each lasting 2.5 hours weekly, supplemented with homework and daily assignments. Practicing mindfulness enables individuals to recognize and enhance their strengths, fostering health in prevention, treatment, and rehabilitation. This cognitive therapy approach illustrates the correlation between thoughts, emotions, and physical sensations. It includes stretching yoga, meditation techniques, relaxation, and body scanning exercises.[9]
Mindfulness-based interventions have proven effective in enhancing various psychosocial conditions, such as depression, anxiety, chronic pain, borderline personality disorder, and stress. These interventions address both the mental and physical aspects of these issues and have been used to reduce anxiety in patients with medical conditions. Furthermore, individuals learn to embrace and tolerate anxiety or depression, recognizing that these emotional states are often transient.[10] Since mindfulness exercises primarily focus on a neutral stimulus, such as breathing, self-control, and attention, these are considered the main mechanisms that effectively reduce stress and anxiety while increasing muscle relaxation.[11] Studies have shown that practicing mindfulness enhances one’s ability to control anxiety symptoms by improving self-regulation and strengthening emotional and cognitive abilities related to the cerebral cortex.[12]
Health is a complex process that fluctuates throughout life. High levels of physical, mental, psychological, social, genetic, and individual abilities are all components of desirable health.[13] A person’s lifestyle encompasses all actions they can control or those that influence their risk factors for illness.[14] Health-protecting components reduce the risk of diseases or injuries, whereas health-promoting components contribute to a multi-dimensional model that maintains or increases self-actualization, well-being, and satisfaction.[15] Unhealthy behaviors, such as smoking, inactivity, and poor eating habits, are the leading causes of death and illness in today’s societies. Many diseases are associated with insufficient physical activity, a low intake of fruits and vegetables, and excessive consumption of fast foods.[16]
Walker et al. developed the Health-Promoting Lifestyle Profile (HPLP) in 1987 and revised it in 1996. According to the HPLP, leading a healthy lifestyle involves several factors, including interpersonal relationships, spiritual development, psychological stress management, physical activity, nutrition, and health responsibilities.[17] Common risk factors for infertility include smoking, a body mass index under 18.5 or over 25, over-exercising or low physical activity, drinking alcohol, consuming more than 300 mg of caffeine per day, and psychological stress.[18]
In addition to the impact of exercise and physical activity on general health and fertility, diet and nutrition are crucial pillars of a healthy life, mental health, and psychological well-being.[19] Some studies indicate that the average prevalence of infertility in Iran ranges from 11.5% to 15.7%.[20] Infertility is often considered a medical issue, but it also threatens mental, spiritual, psychosocial, and cultural aspects of health.[21]
This study aims to investigate the effects of mindfulness and lifestyle modification on pregnancy rates as the primary outcome and anxiety levels and health-promoting lifestyles (HPLs) as secondary outcomes in couples undergoing infertility treatments. While MBSR and HPL are effective individually for improving lifestyle and creating calmness and relaxation, their combined use may enhance pregnancy results, which this research examines. Additionally, since women are generally more interested in health issues and men have less opportunity to engage in health promotion due to occupational demands, their participation in this research may help men achieve higher health levels and improve ART outcomes. Support groups were also formed to discuss issues and problems related to the research topic.
Materials and Methods
Study design and setting
Based on a pre-published protocol, a controlled clinical trial was conducted from May 2022 to June 2023 at the Afarinesh Clinic of the Akbarabadi Academic Medical Center of the Iran University of Medical Sciences.
Study participants and sampling
The study included 300 infertile couples who were candidates for ART at Afarinesh Clinic, selected using the convenience sampling method. The inclusion criteria were age between 18 and 40 years, willingness to participate in the study, literacy of at least one spouse, and undergoing infertility treatment (IVF/ICSI) for the first or second time.
The exclusion criteria were a history of chronic disease, emergency medical procedures, accidents, or sudden stress.
