Efficacy evaluation of an affectionate touch-based psychological intervention program for in vitro fertilization-embryo transfer patients: A controlled trial

Table 1 Affective touch interactive exercise intervention protocol

Level-1 indicator	Level-2 indicator	Level-3 indicator	Content
Tactile actions	Affectionate touch	Hugging, arm around waist or shoulder: Conveying security and intimacy	Explain the categories of affective touch actions to participants, emphasizing their positive effects and significance. Instruct participants to perform daily conscious tactile actions. Perform affectionate touch actions (e.g., hug, kiss) at least once daily upon waking up, before going out, after work, and before sleep. Perform at least one playful touch and/or deep touch action weekly. Log the completion of these actions daily before sleep
	Playful touch	Playful or teasing touches: Light-hearted physical interactions such as patting the head, gentle pinching, or tickling
	Deep touch	Massage: Relieving stress and fatigue through massage to enhance physical and emotional connection
		Sitting/Lying next to the partner with bodies overlapping or touching
		Body exploration: Exploring each other’s bodies with mutual consent to build trust and intimacy
Shared activities	Leisure activities	Engaging in casual conversation or deep, intimate dialogue with the partner	Explain the concept and significance of shared activities to participants. Instruct participants to complete at least one shared activity per week, each lasting no less than 30 minutes. Log the completion of the activity
		Engaging in shared leisure activities or spending time together (e.g., taking a walk, watching a movie)
	Shared responsibilities	Making plans or working (handling affairs) with the partner
		Doing housework together with the partner
Positive acceptance	Verbal expression	Expressing understanding of the partner’s feelings	Explain the concept and significance of positive acceptance to participants. Instruct participants to reflect on and summarize positive interactions with their partner daily and complete a daily behavior log
		Expressing confidence in the partner
		Expressing acceptance or care for the partner
		Complimenting the partner
		Telling the partner positive or good things about him/her
	Action support	Creating convenience for the partner
		Sharing or lightening the partner’s responsibilities
	Emotional support	Showing interest in learning about the partner’s day
		Making the partner feel valued in multiple ways, including but not limited to eye contact, feeling seen/understood, and unconditional understanding

Table 2 Demographic information of participants, median (interquartile rage)/mean ± SD/n (%)

	Male (n = 100)		χ2/Z/t	P value	Female (n = 100)		χ2/Z/t	P value
	Intervention group (n = 51)	Control group (n = 49)			Intervention group (n = 51)	Control group (n = 49)
Age	35 (31-37)	33 (30.5-39.5)	Z = -0.304	0.761	33(30-35)	32 (29-35)	Z = -0.948	0.343
BMI	24.25 ± 3.08	24.61 ± 3.66	t = -0.53	0.597	22.22 (21.1-24.1)	23.67(20.5-25.6)	Z = -1.048	0.295
Education			χ2f = 0.260	1			χ2f = 5.075	0.161
Middle school	5 (9.8)	5 (10.2)			6 (11.8)	9 (18.4)
High school	7 (13.7)	7 (14.3)			4 (7.8)	10 (20.4)
Undergraduate	35 (68.6)	34 (69.4)			36 (70.6)	25 (51)
Graduate	4 (7.8)	3 (6.1)			5 (9.8)	5 (10.2)
Smoking			χ2 = 3.780	0.286			χ2f = 0.970	1
No	33 (64.7)	25 (51)			50 (98)	49 (100)
Seldom	7 (13.7)	6 (12.2)			1 (2)	0 (0)
Occasional	4 (7.8)	10 (20.4)
Often	7 (13.7)	8 (16.3)
Drinking			χ2f = 4.487	0.201			χ2a = 0.223	0.637
No	22 (43.1)	29 (59.2)			49 (96.1)	45 (91.8)
Seldom	23 (45.1)	13 (26.5)			2 (3.9)	4 (8.2)
Occasional	4 (7.8)	6 (12.2)
Often	2 (3.9)	1 (2)
Marriage length	5 (3-9)	4 (3-8)	Z = -1.117	0.264	5(3-8)	5 (3-6.5)	Z = -0.902	0.367
Treatment length	2 (2-3)	2 (1-3)	Z = -1.786	0.074	2 (1-3)	2 (1-3)	Z = -1.027	0.304
Daily exercise time	0.8 (0.5-1)	1 (0.5-1)	Z = -1.143	0.253	0.5 (0.5-1)	0.5 (0.5-1)	Z = -0.318	0.751

χ² denotes the χ² test; f denotes Fisher’s exact test; Z denotes the nonparametric Mann-Whitney U test; t denotes the independent samples t-test. BMI: Body mass index.

