Table 1.

Characteristics of the articles included in the systematic review

Reference title	Source (author, year)	Study, population sample size	Aim of the study	Intervention program	Outcome measures	Results and discussion main issues	Quality assessment
Impact of a group mind/body intervention on pregnancy rates IVF patients	Domar et al. (2011)	143 women aged 40 years, who were about to begin their first IVF cycle (n = 143).	To determine if a mind/body group intervention was associated with an increase in pregnancy rates in a group of women who were about to undergo their first IVF cycle.	After the Structured Clinical Interview for the Diagnostic and Statistical Manual II, the sample’s randomization through computer- generated random numbers. The experimental group was subjected to the mind/body program for infertility. It is a 10-week group stress management program whose focus is on cognitive behaviour therapy, relaxation training, negative health behaviour modification, and social support components all mind/body programs are heterogeneous for patient diagnosis and stage of treatment. Control subjects were told that they would receive a $50 spa gift certificate for every 3 months that they remained in the study, with a bonus $100 certificate if they remained in the study for a year. The control patients had the identical amount of contact with the research assistant as the intervention patients.	Clinical pregnancy rate	Infertility patients with varied diagnoses and at different stages of treatment, who participated in the mind/body program for infertility experienced significantly higher pregnancy rates than control subjects. It has been observed in the mind/body program from patient self-reports that physical and psychological symptom improvements are noted beginning approximately midway through the program, and they increase thereafter.	85%
Evaluation of preparatory psychosocial counselling for MAR	Hakim et al. (2012)	135 heterosexual couples consecutively referred to a fertility clinic and 83 chose to participate in some phase of the study (n = 145).	To examine couples’ expectations about, and satisfaction with, a single session of preparatory psychosocial counselling provided prior to engaging in MAR. This included an examination of changes in couples’ views of counselling after the session.	To measure expectation of counselling’ survey, anxiety and depressive symptomatology and infertility related stress through self-report questionnaires administration. Immediately after the counselling session, couples received the ‘opinions about counselling’ questionnaire.	The expectations of counselling; anxiety and depressive symptomology; infertility-related stress; opinions about counselling	Most women and men have very positive expectations about preparatory counselling and the perceived benefits exceed these expectations. The women show most elevated symptoms of anxiety and depression with respect to men. Half of the women reported elevated symptoms of anxiety with respect to men. Both women and men with higher levels of global infertility-specific stress expected counselling to be more important than participants reporting lower levels of stress.	82%
Psychological impact of single and multiple courses of assisted reproductive treatments in couples: a comparative study	Reis et al. (2013)	The first group (couples undergoing ART treatment for the first time) included 43 couples, and the second group (couples undergoing consecutive ART treatments) included 46 (n = 89).	Two main objectives: (1) to analyse the psychological impact (anxiety and depression levels) of ART in infertile couples, either the first or consecutive treatments and (2) to examine gender and group differences.	The levels of anxiety survey before ART treatment were assessed using STAI-Form Y; levels of depression before ART treatment were assessed using the beck depression inventory II.	Anxiety and depression levels	Group 1 (first time of ART) showed greater levels of state-anxiety than couples from Group 2 (undergoing consecutive ART treatment). With respect to global levels of depression, couples from Group 2 showed higher levels than couples from Group 1. In terms of state-trait anxiety in both groups, men reported greater levels of state-anxiety than women. With respect to the full scale of depression, there are significant gender differences, showing higher values in women compared to men.	69%
Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by IVF	Kuo et al. (2013)	160 women who completed the questionnaires at 9, 12 and 20 weeks gestation.	To describe development of maternal-foetal attachment in early pregnancy in Taiwanese women who conceived by IVF and to explore the influence of physical symptoms, pregnancy-related anxiety, social support, Chinese childbearing attitudes, and foetal awareness on maternal-foetal attachment at 9, 12 and 20 weeks’ gestation.	Tool’s administration for women who attended the fertility clinic for IVF treatment at the fifth or 6th week of their pregnancy, and at 9, 12 and 20 weeks gestation. The self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese Childbearing Attitude Questionnaire and (6) Awareness of Foetus Scale (for this variables, all participants have been undergoing to ultrasound).	Maternal-fetal attachment and the influence of physical symptoms, pregnancy- related anxiety, social support, Chinese childbearing attitudes, and feta awareness on maternal-foetal attachment	The maternal-foetal attachment began to develop early during the first trimester of pregnancy, as early as 9 weeks gestation and continued to increase from 9–20 weeks. Chinese childbearing attitude, awareness of the foetus, and social support were found to be the factors in relation to maternal-foetal attachment. Pregnancy-related anxiety during the first half of pregnancy was not found to be a significant predictor of MFA.	81%
