The psychological impact of fertility treatment suspensions during the COVID-19 pandemic

Pilot trial of a new self-directed psychological intervention for infertility-related distress

BACKGROUND

Now affecting one in six couples in Canada, infertility is defined as a lack of conception after 12 or more months of regular, unprotected heterosexual intercourse. Infertility is associated with immense psychological burden, particularly for individuals assigned female at birth. Yet existing psychological interventions are not specialized to this population and have been shown to be only marginally effective at relieving distress related to infertility. Thus, a new online self-directed psychological intervention was co-created with a panel of women experiencing infertility, and ultimately consisted of six 10-min video modules addressing the cognitive, emotional, and interpersonal aspects of infertility-related distress.

METHODS

In the current study, 21 women experiencing reduced quality of life related to infertility were recruited to participate in a one-arm pre-post pilot testing the feasibility, acceptability, and preliminary efficacy of the program. Participant adherence and retention were monitored, and participants rated the credibility of the program and the helpfulness of each module as well as provided feedback on the content and format of the program. Pre-to-post changes in fertility quality of life, anxious symptoms, depressive symptoms, and relationship satisfaction were examined.

RESULTS

The program modules were highly rated by participants, with average helpfulness ratings ranging from 7.5 to 8.2/10. Two participants became pregnant and therefore stopped prematurely, 79% of the remaining participants completed all six modules, and participants reported completing 52.8 (SD = 82.0) min of homework per week. Participants perceived the intervention as highly credible and generally approved of the format, length, and speed; however, 68% of participants had recommendations for additional content to be included in the intervention. While relationship satisfaction did not change significantly over time, large pre-to-post improvements in fertility quality of life, depression, and anxiety were observed (p < .001; Cohen's ds = 0.9-1.3).

CONCLUSIONS

This self-directed intervention was well received and has the potential to be highly effective in reducing infertility-related distress, informing future development and optimization.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05103982.

Psychological impact of the COVID-19 pandemic on infertile patients: A systematic review and meta-analysis

The present study aimed to examine the psychological impact of the COVID-19 pandemic on infertile patients. We adopted a comparison design and searched articles published from 1 September 2016 to 31 December 2019 as the control group, while articles published from 1 January 2020 to 31 April 2023 were treated as the pandemic group. Specifically, Web of Science, PubMed, Medline, PsycArticle, CNKI and PsycINFO were searched to identify potential eligible records. Risk of bias was assessed, and random-effects meta-analyses were conducted to estimate the prevalence of specific mental health problems. Forty studies with a total of 19,480 participants were included in the analysis. The pooled prevalence of anxiety in the pandemic group was significantly higher than that in the control group. The depression and stress prevalence in the pandemic group was higher than that in the control group, yet did not reach statistical significance. A subgroup analysis revealed region differences with developed countries exhibiting higher rates of anxiety and depression in the pandemic group, but the result was the opposite in the control group. Physiological factors, psychological factors and social factors correlated with infertile patients' mental health were identified. The COVID-19 pandemic had a significant negative impact on infertile patients' mental health, emphasizing the importance of ways to mitigate the risks during the pandemic.

The Covid-19 Infection Effect on Assisted Reproductive Method Outcomes

Objective

COVID-19 can have potential pathogenic effects on the oocyte and embryos, but there is limited data about its impact. This study aimed to investigate the COVID-19 impact on the outcome of Assisted Reproduction Techniques (ART) methods.

Materials and methods

This case-control study was conducted on 190 infertile women who underwent oocyte retrieval at Yas Hospital in vitro fertilization (IVF) department affiliated to Tehran University of Medical Sciences, from October 2021 to October 2022. The case group was defined as women whose PCR test was positive on puncture day and the control group was women with COVID-19 negative tests on puncture day. The study outcome measurements included the number of oocytes retrieved and the number and quality of embryos. Finally, the data were analyzed by SPSS 24.

Results

The mean age of the participants was 32.89 ± 5.58 years with an age range of 18-49 years. No significant difference was observed between the two groups regarding baseline variables. The mean number of oocytes was significantly (p =0.001) lower in the case (6.68±4.25) group versus the control (9.07±4.10) group. While there was no statistically significant difference regarding the mean number of embryos in the study groups, No grade A embryos were observed in more than half (57.5%) of the women in the case group. Furthermore, the frequency of grade C embryos on average was 1.08±1.11 in the case group and 0.57±0.75 in the control group, with a statistically significant difference (p =0.010).

Conclusion

The findings of this research highlighted that women infected with COVID-19 on the puncture day have a lower number of oocytes and also good-quality embryos.

Alkuwaisi M, Zoromba MA. Prevalence of Depression and Its Associated Factors Among Hemodialysis Patients in Hodeida City, Yemen

Background

Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen.

Methods

A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05.

Results

The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035).

Conclusion

Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions.

Implications for practice

Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.

Testing an Evidence-Based Self-Help Program for Infertility-Related Distress: Protocol for a Randomized Controlled Trial

BACKGROUND

Infertility-the inability to achieve pregnancy despite ≥12 months of focused attempts to conceive-is experienced by 1 in 6 couples. Women typically carry a disproportionate share of the psychological burden associated with infertility, experiencing poor quality of life, and 30%-40% experiencing depressive mood or anxiety. Unfortunately, currently available psychological interventions targeting infertility-related distress are associated with modest effects.

OBJECTIVE

Our team, in collaboration with patient advisors, has designed a self-help intervention for infertility-related distress involving 7 weekly 10-minute videos addressing the cognitive, behavioral, and interpersonal challenges associated with infertility, delivered through a mobile app. A feasibility study suggests that it is well accepted and highly effective in reducing symptoms of anxiety and depressed mood among distressed individuals dealing with infertility. This study represents the next step in this line of research: a fully powered randomized controlled trial comparing the intervention to a waitlist control group.

METHODS

We will recruit 170 individuals struggling to become pregnant in Canada or the United States to be randomized to our 7-week self-help program or a treatment-as-usual condition. The primary outcome will be fertility quality of life, while secondary outcomes will include depressive symptoms, anxious symptoms, and relationship quality, assessed before and after the program as well as biweekly for 16 weeks following completion of the program. Self-reported health care use and the presence of diagnosed mood and anxiety disorders, assessed through a structured psychiatric interview, will also be assessed immediately following the intervention and at the 16-week follow-up assessment. Treatment adherence and retention will also be recorded throughout the intervention. Multilevel modeling will compare the intervention arm to the treatment-as-usual condition in terms of all continuous outcomes across the 9 measurement points. Logistic regression will be used to assess the occurrence of mood and anxiety disorders in the 2 treatment arms at the posttreatment assessment as well as at the 16-week follow-up. Sensitivity analyses will examine potential treatment moderators: membership in the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) communities, baseline fertility quality of life, cultural background, disability status, and pursuit of conception through medical intervention.

RESULTS

We expect our intervention to be more effective than treatment-as-usual in improving all mental health parameters assessed and decreasing health care use related to both mental and reproductive health. Effects are expected to be larger with decreasing baseline quality of life and equally effective regardless of membership in the LGBTQIA+ communities, cultural background, or disability status.

CONCLUSIONS

If our intervention is successful, this would suggest that it should be scaled up and made publicly available. The availability of this program would fill an important gap in light of the high rates of psychopathology among those experiencing infertility and considering the current lack of effective psychotherapy approaches for infertility.

TRIAL REGISTRATION

Clinicaltrials.gov NCT06006936; https://classic.clinicaltrials.gov/ct2/show/NCT06006936.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/52662.

Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies

BACKGROUND

Access to fertility treatments is considered a reproductive right, but because of the quarantine due to the coronavirus pandemic most infertility treatments were suspended, which might affect the psychological and emotional health of infertile patients. Therefore, this study was conducted to review the mental health of infertile patients facing treatment suspension due to the coronavirus pandemic.

METHODS

This study was conducted based on the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. The Web of Science, PubMed, Embase, Scopus, and Cochrane library databases were searched by two independent researchers, without time limitation until 31 December 2022. All observational studies regarding the mental health of infertile patients facing treatment suspension including anxiety, depression, and stress were included in the study. Qualitative studies, editorials, brief communications, commentaries, conference papers, guidelines, and studies with no full text were excluded. Quality assessment was carried out using Newcastle-Ottawa Scale by two researchers, independently. The random effects model was used to estimate the pooled prevalence of mental health problems. Meta-regression and subgroup analysis were used to confirm the sources of heterogeneity.