Table 3 Baseline measures, median (interquartile rage)

	Male (n = 100)		Z/t	P value	Female (n = 100)		Z/t	P value
	IG (n = 51)	CG (n = 49)			IG (n = 51)	CG (n = 49)
Total score	55 (51-61)	55 (49.5-60)	Z = -0.784	0.433	58 (53-62)	55 (48.5-62.5)	Z = -1.478	0.139
Affection	21 (20-24)	20 (19-23)	Z = -1.713	0.087	21 (20-22)	20 (18.5-25)	Z = -0.423	0.672
Cognitive	20 (19-23)	21 (20-24.5)	Z = -1.234	0.217	21 (20-23)	20 (19.5-24.5)	Z = -0.472	0.637
Communication	14 (12-16)	14 (8-16)	Z = -0.942	0.346	15 (13-16)	15 (12-16.5)	Z = -1.073	0.283
Depression	4 (2-8)	4 (0-9)	Z = -0.601	0.548	8 (4-10)	6 (2-12)	Z = -0.017	0.986
Anxiety	6 (2-10)	4 (2-10)	Z = -0.08	0.936	6 (4-10)	6 (4-12)	Z = -1.041	0.298
Stress	10 (6-14)	10 (6-14)	Z = -0.146	0.884	12.35 ± 5.56	13.18 ± 7.19	t = -0.644	0.521
Affectionate touch	14 (10-19)	17 (12-19)	Z = -1.381	0.167	15 (10-19)	17 (11.5-20)	Z = -1.049	0.294

IG: Intervention group; CG: Control group.

Table 4 Marital status of males, mean ± SE

Time	Control group	Intervention group	Within-group change (control) β (95%CI); P value	Within-group change (intervention) β (95%CI); P value	Group-time interaction difference Δ (95%CI)	Interaction P value	Effect size (Cohen’s d)
Total
Pre-intervention	55.46 ± 0.60	55.97 ± 0.60
Post-intervention	56.90 ± 0.91	61.20 ± 0.70	1.45 (-0.66 to 3.56); P = 0.180	5.24 (3.90-6.57); P < 0.001	3.79 (1.29-6.28)	0.003	0.6
Affection
Pre-intervention	20.97 ± 0.24	21.35 ± 0.24
Post-intervention	22.01 ± 0.38	23.23 ± 0.25	1.04 (0.05-2.04); P = 0.042	1.88 (1.40-2.36); P < 0.001	0.84 (-0.26 to 1.95)	0.135	0.3
Cognitive
Pre-intervention	21.49 ± 0.34	21.31 ± 0.32
Post-intervention	21.57 ± 0.54	22.49 ± 0.42	0.08 (-1.05 to 1.21); P = 0.888	1.18 (0.47-1.88); P = 0.001	1.09 (-0.24 to 2.42)	0.107	0.32
Communication
Pre-intervention	13.10 ± 0.36	13.36 ± 0.34
Post-intervention	13.43 ± 0.47	15.53 ± 0.40	0.33 (-0.89 to 1.54); P = 0.600	2.18 (1.33-3.02); P < 0.001	1.85 (0.37-3.33)	0.014	0.49

CI: Confidence interval.