Are patients at risk for psychological maladjustment during fertility treatment less willing to comply with treatment? Results from the Portuguese validation of the SCREENIVF	Lopes et al. (2014)	291 women and 92 men undergoing any stage of fertility treatment (n = 383).	Two main objectives: (1) to investigate the psychometric properties of the Portuguese version of the SCREENIVF and (2) to investigate the relationship between vulnerability to psychological maladjustment and compliance by looking at patients’ intentions to comply with treatment.	The SCREENIVF; it’s a self-report questionnaire composed of 34 items organized in 5 dimensions that assess risk for maladjustment. Participants were recruited online and at the clinical setting.	Anxiety, depression, helplessness, acceptance cognitions, social support, QOL, compliance intentions	Women and men at risk for psychological maladjustment were equally willing to comply with treatment as those not at risk and no associations between risk factors and compliance intentions were found. However, an unexpected result showed that more anxious patients are less willing to comply with treatment only if they perceive higher control (i.e. lower helplessness).	77%
Are repeated ART treatments and an unsuccessful outcome risk factors for unipolar depression in infertile women	Sejbaek et al. (2015)	41050 women who received ART treatment from 1 January 1994 to 30 September 2009, in Denmark.	To investigate if repeated ART treatment cycles were a risk factor of a clinical diagnosis of unipolar depression and to investigate if unsuccessful ART treatment was a risk factor of unipolar depression in a cohort of female ART patients.	The Copenhagen Multi-Centre Psychosocial Infertility Research Program, a register-based, national cohort study.	The outcomes measures were Assisted Reproductive Technology, live birth, and clinically diagnosed depression in a large national study population	Women having received ART treatment who achieved a live birth were at higher risk of a unipolar depression diagnosis compared with women who had not yet given birth to a child. However, repeated ART treatments did not seem to increase the risk of a subsequent unipolar depression diagnosis compared with women with only one treatment cycle. The study showed that women who underwent ART and achieved a live birth had a higher risk of unipolar depression compared with women with no live birth yet. Women giving birth after ART also had an increased risk of any type of psychiatric disorder compared with women with no delivery. The number of ART treatment was not associated with unipolar depression among women undergoing ART treatment.	83%
Anxiety, depression, and attachment before and after the first-trimester screening for Down syndrome: comparing couples who undergo ART with those who conceive spontaneously	Udry-Jørgensen et al. (2015)	47 couples had undergone an ART treatment, and 49 had conceived spontaneously were recruited.	Two main objectives: (1) to understand the changes in the psychological status of the parents to be from before to after the first-trimester prenatal screening test at around 12 weeks of gestational age, by comparing state anxiety, prenatal attachment, and prepartum depression in couples from an SC group with couples who had undergone IVF or intracytoplasmic sperm injection, that is, assisted reproductive technology and (2) to identify a subgroup that was particularly vulnerable because of anxiety.	STAI to assess the anxiety, EPDS to measure prepartum depression, and the Maternal and Paternal Antenatal Attachment Questionnaire to measure Prenatal Attachment, before the first-trimester combined prenatal screening test at around 12 weeks of gestational age (T1) and just after receiving the results at approximately 14 weeks of gestational age (T2).	Anxiety, prepartum depression, prenatal attachment	Anxiety decreased significantly in both women and men, as did depression in men. Attachment increased significantly in both women and men. Women in the ART group experienced a greater decrease from T1 to T2 in anxiety than women in the SC group, whose anxiety decreased only slightly. For depression, a similar pattern was observed: Prepartum depression tended to decrease in women from the ART group but was stable in women in the SC group. With regard to the clinical anxiety group, time had no significant effect on depression; anxiety tended to decrease. The increase in attachment was significant.	87%