The sample size was determined based on the study by Kaya et al.[18] using G-Power software to compare two proportions. The assumptions were P1 = 33% (clinical pregnancy in the intervention group), P2 = 19% (clinical pregnancy in the control group), two-sided α = 0.05, β = 20%, and n1/n2 = 1. This resulted in 300 participants for each group (150 men and 150 women).
Data collection tools and techniques
Data were collected using the demographic-midwifery questionnaire, the HPLP-II, and the Beck Anxiety Inventory (BAI). These tools were administered in face-to-face interviews.
The demographics-midwifery questionnaire included age, job status, educational level, income adequacy, duration of marriage (years), and the duration, type, and cause of infertility.
The BAI, developed by Aaron Beck et al.[22] (1990), measures the severity of clinical anxiety symptoms. It consists of 21 items scored on a four-point Likert scale (0: not at all to 3: severe), with a total score range of 0–64. Kaviani et al. confirmed the reliability of this tool with a Cronbach’s alpha of 0.92.[23]
The HPLP-II measures health-promoting behaviors across six dimensions: Nutrition (following an eating pattern and food choice) (six items), exercise (regular exercise) (five items), health responsibility (10 items), stress management (identifying sources of stress and stress management measures) (seven items), interpersonal support (maintaining close relationships) (seven items), and self-actualization (13 items).
Nola Pender developed the original profile in 1987.[14] Walker et al.[24] later presented a modified version emphasizing innovative measures and individual perceptions to maintain or increase well-being, self-fulfillment, and satisfaction. Walker and Polerecky reported a Cronbach’s alpha of 0.94% and a three-week reliability coefficient of 0.89% for this tool. Mohammadi Zaidi et al.[16] assessed the Farsi version and reported Cronbach’s alpha and correlation coefficients of 0.82% and 0.91%, respectively.
All infertile couples who were candidates for ART were evaluated based on the inclusion and exclusion criteria. Eligible couples who agreed to participate in the study were selected. The study goals and methods were explained to the participants, who provided written informed consent. Participants were then divided into two groups using the block randomization method with four block sizes. Blinding was achieved by placing the randomization numbers in non-transparent, sealed aluminum envelopes. Midwives at the infertility clinic distributed these envelopes to participants upon entry, directing them to the researcher’s room, where the letter inside the envelope indicated the group assignment. The intervention group received the educational program, while the control group received routine care [Figure 1]. To avoid data contamination, the intervention group did not receive any other intervention except for the interventions determined in the trial.
Figure 1.
Theoretical framework
Intervention
The intervention group attended eight 60-minute sessions of the MBSR + HPL educational program at the clinic. The sessions were structured as follows:
Sessions one and two: Explained the concepts of mind and body and their interrelation.
Sessions three and four: Focused on self-acceptance and learning to forgive oneself and others.
Sessions five and six: Covered self-love and letting go of bodily negativity.
Sessions seven and eight: Discussed suffering and its impact on personality development, followed by a summary and review of previous sessions [Table 1].
Table 1.