RESULTS

Out of 681 studies, 21 studies with 5901 infertile patients were systematically reviewed, from which 16 studies were included in the meta-analysis. The results of all pooled studies showed that the prevalence of anxiety, depression, and stress in female patients was 48.4% (95% CI 34.8-62.3), 42% (95% CI 26.7-59.4), and 55% (95% CI 45.4-65), respectively. Additionally, 64.4% (95% CI 50.7-76.1) of patients wished to resume their treatments despite the coronavirus pandemic.

CONCLUSION

Treatment suspension due to the coronavirus pandemic negatively affected the mental health of infertile patients. It is important to maintain the continuity of fertility care, with special attention paid to mental health of infertile patients, through all the possible measures even during a public health crisis.

Emotional Distress Caused by the Measures Taken in Assisted Reproductive Treatments during the COVID-19 Confinement in Spain

During the pandemic, assisted reproductive treatments suffered from major disruptions in their terms due to the restrictions imposed. The objective of this study is to evaluate the level of anxiety of women whose treatments were either suspended or delayed.

METHODS

Descriptive cross-sectional study conducted between April and May 2020. The State-Trait Anxiety Inventory was applied by telephone in a Spanish adapted version. The research also included social, personal, and work aspects which may be involved in the challenging situation.

RESULTS

A total of 115 patients participated in the study (73.7%). Women showed a mean in trait anxiety of 17.79 (SD = 8.80) and a mean in state anxiety of 19.95 (SD = 9.08). Neither the type of treatment nor the time of infertility were predictors of trait anxiety or state anxiety. Greater age pressure and more worry were associated to greater trait and state anxiety (p < 0.001). The most common emotional reactions to discontinuation of fertility treatments were sadness and anxiety.

CONCLUSIONS

Discontinuation of fertility treatments due to confinement restrictions had a negative impact on the mental health of women who were following a process of assisted reproduction treatment, increasing their levels of emotional distress and anxiety.

The Perspective of Patients and Health Professionals on the Prioritization of Assisted Reproductive Techniques. The PRIOFER Study

Purpose

To determine the perspective of patients and professionals in Assisted Reproduction Units (ARU) on the importance of assisted reproductive techniques (ART) compared to other elective procedures, to highlight the relevance of ART as an elective procedure and the impact of delayed interventions on patients.

Design Patients and Methods

An observational, descriptive, cross-sectional, online survey-based study was conducted in infertility patients and partners (n=98) and ARU healthcare professionals (n=83). The survey included a best-worst scaling (BWS) experiment and an ad-hoc questionnaire to analyze the pandemic impact on ART management and infertility patients in Spain. In the BWS, each respondent established priorities choosing which patient profile should be rated as the highest and lowest priority profile on a waiting list. To understand the importance that they give to assisted reproduction compared to other procedures, three very common elective procedures involving different patient profiles were selected: cataract surgery, knee arthroplasty, and varicose vein surgery. For each procedure, three hypothetical patient profiles corresponding to three different degrees of severity on a waiting list were designed.

Results

Patients attributed greater importance to ART profiles (BWS score: patients 0.14 vs professionals -0.05; p<0.01) whereas professionals prioritized cataract surgery (patients 0.06 vs professionals 0.23; p<0.01). Concerning the profile severity, more severe profiles were prioritized in all procedures by both groups. Patients' and professionals' perspectives on the impact of the pandemic were similar, with exceptions: information received for resuming ART; health care provision in crisis situations; and reduction of parenting options. The pandemic affected patients' ability to conceive a child (70.4% of those surveyed), their psychological well-being (75.5%), and partner, social, and work relationships (69.4%).

Conclusion

Preference studies involving patients and professionals can provide important information to define framework criteria for the management of waiting lists for elective procedures, and to prioritize interventions during pandemic periods. The pandemic impact on infertility patients highlights the relevance of developing measures and strategies to cope with similar future situations in the most appropriate way.

Understanding the experiences of helplessness, fatigue and coping strategies among women seeking treatment for infertility - A qualitative study

BACKGROUND

Infertility impacts families and communities worldwide, affecting millions of people of reproductive age. The fertility rate in India is alarming. Fertility is valued in the majority of cultures, and having children is a fundamental motivation. The frustration and anger of an infertile woman affect her family, friends, and even her husband. This study aims to assess the factors that contribute to helplessness, fatigue, and coping strategies among women with infertility.

MATERIALS AND METHODS

An in-depth interview was conducted among ten participants, to collect information about the challenges faced by women experiencing infertility. The participants were selected using a purposive sampling technique and they had at least 1 year of experience with infertility. A phenomenological study was utilized and themes and sub-themes were developed. Data was collected by using a list of probing open-ended questions and analyzed by colaizzi method.

RESULTS

Women receiving infertility treatment over a long period of time disclosed that they are dealing with stressful situations in their lives. The experience left them feeling helpless in some stressful conditions. Due to a lack of both financial and emotional support from their family, when they are helpless, they are too worn out to continue their treatment. Some of these women are using different coping strategies to overcome their problems. We found seven common themes from this in-depth interview; 1) Lack of hope and support, 2) Spiritual resources, 3) Negative thoughts, 4) Social abstain, 5) Mental engagement, 6) Emotional concealment, and 7) Coping strategies.

CONCLUSION

This study provides social, emotion and spiritual condition of infertile women in society. The majority of these women struggle with having negative thoughts due to a lack of support, concern, and involvement from their families. These results highlight the need to promote coping strategies, importance of financial and emotional support from the family members.

Embryo development, pregnancy and live birth outcomes following IVF treatment were not compromised during the COVID-19 pandemic

PURPOSE

To evaluate whether outcomes of in vitro fertilization (IVF) are affected during the coronavirus disease-19 (COVID-19) pandemic.

METHODS

This was a single-center, retrospective study. Embryo development, pregnancy, and live birth outcomes were compared between COVID-19 and pre-COVID-19 groups. Blood samples from patients during the COVID-19 pandemic were tested for COVID-19.

RESULTS

After 1:1 random matching, 403 cycles for each group were included in the study. The rates of fertilization, normal fertilization, and blastocyst formation were higher in the COVID-19 group than in the pre-COVID-19 group. No difference was observed in the rates of day 3 good-quality embryos and good-quality blastocysts between the groups. A multivariate analysis showed that the live birth rate in the COVID-19 group was higher than that in the pre-COVID-19 group (51.4% vs. 41.4%, P = 0.010). In fresh cleavage-stage embryo and blastocyst transfer cycles, there were no differences between the groups in terms of pregnancy, obstetric, and perinatal outcomes. In the freeze-all cycles, the live birth rate was higher during the COVID-19 pandemic (58.0% vs. 34.5%, P = 0.006) than during the pre-COVID-19 period following frozen cleavage stage embryo transfer. The rate of gestational diabetes during the COVID-19 pandemic was higher than that during the pre-COVID-19 period (20.3% vs. 2.4%, P = 0.008) following frozen blastocyst transfer. All the serological results of the patients during the COVID-19 pandemic were negative.

CONCLUSION

Our results indicate that embryo development, pregnancy, and live birth outcomes in uninfected patients were not compromised during the COVID-19 pandemic at our center.

SARS-CoV-2 infection and female reproductive health: A narrative review

The COVID-19 pandemic has had a profound global impact, affecting people's physical and mental health, and their social and economic circumstances. Mitigation measures have disproportionately affected women. Studies have reported menstrual cycle and psychological disturbance associated with the pandemic. Pregnancy is a risk factor for severe COVID-19 disease. Reports have also demonstrated associations between COVID-19 infection, vaccination and Long COVID syndrome and reproductive health disturbance. However, studies are limited and there may be significant geographical variation. Also there is bias amongst published studies, and menstrual cycle data was not included in COVID-19 and vaccine trials. Longitudinal population based studies are required. In this review we discuss existing data, along with recommendations for further research required in this area. We also discuss a pragmatic approach to women presenting with reproductive health disturbance in the era of the pandemic, encompassing a multi-system assessment of psychological, reproductive health and lifestyle.