Table 5 Marital relationship status among females, mean ± SE

Time	Control group	Intervention group	Within-group change (control) β (95%CI); P value	Within-group change (intervention) β (95%CI); P value	Group-time interaction difference Δ (95%CI)	Interaction P value	Effect size (Cohen’s d)
Total
Pre-intervention	54.93 ± 0.59	56.05 ± 0.43
Post-intervention	56.46 ± 1.08	61.87 ± 0.58	1.53 (-1.44 to 4.50); P = 0.313	5.82 (4.31-7.34); P < 0.001	4.29 (0.96-7.62)	0.012	0.51
Affection
Pre-intervention	20.28 ± 0.33	20.64 ± 0.22
Post-intervention	20.65 ± 0.47	23.21 ± 0.35	0.37 (-1.05 to 1.79); P = 0.613	2.57 (1.65-3.48); P < 0.001	2.20 (0.51-3.89)	0.011	0.51
Cognitive
Pre-intervention	20.45 ± 0.34	20.84 ± 0.24
Post-intervention	21.35 ± 0.65	21.72 ± 0.36	0.90 (-0.74 to 2.54); P = 0.285	0.88 (0.06-1.70); P = 0.036	-0.02 (-1.85 to 1.82)	0.987	0
Communication
Pre-intervention	14.12 ± 0.32	14.60 ± 0.23
Post-intervention	14.38 ± 0.64	16.97 ± 0.32	0.27 (-1.36 to 1.89); P = 0.750	2.37 (1.61-3.14); P < 0.001	2.11 (0.31-3.91)	0.022	0.46

CI: Confidence interval.

Table 6 Mental health status of males, mean ± SE

Time	Control group	Intervention group	Within-group change (control) β (95%CI); P value	Within-group change (intervention) β (95%CI); P value	Group-time interaction difference Δ (95%CI)	Interaction P value	Effect size (Cohen’s d)
Depression
Pre-intervention	6.27 ± 0.48	6.23 ± 0.48
Post-intervention	5.04 ± 0.78	3.92 ± 0.59	-1.22 (-3.00 to 0.55); P = 0.179	-2.31 (-3.51 to -1.12); P < 0.001	-1.09 (-3.23 to 1.05)	0.319	0.2
Anxiety
Pre-intervention	6.07 ± 0.33	5.94 ± 0.36
Post-intervention	5.17 ± 0.51	3.31 ± 0.40	-0.90 (-2.14 to 0.34); P = 0.157	-2.63 (-3.57 to -1.68); P < 0.001	-1.73 (-3.29 to -0.17)	0.03	0.44
Stress
Pre-intervention	10.34 ± 0.38	10.37 ± 0.41
Post-intervention	8.13 ± 0.61	6.06 ± 0.54	-2.20 (-3.67 to -0.74); P = 0.004	-4.31 (-5.42 to -3.20); P < 0.001	-2.11 (-3.95 to -0.27)	0.025	0.45

CI: Confidence interval.

Table 7 Mental health status among females, mean ± SE

Time	Control group	Intervention group	Within-group change (control) β (95%CI); P value	Within-group change (intervention) β (95%CI); P value	Group-time interaction difference Δ (95%CI)	Interaction P value	Effect size (Cohen’s d)
Depression
Pre-intervention	7.38 ± 0.36	7.43 ± 0.36
Post-intervention	6.12 ± 0.85	4.60 ± 0.48	-1.27 (-3.34 to 0.81); P = 0.234	-2.82 (-3.95 to -1.69); P < 0.001	-1.09 (-3.23 to 1.05)	0.319	0.2
Anxiety
Pre-intervention	7.58 ± 0.28	7.26 ± 0.30
Post-intervention	6.03 ± 0.60	5.46 ± 0.50	-1.55 (-3.03 to -0.07); P = 0.041	-1.80 (-2.96 to -0.65); P = 0.003	-1.73 (-3.29 to -0.17)	0.03	0.44
Stress
Pre-intervention	12.93 ± 0.39	12.66 ± 0.33
Post-intervention	10.57 ± 0.74	7.68 ± 0.55	-2.37 (-4.27 to -0.46); P = 0.016	-4.98 (-6.35 to -3.61); P < 0.001	-2.11 (-3.95 to -0.27)	0.025	0.45

CI: Confidence interval.

