Integrative Mind-Body and Lifestyle Nursing Interventions for Infertility: A Systematic Review and Meta-Analysis of Clinical Efficacy and Patient-Reported Outcomes

Background: Infertility, affecting up to ۱۵% of reproductive-aged couples globally, is a significant physical and psychological stressor, often leading to anxiety, depression, and reduced quality of life. While assisted reproductive technologies (ART) are standard, nurse-led integrative interventions combining mind-body practices and lifestyle modifications are increasingly explored as adjunct therapies. This systematic review and meta-analysis aimed to rigorously evaluate the impact of these nurse-delivered integrative interventions on clinical pregnancy rates, live birth rates, and patient-reported psychological outcomes in individuals undergoing infertility treatment. Methods: A systematic literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July ۲۰۲۵. The search strategy utilized a combination of Medical Subject Headings (MeSH) and free-text terms related to "infertility," "nursing," "mind-body," "lifestyle," and "randomized controlled trial." Included studies randomized controlled trials (RCTs) or quasi-experimental studies of nurse-delivered interventions integrating mind-body techniques (e.g., meditation, yoga) and/or lifestyle modifications (e.g., diet, exercise). Two independent reviewers screened articles, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias (RoB) ۲.۰ tool. Meta-analyses employed random-effects models (DerSimonian-Laird method) to calculate pooled relative risks (RR) for binary outcomes (pregnancy, live birth) and standardized mean differences (SMD) for continuous psychological outcomes (anxiety, stress). Heterogeneity was assessed using the I^۲ statistic, and publication bias was explored with Egger's and Begg's tests. Results: A total of ۱۷ studies, encompassing ۲,۱۵۰ participants, met the inclusion criteria. The pooled results indicated that nurse-led integrative interventions significantly improved clinical pregnancy rates compared to usual care or waiting list controls (RR = ۱.۳۱, ۹۵% CI: ۱.۱۰–۱.۵۶, p = ۰.۰۰۲). While an increase in live birth rates was observed, it did not reach statistical significance (RR = ۱.۲۰, ۹۵% CI: ۰.۹۵–۱.۵۱, p = ۰.۱۳). Importantly, these interventions were highly effective in enhancing psychological well-being, showing a large, statistically significant reduction in self-reported stress and anxiety (SMD = ۰.۴۴, ۹۵% CI: ۰.۲۲–۰.۶۶, p < ۰.۰۰۱). Subgroup analysis suggested that interventions combining both mind-body training and comprehensive lifestyle education had the largest effect size. Publication bias was low across all primary outcomes (Egger's test, p > ۰.۰۵). Conclusion: Nurse-led integrative mind-body and lifestyle interventions are a clinically impactful and evidence-based adjunct therapy in infertility care. They demonstrate significant efficacy in improving both reproductive outcomes, specifically clinical pregnancy rates, and crucial patient-reported psychosocial outcomes. These findings strongly support the integration of these holistic nursing programs into standard infertility treatment pathways to improve patient care and treatment success.

کلیدواژه ها:

Mind-body interventions ، infertility ، lifestyle optimization ، nurse-led care ، systematic review ، meta-analysis