Emotions, thoughts, and coping strategies of women with infertility problems on changes in treatment during Covid-19 pandemic: A qualitative study

This study assesses the emotions, thoughts, and coping strategies of women with infertility problems associated with the changes in treatment during the COVID-19 pandemic using Lazarus and Folkman's Transactional Model of Stress and Coping. This qualitative study was based on two Internet forums between October-December 2020, and the comments of 30 women. Four themes were assessed: psychological changes, cognitive changes, changes in social life, and coping strategies. Women reported that the closure of fertility clinics negatively impacted their lives. They experienced despair, uncertainty, disappointment, anger, sadness, and exhaustion from waiting. The expressions of women about coping strategies mostly include emotion-based coping strategies. This study illustrated the importance of using qualitative methods to describe and specify stress and coping strategies in women whose infertility treatment was delayed. It is believed that approaches based on Lazarus and Folkman's model could help healthcare professionals to determine potential stressors for women with infertility during the pandemic, and to identify areas that required improved personal coping strategies.

Pathways to social support: IVF patients' motivation toward peers and selection preferences

Infertility rates are increasing internationally, and its treatment, in-vitro fertilization (IVF) imposes stress on women as primary patients. In this study, led by a researcher with lived experience in infertility, we seek to uncover the pathways that lead IVF patients toward peer support; mainly what precipitates patients' decisions to seek peer support and how they select their peer. Having interviewed 23 IVF patients, we found that prior to disclosing to a peer, women reflect on information about their condition and their personal support needs and reconcile support gaps within their couple and social circles as they gauge their personal motivation to seek peer support. The demands of IVF compel patients to gravitate toward other women with shared experience. Prior to disclosure, patients consider diverse points of connection as well as desirable peer traits including previous IVF experience, other common ground and full transparency in a peer's communication style.

Psychological status of infertile men during the Coronavirus Disease 2019 Pandemic in China: a cross-sectional investigation

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak has had a widespread and profound impact on people's mental health. The factors associated with mental symptoms among men diagnosed with infertility, a disease closely related to psychological conditions, remain unclear. The aim of this study is to investigate the risk factors associated with mental symptoms among infertile Chinese men during the pandemic.

RESULTS

A total of 4,098 eligible participants were recruited in this cross-sectional, nationwide study, including 2,034 (49.6%) with primary infertility and 2,064 (50.4%) with secondary infertility. The prevalence of mental health conditions was 36.3%, 39.6%, and 6.7% for anxiety, depression, and post-pandemic stress, respectively. Sexual dysfunction is associated with a higher risk with adjusted odds ratios (ORs) of 1.40 for anxiety, 1.38 for depression, and 2.32 for stress. Men receiving infertility drug therapy displayed a higher risk for anxiety (adjusted OR, 1.31) and depression (adjusted OR, 1.28) symptoms, while those receiving intrauterine insemination had a lower risk of anxiety (adjusted OR, 0.56) and depression (adjusted OR, 0.55) symptoms.

CONCLUSION

The COVID-19 pandemic has had a significant psychological impact on infertile men. Several psychologically vulnerable populations were identified, including individuals with sexual dysfunction, respondents receiving infertility drug therapy, and those experiencing control measures for COVID-19. The findings provide a comprehensive profile of the mental health status of infertile Chinese men during the COVID-19 outbreak and provide potential psychological intervention strategies.

Quality of Life among Couples with a Fertility Related Diagnosis

Fertility-related stress can negatively impact infertile couples' quality of life (QoL). Most previous studies have concentrated on the effects of stress and infertility on individual persons, especially women, though infertility affects the QoL of both spouses. Our research aimed to investigate the roles of infertility and stress in couples' quality of life as a single unit. The research sample consisted of 202 spouses, i.e., 101 couples, with a mean age of 39.5 years (SD = 4.9 years) undergoing fertility treatment at Athens Naval Hospital-Assisted Reproduction Unit. Data collection was completed via self-administered questionnaires: the FertiQoL International Questionnaire for measuring the quality of life in infertility and The Demographic Information and Medical History Questionnaire. Data collection was conducted between January and November 2022. Quantitative variables are expressed as mean values (standard deviation) and as median interquartile range, and qualitative variables are expressed as absolute and relative frequencies. Pearson's (r) and Spearman's (rho) correlations coefficients were used to explore the association of two continuous variables. Multiple linear regression analysis was used with dependence on the Ferti-QoL's subscales. The regression equation included terms for participants' demographics and information from their medical history. Adjusted regression coefficients (β) with standard errors (SE) were computed from the results of the linear regression analyses. All reported p values are two-tailed. Statistical significance was set to p < 0.05, and analyses were conducted using SPSS statistical software (version 22.0). We found that greater anxiety and depression were significantly associated with worse quality of life. Additionally, quality of life, according to Ferti-QoL, was significantly worse in women, participants with a high level of education, those with greater depressive symptoms, and those with greater state scores. Findings of this study highlight the need for implementing interventions of supportive care methods, counseling, stress reduction methods, and improving the fertility-related quality of life of infertile couples.

Bio-Psycho-Social Approach to Reproductive Mental Health and Reproductive Decisions

The reproductive period in the human life cycle covers a great part of a person's existence and is associated with many significant life changes [...].

The Impact of Coronavirus Disease 2019 Pandemic on Female Patients Seeking or Undergoing Fertility Treatment in a Single In vitro Fertilisation Clinic in Greece: An International, Cross-sectional Study

Background

The temporary delay in fertility treatments due to the coronavirus disease 2019 (COVID-19) pandemic, in combination with the imposed lockdowns, has created psychological distress and anxiety amongst infertile patients.

Aims

The aim of this study was to evaluate how the pandemic has influenced assisted reproduction technology (ART) patients in Greece, during the second wave of the pandemic. An additional aim was to examine the effects of the pandemic on cross-border patients in particular, compared to national ones.

Settings and Design

This study was a cross-sectional, questionnaire-based study, distributed to 409 patients of a single in vitro fertilisation (IVF) clinic in Greece, during the period between January until the end of April 2021.

Materials and Methods

The survey was conducted online via E-mail and was distributed to national and international female patients of a single IVF clinic in Greece, who were undergoing ART treatment during the second wave of the COVID-19 pandemic. Patient participation was anonymous, and participants provided informed consent for collection and publication of data.

Statistical Analysis Used

The mean values of baseline characteristics, along with answer percentages per questionnaire item, were calculated. Collected data were cross-tabulated, and the Chi-square test was used as a measurement of the differences between national and cross-border patients. A P value lower than 0.05 was considered statistically significant. All analyses were conducted using the SPSS Statistics software.

Results

From 409 initial candidates, 106 women, with a mean age of 41.2 years, completed the questionnaire (26% response rate). The majority of national patients did not experience any delays in their fertility plans (62%), while cross-border patients experienced over 6 months of delays (54.7%). The main reason for fertility postponement was travel restrictions due to COVID-19 for cross-border patients (62.5%), while national patients cited additional reasons. The majority of patients experienced a degree of stress (65.2%) due to the delays, however were not fearful of COVID-19 infection (54.7%). Most patients were aware of the protective measures taken by IVF clinics (80.2%), and this was a determinant factor (71.7%) for their decision to restart their fertility treatment.

Conclusion

The COVID-19 pandemic lockdowns had a significant emotional impact on patient receiving or undergoing ART treatment in Greece. This impact was more pronounced on cross-border patients. This highlights the need for continuation of ART care, with the appropriate protective measures, during the pandemic, as well as during similar times of crisis in the future.