Table 8 Semen parameters, mean ± SD

Time	CG	IG	CG difference β (95%CI); P value	IG difference β (95%CI); P value	Difference β (95%CI)	P value
Semen volume
T1	3.22 ± 0.05	3.15 ± 0.05			-0.07 (-0.20 to 0.07)	0.342
T2	3.27 ± 0.15	3.22 ± 0.15	0.05 (-0.29 to 0.39); P = 0.767	0.07 (-0.27 to 0.41); P = 0.691	0.02 (-0.46 to 0.50)	0.939
T3	2.71 ± 0.26	2.85 ± 0.21	-0.51 (-1.04 to 0.02); P = 0.062	-0.31 (-0.74 to 0.13); P = 0.174	0.20 (-0.49 to 0.90)	0.564
Sperm motility rate
T1	46.56 ± 0.33	46.25 ± 0.32			-0.31 (-1.21 to 0.59)	0.500
T2	46.84 ± 1.73	54.87 ± 1.45	0.27 (-3.31 to 3.86); P = 0.881	8.62 (5.58-11.66); P < 0.001	8.34 (3.64 to 13.05)	0.001
T3	46.39 ± 2.16	51.81 ± 2.62	-0.17 (-4.42 to 4.08); P = 0.937	5.56 (0.30-10.81); P = 0.039	5.73 (-1.04 to 12.50)	0.097
Progressive motility rate
T1	37.85 ± 0.34	37.43 ± 0.34			-0.42 (-1.35 to 0.51)	0.372
T2	38.50 ± 1.67	45.89 ± 1.20	0.64 (-2.84 to 4.12); P = 0.718	8.46 (5.99-10.92); P < 0.001	7.81 (3.55-12.08)	< 0.001
T3	36.68 ± 2.39	44.16 ± 2.89	-1.18 (-6.00 to 3.64); P = 0.633	6.73 (0.87-12.59); P = 0.025	7.91 (0.30-15.51)	0.042
Sperm concentration
T1	76.53 ± 1.92	80.06 ± 2.44			3.52 (-2.42 to 9.47)	0.245
T2	79.94 ± 7.14	87.21 ± 8.69	3.41 (-12.72 to 19.53); P = 0.679	7.15 (-11.13 to 25.42); P = 0.444	3.74 (-20.66 to 28.14)	0.764
T3	85.91 ± 5.74	86.63 ± 13.84	9.38 (-2.28 to 21.05); P = 0.116	6.57 (-21.82 to 34.96); P = 0.651	-2.81 (-33.41 to 27.78)	0.857
Total sperm count
T1	231.98 ± 7.99	233.20 ± 8.02			1.23 (-21.01 to 23.46)	0.914
T2	257.58 ± 25.47	260.17 ± 32.48	25.61 (-29.41 to 80.62); P = 0.363	26.97 (-42.66 to 96.59); P = 0.449	1.36 (-87.29 to 90.01)	0.976
T3	205.24 ± 27.64	217.25 ± 32.16	-26.74 (-85.54 to 32.06); P = 0.374	-15.95 (-84.83 to 52.93); P = 0.650	10.79 (-79.09 to 100.67)	0.814

CG: Control group; IG: Intervention group; CI: Confidence interval.

Table 9 Summary of statistically significant outcomes

Outcome measure	Measurement	Gender	Key finding (intervention vs control)	Statistical significance (interaction)	Clinical/practical implication
Marital relationship	Communication	Male	Significant improvement in communication scores over time relative to control	β = 1.85, P = 0.014	Improved verbal/non-verbal exchange
	Communication	Female	Significant improvement in communication scores	β= 2.11, P = 0.022	Enhanced emotional expression
	Affection	Female	Significant increase in affection scores	β = 2.20, P = 0.011	Stronger emotional bonding
	Total score	Both	Significant improvement in overall relationship quality	Male: P = 0.003; female: P = 0.012	Better dyadic adjustment during IVF
Mental health	Anxiety	Male	Significant reduction in anxiety symptoms	β = -1.73, P = 0.030	Reduced treatment-related arousal
	Stress	Both	Significant reduction in stress levels	Male: P = 0.025; female: P = 0.029	Effective stress buffering
Reproductive	Sperm progressive motility	Male	Significant increase in progressive motility at week 3 and week 4	Week 3: P < 0.001; week 4: P = 0.042	Improved functional semen quality

IVF: In vitro fertilization.