Table 2 Characteristics of e-health interventions to meet the needs of infertile patients

Adeleye et al., 2022, USA [23]

Randomized, double-blinded, placebo-controlled trial

• Self-efficacy

• Stress or treatment burden

• No significant difference between the two groups due to self-efficacy, fertility quality of life treatment, and perceived stress using an intention-to-treat analysis

• Increasing the confidence of the intervention group in medication administration for treatment by 4 times (OR 4.70 and p < 0.01)

• The reduction of medication errors in the intervention group (OR 0.37 and p = 0.03)

Educational videos about fertility drugs have no effect on psychological health but improve confidence in the treatment and reduce medication errors

NG et al., 2021, England [12]

Prospective RCT iPLAN trial

• Nutrition risk score at 12 weeks

• Lifestyle risk score at 12 weeks

• Adherence to the program at 12 and 24 weeks after randomization

• Reduction of composite risk score at the 12th week in the intervention group (composite risk score = risk score for intake of folic acid, vegetables and fruits, tobacco, and alcohol use)

• The difference in CRS between the intervention and control groups was −0.47 (95% confidence interval −0.97 to 0.02) at 12 weeks and −0.32 (95% confidence interval: −0.82 to 0.15) at 24 weeks

• Significant reduction of lifestyle risk scores in women with a body mass index of 25 kg/m² or above compared to women with a body mass index of below than 25 kg/m²

• The chance of getting pregnant at the 24th weeks in the intervention group increased compared to the control group (OR: 2.83, 95% CI: 0.35 to 57.76)

The online lifestyle coaching platform is more effective to provide the lifestyle advice and modifying behaviors to support women with a history of infertility or repeated miscarriages

Martin et al., 2021, USA [18]

Multicenter RCT

• Residual drug

• Occurrence of medication errors

• The amount of sent messages and patient -phone calls

• Patient satisfaction

• No significant difference between the two groups due to the average number of portal messages (p = 0.532) and telephone calls (p = 0.394), estimated number of remaining units of rFSH (p = 0.829), HMG vials (p = 0.329), or the doses of GnRH antagonist (p = 0.947), the number of errors in medication administration (p = 0.339), 12 patients in the control group (69/12, 14.4%) and 8 patients in the intervention group (8/72, 11.1%)

○ No significant difference between the two groups due to the amount of the remaining drug, the estimated cost of drug waste in the control group (US $2578 ± US $2056) and in the case group (US $2554 ± US $1855)

• No significant difference between the two groups due to patients’ satisfaction with the clinic experience (p = 0.916)

The OnTrack application did not affect reducing medication errors, medication surplus, or the number of messages sent from the patient. This application and others like it can improve patient-doctor communication during IVF treatment, increase satisfaction, and more successful pregnancy

Many patients had medication surplus, which is necessary to pay attention to reduce costs during IVF

Timmers et al., 2021, Netherland [24]

RCT

• The satisfaction level with the information provided in the application

• Level of knowledge

• Ability to take medication

• Quality of treatment

• Quality of healthcare

• Application usage

• Increased satisfaction with the information received 2 days after the IVF (p = .004)

• Increased level of knowledge 2 days after IVF consultation in the intervention group (p < .001)

Compared to standard training, using an application to provide timely information about IVF treatment increases the patient satisfaction

Using this application increases people’s knowledge about steps and procedures of IVF treatment, and finally, the usage statistics of this application show the information needs of the patients and their willingness to use an e-health application as part of treatment

Clifton et al., 2020, USA [15]

A randomized pilot trial

• Retention

• Adhere

• Satisfaction

• Distress

• Pregnancy

○ To be comparable to the retention, adherence, and satisfaction rates to those reported in other Internet-based RCTs

○ Significant reduction in distress (anxiety, p = .003; depression, p = .007; stress, p = .041 fertility social, p = .018; fertility sexual, p = .006), estimated as medium-to large effect sizes (ds = 0.45 to 0.86)

○ Higher odds of becoming pregnant 4.47 times for intervention group participants as compared to wait-list group, OR, 95% CI [1.56, 12.85], and p = .005 and occurred earlier

Smarter Pregnancy Coaching platform improves the consumption of vegetables, fruits, and folic acid supplements and reduces smoking and alcohol consumption in couples undergoing IVF/ICSI

Oostingh et al., 2020, Netherlands [13]

Multicenter, single-blinded, randomized controlled trial

Modification of inappropriate nutritional behaviors based on reducing the DRS at 24 weeks after the program started

Modification of nutritional behaviors, and lifestyle at 36 weeks after the program started

• Significant improvement in the nutritional behaviors of women and men in the intervention group compared to the control group after 24 weeks of coaching (Ɓ = 0.779, 95% confidence interval [CI] 0.456–1.090 for women; Ɓ = 0.826, 95% CI 0.416–1.284 for men) after 24 weeks of coaching

• Significant improvement of inadequate lifestyle behaviors of women (Ɓ = 0.108, 95% CI 0.021–0.203)

The Smarter Pregnancy mHealth coaching program improves crucial habits for IVF/ICSI couples