Impact of COVID-19 on mental health of infertile couple: A rapid systematic review

Infertile couples experience a lot of psychological stress due to the inability to achieve the desired social role. Couples who decide to continue assisted reproductive therapy (ART) during the epidemic also experience the psychological impact of the COVID-19 epidemic, which affects their daily lives due to social isolation, quarantine, travel restrictions, and cancellation of treatment. Therefore, the purpose of this study was to assess the mental health of infertile couple pausing or delaying their treatment due to the COVID-19 pandemic. PubMed, Scopus, Cochrane, Embase, Web of Science, ScienceDirect, Google Scholar, Research Gate, and the World Health Organization databases and websites were systematically searched for original studies concerning abortion in the era of COVID-19 pandemic published by August 15, 2021. We used the following keywords: "COVID-19 Corona virus, infertility, reproductive technique, fertilization, assisted reproduction, pregnant termination, psychological, in vitro mental status, depressive symptoms, and anxiety." In sum, after automatically and manually search and excluding duplicates, 269 articles were found. In final, after screening, 18 articles were selected. Most patients experienced negative emotions during the COVID-19 epidemic. When reproductive services were re-established, participants showed higher levels of anxiety and lower quality of life than before quarantine. Women who thought pregnancy was more important than getting COVID-19 had higher levels of anxiety than women who thought otherwise (P < 0.05). The COVID-19 pandemic has negative impacts on the mental health and quality of life of patients seeking fertility services and coping with it requires timely and appropriate psychological intervention, accurate information, and social and organizational support.

Impact of COVID-19 pandemic on depression and hopelessness in infertile women

INTRODUCTION

COVID-19 has negative and sometimes irreversible effects on infertile women. This study aimed to investigate hopelessness and depression in infertile women whose treatment has been delayed due to COVID-19.

METHODS

This case-control study was conducted online on 172 infertile women. The case group included infertile women under treatment whose treatment was delayed during the COVID-19 pandemic, and the control group was selected from infertile women who were not under infertile treatment. This study was conducted between April and December 2021 in Jahrom, Iran. Beck hopelessness standard questionnaire (BHS) and Beck Depression Inventory (BDI) were used to collect data, and p < 0.05 was considered significant.

RESULTS

The mean score of hopelessness in women in the case group was 9.48 ± 1.80 compared to the control group 8.66 ± 1.34 (OR = 1.39 95% CI = 1.13-1.71), and its areas (OR = 1.33 95% CI = 1.003-2.43), Emotions and expectations score (OR = 1.59 95% CI = 1.07-2.37), Motivation loss score (OR = 2.02 95% CI = 1.49-2.73), Hope score, and depression in women in the case group was 40.33 ± 10.87to 36.72 ± 11.40 compared to the control (OR = 1.17 95% CI = 1.11-1.23). All these variables showed an increase in the case group compared to the control group (p < 0.05).

CONCLUSION

The results showed that infertile women whose treatment was delayed were more frustrated and depressed than women in the control group. COVID-19 epidemic and discontinuation of infertile treatments in infertile women seem to have negative psychological effects. Therefore, the psychological effects of this epidemic on infertile women should not be ignored, so planners should put social and family support at the top of the program.

Mental health and coping with fertility treatment cessation during the COVID-19 pandemic in the UK

PURPOSE

This study examined experiences during the cessation of fertility treatment due to the COVID-19 pandemic, including levels of mental health, coping strategies used to manage uncertainty about treatment due to the pandemic, sources of support, and predictors of mental health.

METHODS

One hundred and seventy-five participants in the UK completed an online survey.

RESULTS

Half of the participants experienced clinical levels of anxiety and/or depression, and 20% reported suicidal feelings as a result of the uncertainty about treatment due to the pandemic. Support from friends, family and online forums were reported by more than half of participants, but support from fertility clinics or counsellors were reported by less than one quarter. The strategy used most frequently to cope with the uncertainty about treatment due to the pandemic was self-distraction, and this predicted reduced depression. However, self-blame, behavioral disengagement and venting predicted increased depression and self-blame, behavioral disengagement, and denial predicted increased anxiety.

CONCLUSIONS

Fertility clinic communication and psychological support, such as counselling, which had substantially reduced during treatment cessation, could include some focus on personal coping, including what to avoid. Psychological support is likely to be more important now than ever. Despite resumption of treatment, the impacts of the period of cessation and of COVID-19 are likely to continue to reverberate.

I Had to Go in a Bubble: Investigating the Effects of COVID-19 on Fertility Treatments and Nutrition

Background:

Individuals modify their lifestyles including nutrition to improve fertility. The COVID-19 pandemic limited access to clinical offices or resulted in the closure of fertility clinics. The pandemic also impacted diet through reduced availability and lifestyle choices. This article's purpose was to understand the consequences of the COVID-19 pandemic on diet, lifestyle, and the course of fertility treatment.

Methods:

The research was conducted through qualitative data collected for a larger study regarding fertility and nutritional guidance. Thematic analysis from eight interviews was used to uncover major and subthemes among the transcripts.

Results:

The results showed two resulting main themes: disruption and distress on the fertility journey of these individuals, as well as the added stress of limited food access, which reduced their ability to continue their dietary choices.

Conclusions:

Our findings indicate substantial disruptions to food access and to individuals' fertility treatment during the first year of the COVID-19 pandemic. Recommendations from these findings suggest that consistent clinic policies can allow for increased support system integration. A further recommendation is the need for a multidisciplinary team to support the individuals going through fertility treatments, such as a registered dietitian to help meal plan around their diet protocol. A registered dietitian would be able to assist patients in making adjustments when faced with limited access to certain food resources as a result of the pandemic.

Impact of COVID-19 on fertility and assisted reproductive technology (ART): a systematic review

The appearance of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major obstacle for the performing of current medical activities throughout the world. COVID-19 has affected humanity in many ways, thus causing a great medical, social, economic, and political instability. The aim of this study was to make an analysis of the scientific data obtained by so far to highlight the impact that COVID-19 has had on fertility and assisted reproductive technology (ART). Infection with SARS-CoV-2 alters the normal immune response by local and systemic damage to tissues and organs. After the virus enters the body, the first lesions are produced in the respiratory tract. Extrapulmonary lesions specific to COVID-19 include acute renal lesions/acute kidney damage, hepatocellular lesions, neurological diseases, myocardial dysfunction and arrhythmia, gastrointestinal diseases but also genital impairment. The possible impairment of the male reproductive system is because angiotensin-converting enzyme 2 (ACE2) receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. Many published studies to date have pointed out that COVID-19 could also affect female fertility and disrupt the functions of the female reproductive system. The theory that this virus can also be transmitted sexually and can cause infertility or testicular damage is supported by the fact that the virus can be isolated in the semen of COVID-19 patients but only during the disease. Choosing the best method of treating infertility during the COVID-19 pandemic is multifactorial, but the risk of infection and compliance with specific ART hygiene protocols must always be considered. Currently, there is no scientific basis regarding the fact that the COVID-19 vaccination would influence fertility.

Psychological status of infertile patients who had in vitro fertilization treatment interrupted or postponed due to COVID-19 pandemic: a cross-sectional study

PURPOSE

To explore the psychological status of infertile women and men who had in-vitro fertilization (IVF) treatment interrupted or postponed because of the COVID-19 emergency.

MATERIALS AND METHODS

An electronic survey (NCT04395755) was e-mailed between April and June 2020 to couples whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. The presence and severity of symptoms suggestive of anxiety and/or depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with preexisting psychiatric disorders were excluded.

RESULTS

Overall, 524 out of 646 patients completed the survey. The prevalence of anxiety and/or depression feelings was significantly higher in women, mainly if aged more than 35 years and with a previous IVF attempt. The occurrence of these psychological symptoms was significantly associated with the time spent on COVID-19 related news per day and partner with evidence of psychological disorder and, in females, with a diagnosis of poor ovarian reserve, diagnosis of endometriosis or uterine fibroids.

CONCLUSIONS

The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment has been significant. IVF centers should systematically offer these couples adequate psychological counseling to improve mental health.

The impact of the COVID-19 pandemic on women seeking fertility treatment: the patient's perspective

PURPOSE

This study sought the views of women with impaired fertility on the impact of the COVID-19 pandemic on their fertility treatment and psychological wellbeing.

METHODS

A cross-sectional, anonymous, online questionnaire was completed in June-December 2020 by 249 women attending fertility clinics across Germany. All women seeking treatment in fertility clinics were eligible to participate. The online survey covered questions about the patient's quality of life, their opinions about the professional societies' recommendations and their effects as well as any concerns about infection with SARS-CoV-2.

