In a groundbreaking systematic review published in BMC Psychology in 2025, researchers Salarfard, Mahmoudinia, Rahimi, and colleagues delve deeply into the nuanced relationship between counselling methodologies and their influence on marital intimacy among women and couples grappling with infertility. This comprehensive analysis arrives at a critical time when infertility is increasingly recognized not just as a biological challenge but as a profound psychosocial stressor affecting the intricate fabric of intimate relationships. The study meticulously synthesizes a wide array of counselling approaches, evaluating their efficacy in fostering emotional connection, communication, and intimacy within affected partnerships.
Infertility, defined as the inability to conceive after a year or more of unprotected intercourse, triggers considerable psychological distress for many couples worldwide. While medical interventions attempt to address the physiological aspects, the emotional and relational consequences often remain insufficiently explored or treated. The review underscores how infertility can fracture core dimensions of marital intimacy, including trust, emotional closeness, physical affection, and sexual satisfaction. This interdependence between psychological well-being and physical intimacy necessitates targeted counselling interventions to support couples beyond clinical treatment alone.
The authors conducted an extensive literature search across multiple databases, aggregating studies that applied diverse counselling models to couples or women facing infertility challenges. Cognitive-behavioral therapy (CBT), emotionally focused therapy (EFT), psychoeducation, mindfulness-based approaches, and systemic family therapy emerge as prominent modalities analyzed within the review. Their impact is assessed not only in terms of reducing anxiety and depression but also through enhancing communication patterns, emotional responsiveness, and sexual satisfaction, thereby facilitating a restoration or strengthening of intimacy.
A key finding highlighted in the review concerns the effectiveness of emotionally focused therapy (EFT), which centers on identifying and restructuring emotional responses that inhibit intimacy. EFT’s emphasis on fostering secure attachment bonds between partners shows notable promise in creating an environment conducive to vulnerability and mutual understanding. For couples burdened by the stress of infertility, EFT provides tools to renegotiate emotional needs and fears, ultimately revitalizing the intimacy that may have diminished during their struggle.
Cognitive-behavioral therapy (CBT) also features prominently for its ability to restructure maladaptive thought patterns that contribute to emotional withdrawal and relational distress. CBT interventions tailored to infertility-related stress equip individuals and couples with coping strategies that mitigate the psychological toll of repeated clinical disappointments or social stigma. By addressing intrusive negative thoughts, CBT facilitates an improved emotional climate within the relationship, which correlates with enhanced intimacy.
Beyond these traditional psychotherapeutic approaches, the review brings attention to mindfulness-based interventions that emphasize present-moment awareness and acceptance. Such practices have proven effective in alleviating anxiety and fostering emotional regulation, which indirectly supports intimacy by enabling partners to remain emotionally connected rather than overwhelmed by stress. Mindfulness also encourages compassionate communication, which is crucial when discussing sensitive topics such as infertility treatment outcomes or fears about the future.
Psychoeducational counselling, which combines information dissemination with emotional support, is another significant methodology explored. This approach recognizes moments of confusion and misinformation surrounding infertility and assists couples in understanding the medical, emotional, and relational aspects of their condition. Educational empowerment reduces feelings of helplessness and isolation, leading to a more collaborative and empathetic partnership—essential components of intimacy.
Systemic family therapy broadens the lens by recognizing infertility’s impact beyond the couple to encompass family dynamics and social support systems. By involving extended family or addressing systemic relational patterns, such therapy aims to alleviate external pressures that may further strain intimacy between partners. This holistic approach acknowledges that marital intimacy is embedded in wider social and familial contexts, thus requiring multi-layered intervention.
Importantly, the review finds that the timing and adaptability of counselling interventions play crucial roles in their success. Early intervention post-diagnosis and continuous support throughout treatment cycles result in better preservation of marital intimacy. Flexible tailoring of counselling content to individual and cultural contexts further enhances engagement and effectiveness, recognizing that infertility experiences and notions of intimacy vary widely across populations.
While many studies demonstrate positive outcomes, the authors emphasize the need for greater methodological rigor and longitudinal research to clearly establish causality and long-term benefits. Diverse outcome measures of marital intimacy, including validated psychological scales and qualitative assessments, are essential to capture the multidimensional nature of intimacy changes over time. The review advocates for integrating intimacy-focused counselling as a standard component of infertility care protocols worldwide.
This systematic review not only advances the scientific understanding of infertility’s psychological repercussions but also serves as a call to action for healthcare providers. Fertility specialists, mental health practitioners, and policy makers are urged to collaborate more closely in developing and disseminating counselling frameworks that explicitly target relational intimacy. Such integrative care models are poised to improve not only individual psychological health but also the relational well-being that is foundational to family formation.
Moreover, by exploring the mechanisms through which counselling improves intimacy, the review opens avenues for innovative intervention designs. For example, digital platforms and telehealth counselling can offer accessible, stigma-reducing support tailored to the unique challenges faced by infertile couples. Future research might also consider the intersectionality of gender, culture, and socioeconomic factors in shaping infertility experiences and responsive counselling approaches.
In an era where assisted reproductive technologies increasingly dominate infertility treatment, this systematic review reminds us that the emotional and relational dimensions remain paramount. Counselling interventions that restore and reinforce marital intimacy serve as powerful complements to clinical solutions, enriching the holistic healing journey. This multi-faceted approach respects human resilience and affirms the centrality of intimacy to marital satisfaction and overall quality of life amidst adversity.
As the dialogue around infertility evolves, this comprehensive synthesis consolidates and elevates the evidence base, making a compelling case for embedding comprehensive counselling services into the standard care regimen. It encourages health systems to extend beyond biological markers of success and embrace the psychological and relational triumphs essential to enduring wellbeing. The systematic review by Salarfard et al. stands as a milestone in bridging mental health, relational science, and reproductive medicine with lasting implications for research, clinical practice, and affected couples worldwide.
Subject of Research: The impact of various counselling approaches on marital intimacy among women and couples experiencing infertility.
Article Title: A systematic review of counselling approaches and their impact on marital intimacy among women and couples experiencing infertility.
Article References: Salarfard, M., Mahmoudinia, M., Rahimi, M. et al. A systematic review of counselling approaches and their impact on marital intimacy among women and couples experiencing infertility. BMC Psychol 13, 1089 (2025). https://doi.org/10.1186/s40359-025-03430-4
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