The outline of the intervention
| Sessions | Objectives | Description of activities |
|---|---|---|
| 1 and 2 | Greeting, describing, stress, anxiety, introducing infertility and its pressure on individuals; describing MBSR, training stress reduction technique |
Warm up and identifying the participants; familiarity with infertility and its effects on the soul and mind, the mind’s movements to the past and the future, bringing the mind to the present moment by eating raisins and doing things with full attention, describing the nature of stress and its effects on body organs and physiology; practical education: Body scanning, breathing, body massage, and meditation. Relaxation, continue homework |
| 3 and 4 | Strengthening self-help skills. Understanding negative states, emotions and thoughts strengthening inner peace and tranquility Facilitating self-acceptance and forgiveness; improving marital relationships |
Sharing life experiences with a couple or in same problem group; emotion management technique; imagination; self-kindness in injuries and failures by positive appraisal; identifying personal strengths and weaknesses; joint activities for couples such as massaging, meditation, conversation about each other’s values, expectations, and possible injuries and pains caused by infertility treatments, and performing physical exercises as well as relaxation and breathing techniques |
| 5 and 6 | Increasing the sense of peace and self-control | Advanced muscle relaxation techniques, positive thinking, seeing half full, and lifelong learning |
| 7 and 8 | Reducing anxiety caused by infertility and IVF procedures facilitates the acceptance of limitations and adversities; trying to rebuild yourself and your life | Introducing the techniques for improving the lifestyle and physical and mental well-being; implementing life skills ways and using problem-solving techniques; guided visualization; modifying and accepting any results; sharing the concerns and worries with the spouse and the group members; writing a letter of appreciation to yourself, drawing a picture that portrays the couple’s understanding of the family, writing down all the negative feelings (past sorrows and future worries), physical activity; sharing personal experiences as homework, expressing painful emotions and their effects; re-examining the life priorities, appreciating yourself, others, and life, expressing commitment to yourself and others; summarizing and reviewing previous sessions |
Social networks were used to form groups to facilitate the provision of daily homework, ongoing training, relevant issues, and essential assistance to participants. These groups also addressed participants’ inquiries, guided discussions, and allowed for the exchange and description of experiences. Participants were provided with oral materials through paper brochures. The control group received the clinic’s routine care. Participants in both groups completed a post-test at the end of the intervention.
Data analysis
The obtained data were analyzed statistically using Statistical Package for Social Sciences 21. An independent t-test was used to assess the homogeneity of the quantitative variables in the demographic-midwifery questionnaire. The Chi-square and Fisher’s exact tests were used for qualitative variables. The Chi-square test and independent t-test were also performed to compare the study groups regarding the number of clinical pregnancies and HPL and anxiety post-intervention mean scores. Statistical significance was set at P < 0.05.
Ethical consideration
This research project was approved by the Ethics Committee of Shahroud University of Medical Sciences and registered with the Iranian Registry of Clinical Trials (IRCT20190529043754N1).
Results
This study evaluated 468 people for eligibility, but 168 did not meet the inclusion criteria or were unwilling to participate. Ultimately, 300 eligible couples were randomly assigned to the intervention group (150 women) and the control group (150 women). All participants (n = 300 in each group) were analyzed for all outcomes [Figure 2].
Figure 2.
Flowchart of the study
The mean (standard deviation [SD]) age of female participants in the intervention and control groups was 34.1 (4.7) and 34.3 (4.8), respectively (P = 0.78). The mean (SD) age of male participants was 37.4 (4.8) and 37.8 (5.4) in the intervention and control groups, respectively (P = 0.49). About one-third of women (36%) in the intervention group and 22.7% in the control group had a bachelor’s degree or higher educational level (P = 0.003). Most women in both groups were housewives (76.7% in the intervention group and 84.0% in the control group) (P = 0.11). More than half of the men in both groups were self-employed: 52.7% in the intervention group and 58.0% in the control group (P = 0.09).
Most women in both groups reported poor economic status (52.7% in the intervention group and 72.7% in the control group). Most couples in both groups had primary infertility (82% in the intervention group and 81.3% in the control group). The mean (SD) duration of infertility was 5.55 (3.34) years in the intervention group and 5.11 (3.48) years in the control group (P = 0.32). Infertility was attributed to both male and female causes in 63.3% of the intervention group and 56% of the control group. In 28.7% of the couples in both groups, female infertility was the cause, while male factor infertility was present in 6.7% and 12.7% of the intervention and control groups, respectively [Table 2].
Table 2.