RESULTS

Three-quarters of participants disagreed with the pausing of fertility treatments. Women who participated from October to December 2020, when the incidence rate was high, were as likely to disagree as participants that participated from June to September 2020 (73% vs 79%, p = 0.3). Seventy-two participants (29%) had their appointments cancelled. Nearly all (97%) reported being upset by this, with 40 (56%) reporting that they were extremely or very disappointed about the cancellation. Women who had to wait 10 weeks or longer were more likely to be upset by the postponement or cancellation of their appointment than women who had to wait a shorter amount of time (p = 0.01). Many participants (41%) were worried about possible negative effects a SARS-CoV-2 infection might have related to their fertility, pregnancy or unborn child.

CONCLUSION

Postponement of treatments increased distress among patients and should be avoided when possible. Fertility clinics must provide information about the current state of knowledge of SARS-CoV-2 infections in pregnancies and options for immunization.

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

Background

Health services are critically important for older adults, particularly during the Coronavirus disease-19 (COVID-19) pandemic. However, COVID-19 risks, worse financial situation, and lowered income may seriously impact health services by feasibility and accessibility. Therefore, the aim of the present study was empirically to explore how health-seeking behaviors are influenced by new health conditions through COVID-19 risks, worse financial situation, and lowered income.

Methods

Data were from ELSA COVID-19 waves 1 and 2 which included a sample of 6952 and 6710 older adults in the United Kingdom, respectively. The frequency distribution analyses were conducted by Chi-square analysis by gender groups. Zero-inflated Poisson regressions were used to examine how worse financial situation and lowered income were associated with COVID-19 risks and new health conditions. Logistic regressions were employed to examine the associations of COVID-19 risks, worse financial situation, and lowered income with treatment cancellation and accessible care. Cross-sectional mediation models, cross-sectional moderation models, longitudinal mediation models, and longitudinal moderation models were conducted based on Hayes model 6, Hayes model 29, Montoya model 1, and Montoya model 2, respectively.

Results

Most of the sample was >65 years old, females, located in urban place, and involved in long-standing condition. Regression analysis showed that COVID-19 risks, worse financial situation, and lowered income were associated with treatment cancellation and accessible care. In the longitudinal mediations, effect coefficients of ‘X’ → (treatment cancellation in wave 1 (Tcn1)- treatment cancellation in wave 2 (Tcn2))(β = −.0451, p < .0001, low limit confidence interval (LLCI) = −.0618, upper limit confidence interval (ULCI) = −.0284), ‘X’ → (COVID-19 risks in wave 1 (Csk1)- COVID-19 risks in wave 2 (Csk2)) (β = .0592, p < .0001, LLCI = .0361, ULCI = .0824), and ‘X’ → (lowered income in wave 1 (CIn1)- lowered income in wave 2 (CIn2)) (β = −.0351, p = .0001, LLCI = -.0523, ULCI = -.0179) were significant. Additionally, effect coefficients of ‘X’ → (accessible care in wave 1 (Acr1)- accessible care in wave 2 (Acr2)) (β = .3687, p < .0001, LLCI = .3350, ULCI = .4025),'X’ → (Csk1- Csk2) (β = .0676, p = .0005, LLCI = .0294, ULCI = .1058), and ‘X’ → (worse financial situation in wave 1- worse financial situation in wave 2) (β = −.0369, p = .0102, LLCI = -.0650, ULCI = -.0087) were significant.

Conclusions

There were longitudinal mediating effects of COVID-19 risks, worse financial situation, and lowered income on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care. These findings suggest that worse financial situation, lowered income, and COVID-19 risks exerted an influence on the relationship between new health conditions and treatment cancellation and relationship between new health conditions and accessible care among older adults. Findings suggest that longitudinal mediations may be important components of interventions aiming to meet service needs. Long-term health policy implications indicate the need for reducing COVID-19 risks, improving financial situation, and increasing income among the targeted population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02995-8.

The effect of semen collection at home on intrauterine insemination outcomes

BACKGROUND

The WHO 2010 guidelines recognize at-home semen collection as an acceptable alternative to standard collection at the clinic in "exceptional circumstances". There is lack of sufficient data to determine the need for revisiting these recommendations for treatment purposes.

OBJECTIVES

To determine whether at home semen collection has any effect on intrauterine insemination (IUI) cycle outcomes.

MATERIALS AND METHODS

This is a retrospective cohort study of 729 IUI treatment cycles (382 patients) performed at an academic fertility center from 9/19/2019 to 12/31/2020. Semen collected at the "clinic" was used for 343 cycles before the Coronavirus Disease 2019 (COVID-19) pandemic (09/19/2019-3/21/2020), and "at-home" collected specimens were used for 386 cycles following revised protocols with COVID-19 driven changes (5/30/2020-12/31/2020). Logistic regression models were performed to evaluate the effect of "at-home" semen collection on achieving a positive pregnancy test (PPT) and a clinical pregnancy (CP).

RESULTS

Male and female partners' age, ovarian reserve biomarkers, and stimulation regimens used were similar in the "clinic" and "at-home" groups. In unadjusted models, "at-home" collection had no significant effect on the odds for a PPT [OR (95%CI): 0.733(0.503-1.069)] or CP [0.816(0.543-1.226)]. These results persisted even when adjusting for maternal age and anti-Müllerian Hormone: PPT [0.739(0.505-1.081)] and CP [0.826(0.547-1.248)]. Of the semen analysis parameters under evaluation, only motility appeared to significantly impact the odds of achieving a PPT [1.014(1.004-1.025)] and a CP [1.017(1.006-1.029)]. This effect was slightly attenuated for samples collected "at-home" [1.012(0.997-1.027) and 1.015(0.999-1.031), respectively for PPT and CP].

DISCUSSION

This study adds important information to the limited literature regarding the effect of at-home semen collection on IUI outcomes. Under adequate protocols, at-home semen collection should be considered a safe alternative. Additional research is needed to optimize such protocols.

CONCLUSION

Our data suggest that at-home semen collection does not negatively impact IUI pregnancy outcomes. This article is protected by copyright. All rights reserved.

COVID-19 pandemic and the consequential effect on patients with endometriosis

STUDY QUESTION

What was the effect of the coronavirus disease 2019 (COVID-19) pandemic on healthcare and quality of life in those suffering from endometriosis?

SUMMARY ANSWER

Our study reveals a clear correlation between the deterioration of the reported physical and mental state and impaired medical care for patients suffering from endometriosis during the COVID-19 pandemic.

WHAT IS KNOWN ALREADY

The quality of life of patients suffering from endometriosis is compromised in a variety of aspects. In response to the ongoing COVID-19 pandemic, self-isolation practices aimed at curbing the spread of COVID-19 have severely complicated the availability of proper medical care worldwide.

STUDY DESIGN SIZE DURATION

The study involved a cross-sectional international self-reported online survey. Responses were accepted between November 2020 and January 2021. The survey was prepared by the Department of Obstetrics and Gynaecology in a medical university setting. The survey contained 17 questions and was placed online. Cooperation with different endometriosis organizations around the world enabled distribution of the survey through their social media platforms.

PARTICIPANTS/MATERIALS SETTING METHODS

The study participants (n = 3024 replies) originated from 59 countries. The questionnaire was created after a literature review and is partially based on the validated quality of life questionnaires, adjusted to the study question. The survey was then translated to 15 other languages following World Health Organization recommendations as closely as possible. Chi-square tests for independence were carried out for the analysis of the two variables: suspension of health services, and the patients mental and physical well-being.

MAIN RESULTS AND THE ROLE OF CHANCE

Out of 3024 participants from 59 countries who submitted the questionnaire between November 2020 and January 2021, 2964 (98.01%) provided information that enabled a full analysis. For the 1174 participants who had their medical appointments cancelled, 43.7% (n = 513) reported that their symptoms had been aggravated, and 49.3% (n = 579) reported that their mental state had worsened.In comparison, of the 1180 participants who kept their appointments, only 29.4% (n = 347) stated that their symptoms had been aggravated, and 27.5% (n = 325) stated their mental health had worsened. The results showed that there was a significant link between the reported deterioration of mental and physical wellbeing and impaired medical care (cancellation) (P ≪ 0.001). A total of 610 participants did not have medical appointments scheduled, and these participants followed a similar pattern as the participants who kept their appointments, with 29.0% (n = 177) reporting aggravation of symptoms and 28.2% (n = 172) reporting that their mental state had worsened.