Yazdani and colleagues, 2019, Iran [14]

Parallel RCT

Sexual self-concept

○ Significant differences between two groups during the time in terms of positive self-concept domain (120.4 ± 17.9 versus 105.1 ± 16.8)

• An increasing trend of the scores in positive sexual self-concept domain (before intervention 110.6 ± 18.42), (after intervention 120.1 ± 18.7), and (4 weeks after intervention 120.4 ± 17.9) (p < 0.001)

• Decrease in negative sexual self-concept domain (before intervention 24.3 ± 7.87), (after intervention 20.2 ± 7.77), and (4 weeks after intervention 19.65 ± 6.97) (p < 0.001)

• No difference between two groups in terms of situational self-concept (p = 0.06)

Counseling via social networks improves the sexual self-concept and sexual relations of infertile couples

Vause et al., 2017, Canada [22]

Prospective RCT

• Knowledge regarding the IVF process, risks, and logistics assessed before and after the training session

• Patient stress before and after the training session

• Patient satisfaction after the training session and embryo transfer day

○ Increase in knowledge score in two groups after training (p < 0.001)

○ Decrease in stress score in two groups after training (p = 0.05)

• Increasing satisfaction of intervention group with web-based educational tools (p = 0.01)

○ Increase in knowledge score in two groups after training (p < 0.01)

○ Decrease in stress score in two groups after training (p = 0.54)

• Increasing satisfaction of intervention group with web-based educational tools (p = 0.01)

○ Increasing in knowledge score in both groups after the intervention

• No significant difference between participants of high- versus low-income and education status due to knowledge (p = 0.21), stress (p = 0.912), and satisfaction (p = 0.24)

This study’s findings showed that web-based educational tools have a similar effect on increasing knowledge and reducing stress compared to traditional education in both groups

One of the advantages of web-based training is the greater satisfaction of patients undergoing IVF treatment

Van-Dongen et al., 2016, Holland

Single-center, 2-arm, parallel-group, single-blind feasibility RCT

• Demand

• Acceptability

• Usability

• Integration implementation

○ Acceptability of e-treatment program due to current clinical and care guidelines

○ Due to a lack of feeling of need for help, only 44% of people participate in this program (demand)

○ Dropout rate relatively high causes average assessment of applicability

○ Clearly, this intervention is effective (decrease in the percentage of women with clinical symptoms related to the anxiety or depression in the intervention group compared to control group 3 months after the first ART cycle risk difference of 24% (p = 0.03)

Personalized e-therapy program in clinical fertility care to the risk profile of patients is promising and feasible

Sexton et al., 2010, USA [19]

RCT

• General stress

• Stress infertility

Reduction of general stress in the intervention group (after interactive web-based bibliotherapy) (p = .048)

The general stress of infertile women is significantly reduced using an online cognitive behavioral approach

Haemmerli et al., 2010, Switzerland [17]

RCT

• Depression

• Anxiety

• Contact

• Distress

• Infertility

• Fertility rate

• Decreasing in the level of depression in the intervention group 5 months after the intervention compared to before the intervention (p = 0.007)

• Reducing the general level of anxiety in the intervention group 5 months after the intervention compared to before the intervention (p < 0.01)

• Reducing state-trait anxiety level in the intervention group 5 months after the intervention compared to before the intervention (p < 0.01)

Most of the participants (80%) rated Internet support as positive or very positive, and based on high demand for such support, Internet-based interventions are a new and promising approach for infertile patients and need more development and evaluation

Cousineau et al., 2008, USA [16]

RCT

• Infertility distress

• Self-efficacy of infertility

• Decisional conflict

• Marital cohesion

• Coping style

• The dosage of the program and satisfaction with the program 1 month after the use of the program

Enhancing the performance of women participating in the online group program in the following areas:

• Social concerns related to infertility distress (p = 0.038)

• Feeling more informed about medical decisions with which they were contending (p = 0.037)

• Reducing general stress (p = 0.10)

• Reducing sexual concerns (p = 0.059)

• Reducing distress related to life without children (p = 0.063)

• Increasing Infertility self-efficacy (p = 0.067)

• Increasing decision-making clarity (p = 0.079)

In the group that women used, an online program for more than 1 h is as follows:

• Reducing general stress (p = 0.028)

• Increasing self-efficacy (p = 0.024)

This evidence-based e-health program showed that web-based educational intervention has beneficial effects on various psychological domains and is a useful resource for fertility practices

Tuil et al., 2007, Holland [20]

RCT

Patients’ empowerment in the following:

• Participation in decision-making

• General and specific self-efficacy

• Actual and perceived knowledge

• Side effects

• Satisfaction

• Helplessness

• Acceptance

• Social support

• State anxiety

• Depression

• No significant differences were observed in per-person change in patient empowerment (p > 0.05)

• No significant differences regarding per-person change in patient satisfaction (p > 0.05)

• No significant differences in the per-person changes of variables related to infertility problems, social support, anxiety, and depression (p > 0.05)

Using the personalized health records did not affect patient empowerment and did not have an adverse effect on people