Depression, pregnancy-related anxiety and parental-antenatal attachment in couples using PGD	Winter et al. (2016)	60 women with PGD, 58 women with intra-cytoplasmic sperm injection and 69 women with spontaneous conception.	To evaluate significant differences between PGD, intra-cytoplasmic sperm injection and SC couple, regard to depression, anxiety, low level antenatal attachment, social desirability.	Questionnaires online in each trimester (T1: 12–14 weeks, T2: 20–22 weeks, T3: 30–32 weeks of gestation) and at 3 months post-partum (T4). To measure depression, the Dutch version of the EPDS was administered. Pregnancy-related anxieties were assessed using the short version of the Pregnancy Related Anxiety Questionnaire. Maternal/Paternal Antenatal Attachment Scale (further: M/PAAS).	Stress assessed by depression and by pregnancy-specific anxiety and prenatal attachment	PGD couples are not more at risk of developing depression or pregnancy-related anxieties during and after pregnancy compared with intra-cytoplasmic sperm injection or SC couples. Both maternal and paternal antenatal attachment in PGD couples were comparable to bonding processes in intra-cytoplasmic sperm injection and SC couples. Couples in all three conception groups experienced pregnancy-related anxieties to a comparable extent at every stage of gestation.	77%
Coping with infertility: comparison of coping mechanisms and psychological immune competence in fertile and infertile couples	Nagy et al. (2016)	84 parents with a child conceived with ART and 84 parents with a naturally conceived child.	To explore characteristics and differences with regard to coping strategies and psychological immune competence of parents with a child conceived with ART, and parents with a naturally conceived child. To evaluate the differences between genders in coping styles among IVF and naturally conceiving couples.	Coping strategies’ assessment using the Hungarian shortened version of the Ways of Coping Inventory. Psychological immunity was measured by the Psychological Immune Competence Inventory (so personal resilience resources or psychological antibodies provide immunity against damage and stress).	Coping strategies and the Psychological Immune System acts as a protective apparatus which strengthens invulnerability and raises the coping capacity of individuals	IVF couples can control their emotions in a better way than couples in stressful situations. IVF women reported increased ‘Seeking emotional balance’ coping than comparison women, suggesting that more use of positive refocusing and distraction during the infertility treatment might have helped them to cope with their problems. Furthermore, getting into a stressful situation, mothers are more prone to seek emotional and social support and avoid confrontation than fathers, apart from the method of conception. IVF couples possess a ‘stronger’ psychological immune system than parents of naturally conceived children especially as of ‘Sense of coherence’ and ‘Creative self-concept’.	60%
Observed mother–father–child interaction differences in families with MAR conceived twins and singletons	Anderson et al. (2017)	57 families with eighty 6- to 12-year-old MAR children.	To examine reciprocal parent-child interaction behaviours for MAR twins compared with MAR singletons in middle childhood (6–12 years old).	Observational assessment based on focus group and individual interviews with parents of children conceived using MAR. The assessment took place in a room designed to look like a family dining room, with families seated around a dining room table, and they were being recorded. Families were given 15 minutes to discuss 32 statements describing activities or behaviours that may be important to their family. Families were asked to agree on 3–5 statements of most importance and 3–5 statements of least importance to their family. Observational assessments rated the family’s interaction quality. Trained observers used five scales (communication, warmth, listener responsiveness, control, and hostility) from the Iowa Family Interaction Rating Scales (IFIRS; Melby et al., 1998).	Family’s interaction quality: communication, warmth, listener responsiveness, control, and hostility	Mothers displayed few interaction behaviour differences between twins and singletons. One exception is that mothers were less likely to exhibit hostile or irritable behaviours toward twin relative to singleton children. Fathers showed differences in interactions toward twin relative to singleton children. For example, fathers were less likely to engage in supportive communication with twins, or listen well to twin children, relative to fathers of singletons. Fathers also exhibited greater controlling behaviours, as well as more hostile or irritable behaviour toward twin relative to singleton children.	76%