LIMITATIONS REASONS FOR CAUTION

Cultural differences among international participants are to be expected and this may have affected how participants from different countries interpreted and answered the questionnaire. Translating the questionnaire into 15 different languages, even though incorporating backwards translation, could possibly lead to different interpretations of given questions, simply based on different wording in the languages. The majority of respondents (around 90%) were from Europe and South America and therefore the findings may not be generalizable to other locations.

WIDER IMPLICATIONS OF THE FINDINGS

Further research is needed to assess the true impact and long-term consequences of the COVID-19 pandemic for patients living with endometriosis.

STUDY FUNDING/COMPETING INTERESTS

This study received no funding and the authors declare they have no relevant conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Irish fertility patients' attitudes to pregnancy and risk mitigation strategies during the COVID-19 pandemic

The effects of COVID-19 on fertility services became evident in early 2020. Fertility treatments were initially suspended following advice from international fertility governing bodies. We performed a web-based study to investigate the attitudes of male and female fertility patients in Ireland, for risk mitigation strategies and pregnancy advice during the first wave of COVID-19. Despite international recommendations and uncertainty regarding COVID-19 and pregnancy, over two thirds of patients continued trying to conceive, while awaiting recommencement of fertility services. When services resumed, the majority were keen to continue fertility treatment. They were agreeable to telemedicine in place of face-to-face consultations. They felt that privacy was maintained and were comfortable signing consent forms via video link. Large numbers, however, strongly disagreed with the no-partner policy for embryo transfer and early pregnancy scanning, highlighting the importance of partner support. Patients felt strongly that fertility treatments should be classified as essential services and that every effort should be made to continue treatments in future pandemics. These results highlight the importance of maintaining fertility services, while adapting to new practices that may be required. The primary concern of the infertility population is the desire for pregnancy and parenthood. This innate human need trumps concerns regarding COVID-19 for the majority of those affected.

The new normal: a UK fertility clinic experience of universal RT-PCR SARS-CoV-2 testing

Following the temporary closure of fertility clinics in 2020 in many countries across the world, the SARS-CoV-2 pandemic has meant that the sector has had to rapidly adapt to novel ways of operating. The aim of this study was to investigate the efficacy and feasibility of universal real-time polymerase chain reaction testing at an IVF clinic within a UK tertiary referral centre. Between March and December 2020, we performed 2,401 SARS-CoV-2 RT-PCR tests on 1,215 individual patients, of which eight were positive (0.3%). Appropriate positive case identification allowed for delay in treatment initiation or cancellation as applicable. This has allowed our unit to continue to operate safely and efficiently.

Perceptions of the COVID-19 Pandemic among Women with Infertility: Correlations with Dispositional Optimism

People who are more optimistic may experience better psychological health during stressful times. The present study examined the perceptions and emotions surrounding the COVID-19 pandemic among American women who were experiencing fertility problems. We tested if dispositional optimism in these women was associated with less negative perceptions and emotions. We conducted a cross-sectional survey of patients from a single private infertility and reproductive clinic in an urban area in the Midwest, United States. Women, age 18 or older, primarily White and educated, who presented for an appointment to the clinic were invited to participate in an email-based survey. Respondents (N = 304) reported their perceived impact of the COVID-19 pandemic on fertility treatment, emotions associated with this impact, and perceived stress and depressive symptoms. They also completed measures of dispositional optimism and expectations for a future pregnancy. Findings indicated that women perceived an overall negative impact of the pandemic on their treatment plans, which was associated with more negative emotions, lower expectations of future pregnancy, and greater stress and depressive symptoms during the pandemic. However, further correlational analyses revealed that being higher in trait optimism was associated with perceiving a less negative impact of the pandemic, experiencing fewer negative emotions, and less overall stress and depressive symptoms. Although women with fertility problems have perceived the pandemic as negative and disruptive, those who are higher in optimism may be less affected.

Fertility-Related Quality of Life in Men Undergoing Medically Assisted Reproduction During the Pandemic: Perfectionism and Thought Control Beliefs Moderate the Effects of the Type of Treatment

OBJECTIVE

After a diagnosis of infertility, an increasing number of couples turns to the Medically Assisted Reproduction (MAR) to achieve a pregnancy. A diagnosis of infertility has a negative impact on the individual's well-being and it can increase the risk of anxious-depressive symptoms, stress, and low self-esteem. Data associated with infertility-related Quality of Life (QoL) are lacking in men. Little is known about men's experience of infertility and its treatments during the pandemic. Among the variables potentially associated with infertility-related QoL, the role of obsessive beliefs is neglected, although preliminary studies considered perfectionistic traits.

METHOD

One hundred and fifty-one participants were included. Eighty men (mean age: 40.83 years) were attending a MAR pathway. Of these, 50 men (67.5%) were undergoing homologous MAR and 30 men (37.5%) were undergoing heterologous MAR. A control group consisting of 71 subjects (mean age: 36.69 years), paired by age, marital status, and number of children, was drawn from the general population. The Obsessive Beliefs Questionnaire-46, the Depression Anxiety Stress Scales-20, and the Fertility Quality of Life Questionnaire were administered.

RESULTS

High levels of anxiety, depression and stress were moderately associated with lower infertility-related Quality of Life. For men undergoing homologous MAR, perfectionism beliefs represented a vulnerability factor for a lower fertility-related QoL, while for men undergoing heterologous MAR, high thought control beliefs represented a risk factor for a lower fertility-related QoL.

CONCLUSIONS

A focus on the obsessive beliefs should be included in the psychological treatment of infertile men, specifically perfectionism in homologous MAR and control of thoughts in heterologous MAR. Therefore, psychological assessment and support interventions should be personalized according to the MAR pathway and be focused on men's cognitive features in order to improve their QoL during the MAR pathway.

Impact of the COVID-19 Pandemic on Access to Fertility Care: A Retrospective Study at a University-Affiliated Fertility Practice

Objective

To elucidate the impact of the COVID-19 pandemic on access to fertility services.

Methods

A retrospective quality improvement study was conducted at a university-affiliated fertility practice in southwestern Ontario. Annual procedural volumes for intrauterine and donor inseminations (IUI/DI), in vitro fertilization and intracytoplasmic sperm injections (IVF/ICSI), and frozen embryo transfers (FET) during the COVID-19–affected year were compared with mean annual volumes from the 2 preceding years. In addition, volumes for the same procedures were compared between the first quarter of 2021 and mean first quarter volumes from 2018 to 2019. Piecewise linear regressions were conducted to evaluate whether any changes in monthly procedural volume were attributable to the COVID-19 pandemic.

Results

In 2020, our fertility practice attained the mean annual volumes of 89.7% for IUI/DI, 69.0% for IVF/ICSI, and 60.6% for FET. In contrast, in 2021, we performed mean first quarter volumes of 130.1% for IUI/DI, 164.3% for IVF/ICSI, and 126.8% for FET. The slopes of the pre- and post–COVID-19 segments of the piecewise linear regressions were significantly different for IUI/DI (P < 0.001) and IVF/ICSI (P = 0.001), but not for FET (P = 0.133).

Conclusion

The COVID-19 pandemic resulted in decreased annual volumes of medically assisted reproductive procedures at a university-affiliated fertility practice in southwestern Ontario. Impact on monthly procedural volume was confirmed for IUI/DI and IVF/ICSI by linear regression. Local adaptations helped compensate and exceed expected volumes in 2021. As a result, the COVID-19 pandemic resulted in a short-lived limitation in access to fertility care.