Demographic characteristics of participants by treatment group
| Characteristics | Intervention (n=150) n (%) | Control (n=150) n (%) | P |
|---|---|---|---|
| Women age (years)* | 34.18 (4.66) | 34.33 (4.82) | 0.780† |
| Men age (years)* | 37.41 (4.77) | 37.81 (5.39) | 0.497† |
| Women’s educational level | 0.003§ | ||
| Under diploma | 33 (22.0) | 58 (38.6) | |
| Diploma and associate degree | 63 (42.0) | 58 (38.6) | |
| Bachelor’s degree and higher | 54 (36.0) | 34 (22.6) | |
| Men’s educational level | 0.011§ | ||
| Under diploma | 51 (34.0) | 71 (47.3) | |
| Diploma and associate degree | 65 (43.3) | 62 (41.3) | |
| Bachelor’s degree and higher | 34 (22.7) | 17 (11.3) | |
| Women job | 0.110§ | ||
| Housewife | 115 (76.7) | 126 (84.0) | |
| Employed | 35 (23.3) | 24 (16.0) | |
| Men job | 0.096§ | ||
| Worker | 20 (13.3) | 16 (10.7) | |
| Employee | 25 (16.7) | 18 (12.0) | |
| Self-employment | 79 (52.7) | 87 (58.0) | |
| Thermal or toxic Jobs | 24 (16.0) | 19 (12.7) | |
| Other | 2 (1.3) | 10 (6.7) | |
| Family income | 0.001§ | ||
| Insufficient | 79 (52.7) | 109 (72.7) | |
| Relatively or thoroughly sufficient | 71 (47.3) | 41 (27.3) | |
| Infertility duration | 5.5 (3.3) | 5.1 (3.4) | 0.323† |
| Infertility type | 0.881§ | ||
| Primary | 123 (82.0) | 122 (81.3) | |
| Secondary | 27 (18.0) | 28 (18.7) | |
| Infertility cause | 0.247§ | ||
| Female | 43 (28.7) | 43 (28.7) | |
| Male | 10 (6.7) | 19 (12.7) | |
| Female and male | 95 (63.3) | 84 (56.0) | |
| Unknown | 2 (1.3) | 4 (2.7) |
*Data are presented as mean (SD). †Independent t-test. §Chi-square
According to the Chi-square test, the rate of clinical pregnancy was 39.9% in the intervention group and 22% in the control group (P < 0.001).
The pre- and post-intervention mean (SD) scores of HPL were 131.62 (23.35) and 154.26 (17.78) in the intervention group and 123.74 (19.74) and 129.72 (19.43) in the control group. The independent t-test indicated that the post-intervention mean HPL score significantly increased in the intervention group compared to the control group (P < 0.001) [Table 3].
Table 3.
HPL score between intervention and control groups#
| HPL score | Before intervention | After intervention | P | Difference mean (SD)# |
|---|---|---|---|---|
| Women | ||||
| Intervention group n=150 | 131.6 (23.3) | 154.2 (17.7) | <0.001* <0.001* |
22.6 (10.8) |
| Control group n=150 | 123.7 (19.7) | 129.7 (19.4) | 5.9 (8.5) | |
| P | 0.002† | <0.001† | <0.001† | |
| Men | ||||
| Intervention group n=150 | 120.7 (21.7) | 142.0 (19.7) | <0.001* <0.001* |
21.2 (10.1) |
| Control group n=150 | 116.8 (17.5) | 122.3 (18.8) | 5.5 (6.4) | |
| P | 0.086† | <0.001† | <0.001† |
#Data presented as mean±SD, SD: standard deviation. §Mean difference (95% confidence interval). †Independent t-test. *Paired sample test
The pre- and post-intervention mean (SD) scores of HPL in men were 120.73 (21.75) and 142.01 (19.76) in the intervention group and 116.80 (17.56) and 122.32 (18.84) in the control group. The independent t-test demonstrated that the post-intervention mean HPL score of men significantly increased in the intervention group compared to the control group (P < 0.001) [Table 3].
The pre- and post-intervention mean (SD) scores of anxiety in women were 11.76 (9.8) and 4.32 (4.55) in the intervention group and 9.4 (8.5) and 8.92 (8.23) in the control group. The independent t-test showed that the post-intervention mean anxiety score of women was significantly reduced in the intervention group compared to the control group (P < 0.001).
The pre- and post-intervention mean (SD) scores of anxiety in men were 7.27 (6.46) and 3.36 (4.36) in the intervention group, 6.26 (6.29) and 5.92 (6.24) in the control group. The independent t-test indicated that the post-intervention mean anxiety score of men was significantly reduced in the intervention group compared to the control group (P < 0.001) [Table 4].