Antenatal paternal adjustment and paternal attitudes after infertility treatment	Pinto et al. (2018)	197 primiparous men (71 after ART and 126 NC).	To explore the interaction effect of mode of conception and depression on antenatal paternal adjustment and paternal attitudes.	Depression and anxiety’ assessment with EPDS, and STAI. The Portuguese version of the Paternal Adjustment and Paternal Attitudes Questionnaire (PAPA-AN) – antenatal was used to assess antenatal paternal adjustment and paternal attitudes during the second trimester of gestation (20–28 gestational weeks).	Depression and anxiety, and antenatal paternal adjustment and paternal attitudes	NC men showing high depressive symptomatology had lower antenatal marital relationship satisfaction than NC men showing low depressive symptomatology. ART men showing high depressive symptomatology had lower antenatal marital relationship satisfaction than both ART men showing low depressive symptomatology and NC men showing high or low depressive symptomatology. No associations were found with anxiety.	84%
Effect of preparation for maternal role program on self-esteem of women undergoing IVF	Salimi Akin Abadi et al. (2018)	60 mothers undergoing IVF were assigned to intervention and control groups.	To determine the effect of a maternal role preparation program on self- esteem of pregnant mothers undergoing IVF.	A demographic characteristics form and Maternal Self-report Inventory (short version). The scale was used before delivery focusing on two dimensions of ability to accept maternal role and expected interaction with the neonate during pregnancy. It should be noted that the control group only received the routine care. For the intervention group, the preparation program consisted in a face-to-face manner for four 2-hour sessions over four weeks in groups of a maximum of 7–8 individuals. Each training session was accompanied by practice, assignments, and an overview of the content of the previous sessions with the cooperation of mothers. Four weeks after completing the first questionnaire, both groups completed the questionnaire again.	Maternal self-esteem and ability to accept maternal role	The maternal self-esteem scores in the intervention group significantly increased after the preparation program relative to those in the control group. The ability to accept maternal role in the intervention group was significantly different from that in the control group after holding the maternal preparation program.	75%
Assisted reproductive technologies are slightly associated with maternal lack of affection toward the newborn: the Japan Environment and Children’s Study	Yoshimasu et al. (2020)	Mothers and children during pregnancy and at 1 year after delivery; mothers were classified in infertility group with ART (n = 2792), infertility group with non-ART treatment (ovulation induction and intrauterine insemination) (n = 3835) and unaided pregnancy group (n = 78726).	To evaluate the association between use of ART and mother-to-infant bonding.	The mother-to-infant bonding assessment with the Japanese version of MIBS-J 17 at 1 year after delivery. The Japanese version of Ages and Stages Questionnaires (ASQ-3) was used to evaluate infant mental and physical development.	Maternal infant bonding, infant mental and physical development, maternal distress during pregnancy	ART did not have any substantial association with LMIB, shown as a low total score of MIBS-J, but non-ART did. ART was found to be associated with the 2 subcomponents of LMIB; however, lack of affection toward infants and anger/rejection toward them. Mothers who undergo ART treatment may have a difficulty in acquiring a self-image as a mother. Significant correlations were observed between mother-to-infant bonding and babies’ development as well as maternal psychological distress. Among mothers receiving Assisted Reproductive Technology, some factors were more frequently observed among those with poor mother-to-infant bonding, such as being primiparous, having few family members, having had stressful life events, having negative emotion toward pregnancy, insults from partner during pregnancy.	77%
QOL and general health in pregnant women conceived with assisted reproductive technology: a case-control study	Sarafraz Yazdi et al. (2020)	40 pregnant women conceived with ART and 40 pregnant women who conceived spontaneously.	To evaluate QOL and general health in pregnant women conceived with ART.	A Persian version of WHOQOL-BREF for evaluate QOL. Also, a Persian version of General Health Questionnaire-28 (GHQ-28) was used to evaluate general health in the participants for screening of emotional distress and possible psychiatric morbidity. In the present study, participants completed these two questionnaires twice (once in the first and once in the second trimester of pregnancy).	QOL, general health	The QOL in pregnant women conceived with ART was similar to women conceived spontaneously, in the first and second trimesters of pregnancy. It seems that in infertile women following treatment and after successful conception and during pregnancy, QOL is similar to women conceived spontaneously and is not different. Although during pregnancy these women have high distress levels but by progression of pregnancy and increasing certainty about pregnancy, distress level reduces.	60%

ART - assisted reproductive technology, EPDS – the Edinburgh Postnatal Depression Scale, IVF - in vitro fertilization, LMIB - ????, MAR - medically assisted reproduction, MFA - ???, MIBS-J - Mother-to-Infant Bonding Scale, NC - ???, PGD - preimplantation genetic diagnosis, QOL - quality of life, WHOQOL-BREF World Health Organization Quality of Life-BREF Questionnaire, SC – spontaneous conception, STAI – State-Trait Anxiety Inventory