Intolerance of uncertainty and distress in women with delayed IVF treatment due to the COVID-19 pandemic: The mediating role of situation appraisal and coping strategies

The COVID-19 pandemic has caused delays of numerous medical procedures, including IVF. This study investigates the relationship between Intolerance of Uncertainty (IU), situation appraisal-the perceived threat that COVID-19 poses for infertility treatment, coping strategies, and general distress among women with a delayed IVF procedure. SEM showed that situation appraisal is a partial mediator of the relationship between IU and avoidance, as well as the relationship between IU and general distress. The connection between situation appraisal and general distress is partially mediated by avoidance. In this challenging context for mental health, situation appraisal and coping strategies determine the level of distress, where IU, as a dispositional variable, represents the main determinant of the entire reaction.

COVID-19 Pandemic Impacts Decision-Making and Psychosocial Behavior in Women Seeking Fertility Treatment in APAC—an ASPIRE Patient Experience Report

Background: ASPIRE (Asia-Pacific Initiative on Reproduction) aims to develop a “patient-centered” guide to provide fertility treatment based on patient preferences, needs, and concerns during and beyond the SARS-Cov-2 pandemic.

Methods: Women, aged 20–45 years old, trying to conceive for more than 6 months and contemplating for pregnancy including IVF treatment. A country wise analysis of patient behavior, attitudes and concerns, reasons for disruption of treatment and availability of assistance from fertility clinics during SARS-Cov-2 pandemic was performed. Six problem statements addressing patient concerns were identified and corresponding solutions to improve patient experience were formulated. A two-tier recommendation was developed. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” together was >60%.

Results: Women in countries that have better infection control and are living a new normal were less worried about the pandemic influencing their lifestyle and finances. The proportion of women choosing not to continue IVF/IUI treatment during COVID-19 was similar across countries. Sixty-five percent of women in Group A intend to continue treatment during COVID-19 pandemic. Nine out of 10 patients are expected to resume or start treatment once fertility clinics are accessible. A patient-centered guide focusing on management of patient safety concerns, reduction in difficulty of access to hospitals, prioritization of patients, provision of emotional support, and improvement in patient education and acceptance of remote health services was developed.

Conclusion: This ASPIRE patient experience report highlights a patient-centered guide on provision of safe fertility treatment across the Asia-Pacific region, which can be adapted to suit country-specific requirements depending on the stage of the pandemic, local restrictions, and availability of resources.

Investigating the impact of asymptomatic or mild SARS-CoV-2 infection on female fertility and in vitro fertilization outcomes: A retrospective cohort study

Background: The current study aimed to investigate the impact of asymptomatic or mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on female fertility and laboratory and clinical outcomes in assisted reproductive technology (ART) treatments. Methods: Patients undergoing ART treatments in the Reproductive Medicine Center, Tongji Hospital, Wuhan, from May 2020 to February 2021 were enrolled. Seventy of them were positive for serum SARS-CoV-2 antibodies (IgG and/or IgM), and 3973 patients had negative results. Propensity score matching with a ratio of 1:3 was performed, and there were 65 females in the case group and 195 females in the control group. Findings: The ovarian reserves and ovarian responses between groups after matching were similar. The proportions of mature oocytes, damaged oocytes, fertilized oocytes, cleavage embryos, high-quality embryos, and available blastocysts were also similar, despite a slight decrease in the blastocyst formation rate in the case group. In addition, there were no significant differences in terms of the biochemical pregnancy rate, clinical pregnancy rate, early miscarriage rate, or implantation rate. Interpretation: There is no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females may negatively affect female fertility, embryo laboratory outcomes, or clinical outcomes in ART treatments.

Impact of the COVID-19 Pandemic on the Lifestyles and Quality of Life of Women With Fertility Problems: A Cross-Sectional Study

Background: The COVID-19 pandemic has implied worldwide the imposition of confinement measures and mobility restrictions, to a greater or lesser extent. It has also meant the closure of some public medical services such as reproductive care. This situation may have impacted the health-related behaviour and quality of life of women with fertility problems. Objective: The objective of this study was to analyse the effects of confinement and the suspension of reproductive medical care on the lifestyle (diet, physical exercise, and smoking habits), anxiety and depression, and quality of life of infertile women by comparing their pre- and post-confinement situations. Methods: We carried out a cross-sectional, internet-based study. Information was collected on these women's adherence to the Mediterranean diet (MEDAS questionnaire), physical exercise (IPAQ-SF), anxiety and depression (HADS), and quality of life related to fertility (FertiQol) before, during, and after confinement. The survey was conducted between 1 September and 28 October 2020. Results: A total of 85 women participated. There had been a significant increase in anxiety and depression levels (P < 0.001) and an increase in tobacco consumption among female smokers during confinement vs. pre-confinement (62.5% had increased their consumption). The participants had also increased the mean number of hours they spent sitting (P < 0.001). There had also been an increase in vigorous and moderate exercise levels by 40 and 30%, respectively (P = 0.004). However, no differences were observed in these patients' eating habits as a result of confinement (P = 0.416). When the reproduction service was resumed, the participants showed higher anxiety level scores (P = 0.001) with respect to the pre-confinement situation as well as lower mean FertiQol scale score (P = 0.008). Conclusions: Confinement had increased anxiety and depression levels among these infertile women as well as tobacco use among the participants who were smokers. The prolonged closure of reproductive care units decreased the quality of life of the participants of this study. These results suggest the need to implement online programs to improve healthy habits and quality of life of this population group.

The psychological impact of the COVID-19 pandemic on fertility care: a qualitative systematic review

The objective of this systematic review was to characterise psychological impacts of the COVID-19 pandemic related to fertility care. We conducted a systematic search following PRISMA guidelines of five databases (EMBASE, Medline-OVID, CINAHL, Web of Science, and PsycINFO) from March 17^th 2020 to April 10^th 2021. Citing articles were also hand-searched using Scopus. Of the 296 original citations, we included fifteen studies that encompassed 5,851 patients seeking fertility care. Eleven studies only included female participants, while four included both male and female participants. The fifteen studies unanimously concluded that the COVID-19 pandemic caused negative psychological impacts on fertility care. Risk factors included female sex, single marital state, previous ART failure, prior diagnoses of anxiety or depression, and length of time trying to conceive. Specific concerns included the worry and frustration of clinic closure, concerns about pregnancy and COVID-19 infection, and advancing age. There were contrasting beliefs on whether the decision to stop fertility treatments during the COVID-19 pandemic was justified. In addition, we found that many patients preferred to resume fertility treatment, despite anxieties regarding the risk of the COVID-19 virus. We recommend that fertility providers screen patients for risk factors for poor mental health and tailor support for virtual care.

The emotional impact of the Covid-19 pandemic in women facing infertility

People facing infertility are inevitably affected by COVID-19 pandemic, having to delay their parental projects. This study aimed to explore the emotional impact (depression and anxiety symptoms and perceived stress) of the COVID-19 pandemic in Portuguese women pursuing assisted reproductive technology (ART). Results showed 67.4% of participants were in confinement but were dealing with it in a reasonably positive way. Women who continued to work at their workplace presented significantly higher levels of depressive and anxiety symptoms than those who stayed at home. No significant differences were found regarding depression and anxiety symptoms scores when comparing the current sample with an infertility reference sample and a community sample. Depressive and anxiety symptoms remained stable, but there was a significant decrease in perceived stress over the eight-week period. Although these findings do not suggest a worsening of psychological difficulties due to the COVID-19 pandemic, health professionals should be attentive to patients' long-term psychological consequences. It may be helpful to provide additional psychological support to women when restarting their ART treatments.

Life on pause: An analysis of UK fertility patients’ coping mechanisms after the cancellation of fertility treatment due to COVID-19

In March 2020, fertility clinics across the UK began cancelling all assisted reproductive technology (ART) treatment, with the Human Fertilisation and Embryology Authority (HFEA) stopping all ART treatment from going ahead beyond the 15th April 2020 due to the COVID-19 pandemic. This article examines the coping mechanisms adopted by fertility patients during this time, focussing on the emotional support received from online fertility forums and fertility clinics during the indeterminate wait for treatment to resume. The study draws upon an online survey which assessed the mental health and wellbeing of 124 female fertility patients whose ART treatment was cancelled due to the Coronavirus pandemic. The findings indicate a potential for improved communication between fertility clinics and patients in order to reduce psychological stress and isolation during the postponement of ART treatment, alongside better utilisation of online platforms as mechanisms for support. This article adds to the growing body of knowledge concerned with the implications of denying reproductive rights to the infertility community during a global pandemic. It also contributes to sociological discussions on the support mechanisms available to those navigating infertility and the wider social management of uncertainty.