Table 4.
Anxiety score between intervention and control groups#
| Anxiety score | Before intervention | After intervention | P | Difference mean (SD)# |
|---|---|---|---|---|
| Women | ||||
| Intervention group n=150 | 11.7 (9.8) | 4.3 (4.5) | <0.001* <0.001* |
−7.4 (7.1) |
| Control group n=150 | 9.4 (8.5) | 8.9 (8.2) | −0.4 (3.2) | |
| P | 0.027† | <0.001† | <0.001† | |
| Men | ||||
| Intervention group n=150 | 7.2 (6.4) | 3.3 (4.3) | <0.001* <0.001* |
−3.9 (5.1) |
| Control group n=150 | 6.2 (6.2) | 5.9 (6.2) | −0.3 (1.7) | |
| P | 0.173† | <0.001† | <0.001† | <0.001† |
#Data presented as mean±SD, SD: standard deviation. §Mean difference (95% confidence interval). †Independent t-test. *Paired sample test
Discussion
This study underscores the effectiveness of lifestyle improvements and MBSR on pregnancy rates and anxiety in infertile couples. The results showed that clinical pregnancies were significantly higher in the intervention group. The post-intervention mean score of HPL in both men and women in the intervention group significantly increased compared to the control group. Moreover, the pre- and post-intervention mean HPL scores of women were higher than those of men in both groups, suggesting that women are more interested in health-related issues. The results also indicated that the post-intervention mean anxiety scores significantly reduced in both men and women in the intervention group.
Kaya et al.[18] studied Turkish infertile women in both the intervention (HPL) and control groups, reporting that the post-ART rate of clinical pregnancy in the intervention group was higher than in the control group. Their follow-up results one, two, and three months after ART demonstrated a significant reduction in the mean stress level of women in the intervention group (P < 0.001).
According to Kaya, the improved lifestyle score and instances of clinical pregnancies in the intervention group demonstrated the beneficial effects of training and supervising infertile women to adopt a healthier lifestyle before fertility treatments. However, most studies stop following up with participants after pregnancy, which is a limitation. It is not possible to be specific about the potential long-term benefits of education on long-term health issues and pregnancy complications.[18]
According to a clinical trial by Clifton et al.[25] involving 71 American women, the chance of pregnancy was higher in participants who received a mindfulness-based intervention compared to those in the control group. Psychological interventions seem to have the potential to reduce anxiety and increase the likelihood of pregnancy in infertile women.
In a study by van Dijk et al.,[26] each couple received an individual lifestyle training program via email or phone message for 26 weeks, focusing on nutrition and lifestyle modification. The findings demonstrated a correlation between higher chances of becoming pregnant in both infertile and fertile couples and their empowerment to modify unhealthy diets and lifestyles.
In a clinical trial on 60 infertile women, Rahmanifard showed that mindfulness-based cognitive stress therapy improved the mental well-being of infertile women, including subscales of self-acceptance, positive relationships with others, autonomy, mastery of the environment, purposefulness in life, and personal growth. However, no statistically significant difference existed between the intervention and control groups.[27]
Mousavi et al.[28] showed that the MBSR program could reduce the anxiety and stress of infertile women. According to a review study by Wang, mindfulness-based interventions can effectively reduce symptoms of depression and anxiety and improve health-related quality of life in infertile women. Furthermore, some studies have proven the effectiveness of mindfulness interventions in improving independence, a sense of control, and reducing stress in infertile individuals. In this study, clinical pregnancies were significantly higher in the intervention group.[29]
In a study on 94 Egyptian infertile women, pre-ART lifestyle measures increased the rate of positive pregnancy by 36% in the intervention group.[30] Tavousi et al.[31] investigated the effect of MBSR on infertile women undergoing IVF procedures in Iran from 2021 to 2023. An eight-week interventional program was assessed using a related questionnaire, showing significant improvements in quality of life and psychological symptoms post-intervention. These results are consistent with the findings of the present study.
