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Pharmacotherapy or Psychotherapy? Selective Treatment Depression in The Infertile Women with Recurrent Pregnancy Loss: A Triple-Arm Randomized Controlled Trial

Int J Fertil Steril. 2022 Aug 21;16(3):211-219. doi: 10.22074/ijfs.2021.529258.1124.


Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications.<br />The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline<br />in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison<br />with usual care.<br />Materials and Methods: A triple-arm randomized controlled trial was carried out on the 60 depressed infertile<br />women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three<br />groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control<br />group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The<br />participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed<br />using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety<br />Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up.<br />Using statistical package for the social sciences (SPSS) software, data were analyzed.<br />Results: CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size<br />at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more<br />considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to<br />-0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow<br />up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing<br />depression and infertility stress.<br />Conclusion: Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with<br />RPL, with a significant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number:<br />IRCT201304045931N3).

PMID:36029059 | DOI:10.22074/ijfs.2021.529258.1124

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