Psychological experience and coping strategies of patients in the Northeast US delaying care for infertility during the COVID-19 pandemic

BACKGROUND

On March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness.

METHODS

Cross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore's Institute for Reproductive Medicine and Health in NY). Data from multiple choice and open response questions collected demographic, reproductive history, experience and attitudes about Covid-19, prior infertility treatment, sense of hopefulness and stress, coping strategies for mitigating stress and two validated psychological surveys to assess anxiety (six-item short-form State Trait Anxiety Inventory (STAl-6)) and resilience (10-item Connor-Davidson Resilience Scale, (CD-RISC-10).

RESULTS

Seven hundred thirty-four patients were sent invitations to participate. Two hundred fourteen of 734 (29.2%) completed the survey. Patients reported their fertility journey had been delayed a mean of 10 weeks while 60% had been actively trying to conceive > 1.5 years. The top 5 ranked coping skills from a choice of 19 were establishing a daily routine, going outside regularly, exercising, maintaining social connection via phone, social media or Zoom and continuing to work. Having a history of anxiety (p < 0.0001) and having received oral medication as prior infertility treatment (p < 0.0001) were associated with lower resilience. Increased hopefulness about having a child at the time of completing the survey (p < 0.0001) and higher resilience scores (p < 0.0001) were associated with decreased anxiety. Higher reported stress scores (p < 0.0001) were associated with increased anxiety. Multiple multivariate regression showed being non-Hispanic black (p = 0.035) to be predictive of more resilience while variables predictive of less resilience were being a full-time homemaker (p = 0.03), having received oral medication as prior infertility treatment (p = 0.003) and having higher scores on the STAI-6 (< 0.0001).

CONCLUSIONS

Prior to and in anticipation of further pauses in treatment the clinical staff should consider pretreatment screening for psychological distress and provide referral sources. In addition, utilization of a patient centered approach to care should be employed.

Psychological distress and postponed fertility care during the COVID-19 pandemic

Purpose

To evaluate perceptions of delayed fertility care secondary to the COVID-19 pandemic.

Methods

This was a cross-sectional anonymous survey of N = 787/2,287 patients (response rate = 42.6%) from a single academic fertility center. Participants were randomized 1:1 to receive supplemental educational explaining the rationale behind recommendations to delay fertility treatments due to the COVID-19 pandemic. Assessment of well-being was conducted via the Personal Health Questionnaire Depression Scale, the Generalized Anxiety Disorder-7, the Ways of Coping-Revised, the Appraisal of Life Events Scale, and influence of supplemental education on agreement with ASRM COVID-19 Taskforce recommendations and associated distress.

Results

Participants in the education v. no education groups were 35.51 (SD = 4.06) and 37.24 (SD = 5.34) years old, married (90.8% v. 89.8%), had a graduate degree (53.9% v. 55.4%), > 1 year of infertility (73.4% v. 74.4%), and were nulliparous (69.0% v. 72.6%), with moderate to high distress (64.9% v. 64.2%) (ns). Distress was related to age, duration of infertility, and engagement in social support seeking and avoidant coping strategies (P < 0.001). Agreement with recommendations was related to receipt of supplemental education, history of pregnancy loss, and use of cognitive coping (P = 0.001).

Conclusion

Most participants were distressed by the delay of treatments. Supplemental education increased acceptance of recommendations but did not decrease distress. Future treatment delays should include education related to and assessment of understanding of recommendations, and inclusion of mental health professionals in patient care.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10815-020-02023-x.

Infertility Management Disruption During the COVID-19 Outbreak in a Middle-Income Country: Patients' Choices, Attitudes, and Concerns

PURPOSE

This study aims to assess the degree of infertility management service disruption during the pandemic from the patient's point of view, as well as patients' attitudes toward seeking investigations and management, and their thoughts on how appropriate it is for health establishments to continue offering these services during this period while assessing their concerns regarding the risk of COVID-19 infection during treatment or pregnancy.

METHODS

This study involved a cross-sectional survey of 213 women who were seeking infertility management in January 2021 in Jordan. An electronic questionnaire was designed and validated, which was then distributed on social media platforms.

RESULTS

Over half of the participants had experienced some form of voluntary or involuntary disruption of their infertility management journey. The decision to postpone treatment was significantly associated with fear of infection (p = 0.009) and was more likely if they had undergone two or more previous cycles of in vitro fertilization treatment (p = 0.004). The majority of participants agreed that infertility services should remain available during the pandemic for those who chose not to delay their treatment journey, as the delay may have negative financial and psychological implications and may affect the chance to achieve a successful pregnancy in the future.

CONCLUSION

The patients have faced uncertainty regarding the achievability of their long-term fertility goals amidst an atmosphere of general unpredictability for the duration and extent of disruption of their treatment, combined with the fear of infection. Therefore, it is necessary to highlight the need to address how infertility services can be maintained for those who decide to seek treatment during an outbreak while minimizing the risk of contracting COVID-19 in the process.

Anxiety Level During the Second Localized COVID-19 Pandemic Among Quarantined Infertile Women: A Cross-Sectional Survey in China

Infertility usually causes mental health problems for patients and unfavorable emotions such as anxiety and depression can have an adverse effect on women's normal pregnancy. We aimed to compare the anxiety level between infertile female patients in quarantined and non-quarantined areas during the second wave of COVID-19 epidemic. A total of 759 infertile women were included in this cross-sectional study conducted through an online survey. Anxiety was measured by the State-Trait Anxiety Inventory (STAI) tool. Participants were divided into the quarantined group (QG) and non-quarantined group (Non-QG). Independent sample T-test and chi-square test were performed to examine the difference between the two groups. There was no significant difference in the average STAI score of the two groups of infertile women, but responses to the emotional state showed that women in the QG had a higher tendency to be anxious. Participants in QG spent more time paying attention to the dynamics of the epidemic every day, and their sleep (p < 0.01) and mood conditions were worse (p < 0.01) than in the Non-QG. The family relationship of QG is more tense than non-QG. Through the research on the infertility treatment information of the overall research population, it is found the average STAI-State (STAI-S) (p = 0.031) score and STAI-Trait (STAI-T) (p = 0.005) score of women who were infertile for more than 3 years were significantly higher than those of women with <2 years. The STAI-T score of infertile women who underwent in vitro fertilization (IVF) was higher than that of non-IVF women (p = 0.007), but no significant difference was observed with the STAI-S score. To conclude, although the second wave of quarantine during COVID-19 epidemic did not significantly increase anxiety in infertile women, it did lead to an increase in other negative emotions and worse family relationships. Patients with long-term infertility treatment and those who have had IVF are more anxious subgroups.

Emotional Impact of Delay in Fertility Treatment due to COVID-19 Pandemic

Background:

COVID-19 pandemic is an unprecedented public health emergency. When the pandemic started in our country fertility treatment was suspended for sometimes following national and international guidelines. This has led to delay in fertility treatment for some couples which was emotionally upsetting.

Methodology and Design:

This study was done on the patients enrolled at our various fertility units across India. The survey questionnaire was sent to patients during the month of first May to June 15, 2020, when COVID-19 pandemic was active across the country, and fertility units were just resuming the services back. The questionnaire was distributed to 100 patients who were currently under treatment and their response was recorded. Ethical committee approval was not taken as surveys are exempted from IRB.

Results:

This survey was undertaken to understand the emotional impact of delay/cancelation in the fertility treatment during the COVID-19 pandemic. The survey revealed that majority (95%) of couples felt cancelation of cycles as upsetting and 16% reporting it to be extremely upsetting. The impact was seen in the form of mood disturbances, anxiety, sleep disturbances, and depressive ideas. Almost half of the couples (49.4%) were desirous to start the fertility treatment immediately. Their knowledge regarding COVID-19 and pregnancy and future child was limited.

Conclusion:

COVID-19 has had impact on every sphere of life. Delay in treatment and cancelation of cycles were emotionally upsetting to majority of couples and they were keen to restart the treatment sooner than later.