However, Szigeti Judit et al.[32] in Hungary conducted a randomized controlled trial (RCT) on 168 ART candidate women from 2019 to 2022. Participants received a ten-week mind-body online education program, which resulted in reduced anxiety but showed no statistical differences in pregnancy outcomes. Baghbani et al.,[33] in a 2024 study in Iran, compared mindfulness and dry cupping effects on the quality of life of infertile women undergoing IVF. Nineteen women participated, with no statistical difference in conception rates between the MBCT and cupping groups after a two-month intervention. Additionally, Boedt et al.[34] conducted a multicenter RCT using the Pre-Life mobile app to educate and modify lifestyles among Belgian infertile couples undergoing IVF. Their results showed no statistically significant differences in clinical pregnancy rates or outcomes of stress-reducing interventions between the control and intervention groups. The coronavirus disease 2019 pandemic, which prematurely ended Boedt’s study in early 2020, may have contributed to these inconsistent findings regarding the potential effects of preconception lifestyle programs on couples undergoing IVF.
Numerous studies have explored the impact of interventions to modify lifestyle variables on risk factors related to weight, physical activity, and stress management. These studies aim to improve health, reduce disease burden, and increase this group’s live births and successful pregnancy rates. Kim suggests that healthcare providers educate infertile men and women about lifestyle modifications, emphasizing how these changes can enhance fertility rates. Examples of such modifications include adopting a healthy diet, increasing physical activity, reducing alcohol intake, and quitting smoking.[35]
Determining the appropriate amount of physical activity and exercise for individuals can alleviate challenges related to menstruation and ovulation, thereby improving the likelihood of successful pregnancy and delivery. These interventions have resulted in enhanced lifestyles among participants, increasing their chances of achieving pregnancy and improving reproductive health.[15]
Limitations and recommendation
This study benefited from a large sample size, random assignment of participants to study groups, and inclusion of both men and women. However, several limitations should be noted. First, participants were exclusively recruited from the Afarinesh Clinic of Akbarabadi Academic Medical Hospital of Iran University of Medical Sciences, limiting the generalizability of findings to couples in other regions. Second, blinding participants was not feasible due to the nature of the interventions, potentially influencing the study outcomes. Future research should consider prolonged interventions to enhance the lifestyle of infertile couples before ART cycles commence.
Implementing lifestyle improvement programs and MBSR are shown to enhance overall health and reduce anxiety among infertile couples. Therefore, it is recommended that couples undergoing infertility treatments receive these educational programs. Additionally, policymakers are encouraged to create conducive environments for essential lifestyle enhancement programs within reproductive health facilities.
Conclusion
Infertility represents a chronic health condition that significantly impacts individuals and imposes a substantial disease burden. Therefore, promoting the health of infertile couples aligns with health policy objectives, emphasizing the efficacy of non-pharmacological health promotion methods. MBSR techniques offer a cost-effective approach that can be implemented at home, reducing treatment costs and healthcare system burdens.
In addition to positively influencing reproductive health outcomes, these interventions impact various dimensions of couples’ lives. From a preventive healthcare perspective, they constitute primordial and primary prevention strategies that aim to enhance overall health and well-being.
These types of programs can affect the entire pregnancy period of the mother and the fetus and be effective for human recovery.
Ethical approval
Ethical approval for this study was granted by the Ethics Committee of the Shahroud University of Medical Sciences (Ref. IR.SHMU.REC.1399.008).
Conflict of interest
The authors declare no conflict of interest.
Acknowledgements
The authors thank the Research Deputy and the School of Nursing and Midwifery faculty members at Shahroud University of Medical Sciences for their invaluable assistance and support. Special thanks are also given to the Research Unit of Akbarabadi Hospital, the Iran University of Medical Sciences (ShACRDU), and the study participants.
Funding Statement
This study received funding from the Shahroud University of Medical Sciences.
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