key: cord-0847543-2vqoy4c7
authors: Vaughan, Denis A.; Shah, JaiminS.; Penzias, AlanS.; Domar, AliceD.; Toth, ThomasL.
title: Infertility remains a top stressor despite the COVID-19 pandemic
date: 2020-06-05
journal: Reprod Biomed Online
DOI: 10.1016/j.rbmo.2020.05.015
sha: 9a9a3cf03527bf008684a59e408a2bf48d9b370d
doc_id: 847543
cord_uid: 2vqoy4c7

Research Question: What is the psychological impact of the COVID-19 pandemic on infertility patients? Design: An anonymous cross-sectional online survey was sent to patients who attended a large university-affiliated infertility practice, in the United States, between January 1(st) 2019 and April 1(st) 2020. Respondents were asked to note their top three stressors, from a list of ten commonly reported life stressors at three different time points. Results: The questionnaire was sent to 10,481 patients with 3,604 responses (response rate 34%) received. We included 2,202 non-pregnant, female respondents in the final analysis. One third of respondents had a prior diagnosis of an anxiety disorder and 11% reported taking anxiolytic medications; over one quarter had a prior diagnosis of a depressive disorder and 11% reported taking anti-depressant medications. At all three time points, infertility was noted to be the most frequent top stressor. Coronavirus was noted to be the third most common stressor amongst the respondents in early March but, currently, is similar to that of infertility (63% and 66% respectively). 6% of patients stated that infertility treatment, including IVF, should not be offered during the COVID-19 pandemic. Conclusion: Despite the unprecedented global pandemic of COVID-19, causing economic and societal uncertainty, the stress of infertility remains significant and is comparable a stressor to the pandemic itself.

Infertility treatment in the United States and Europe abruptly stopped in mid-March 2020 due to the COVID-19 pandemic upon the recommendations of the American Society for Reproductive Medicine and European Society of Human Reproduction and Embryology 1,2 .

Infertile women experience high levels of distress: in a recent study of women undergoing infertility treatment, 56% scored in the clinical range for depression and 76% for anxiety 3 . Approximately 13% of infertile women report taking anti-depressant medications 4 . We sought to assess the psychological impact of the COVID-19 pandemic on infertility patients.

An anonymous 26 item online questionnaire was sent to patients who attended a large universityaffiliated infertility practice in New England, United States, between January 1 st 2019 and April 1 st 2020. The study was approved by the Institutional Review Board at Beth Israel Deaconess Medical Center.

The questionnaire was sent to 10,481 patients on April 9 th , 2020: 3,604 responses (response rate 34%) were received from April 9 th -16 th . Respondents were asked to note their top three stressors, from a list of ten commonly reported life stressors that included: their job, family, infertility, money, health, friends, partner, the coronavirus, insurance status, and "other"-in which case the respondents could specify another stressor. In our final analysis we excluded patients who reported being pregnant/postpartum and therefore not currently pursuing infertility treatment, as well a small number of male respondents.

We included 2,202 non-pregnant, female respondents in the final analysis. Table 1 outlines respondent characteristics. The majority of respondents were white, married, completed college and were employed. Almost one third of respondents worked in healthcare. Two thirds of respondents were awaiting infertility treatment. One third of respondents had a prior diagnosis of an anxiety disorder and 11% reported taking anxiolytic medications; over one quarter had a prior diagnosis of a depressive disorder and 11% reported taking anti-depressant medications. The mean anxiety and depression scores reported were 3.8 and 3.1, respectively (7-point Likert scale).

Respondents were asked to note their top three stressors: in January 2020, (before the COVID-19 pandemic), in early March (at the beginning) and currently (in the midst of the pandemic). For example, a total of 81% of respondents cited infertility as one of their top three stressors in January, 65% and 43% reported their job and money as one of their top three stressors respectively at that time point (Table  1) . At all three time points, infertility was noted to be the most frequently reported top stressor. Coronavirus was noted to be the third most common stressor amongst the respondents in early March but, currently, is similar to that of infertility (63% and 66% respectively). Only 6% of patients stated that infertility treatment, including IVF, should not be offered during the COVID-19 pandemic.

Infertility is a significant public health issue in the United States with 7.3 million (12%) women aged 15-44 reporting the use of infertility services 5 . Even in the midst of the COVID-19 pandemic, a minority of respondents stated that infertility treatments should not be offered at this time. While mathematical models predicting the epidemiology of the COVID-19 pandemic are not without pitfalls, it is likely that the pandemic will be disruptive to the health system for some time 6 . This delay in treatment will only compound the stress of the infertile population.

Limitations of this study include its response rate. Despite a large number of respondents, it is possible that this is not a representative sample which we are unable to verify owing to the anonymous nature of the survey. In addition, the survey was distributed in the New England area of the United States and the responses may not be generalizable.

Despite the unprecedented global pandemic of COVID-19, causing economic and societal uncertainty, the stress of infertility remains significant and is comparable a stressor to the pandemic itself. 

Patient Management and Clinical Recommendations During The Coronavirus (COVID-19)

Assisted Reproduction and COVID-19, an updated statement from ESHRE

Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services?

Infertility-related stress and the risk of antidepressants prescription in women: a 10-year register study

Infertility service use in the United States: data from the National Survey of Family Growth

Predictive Mathematical Models of the COVID-19 Pandemic: Underlying Principles and Value of Projections

He graduated with honours from the Royal College of Surgeons in Ireland in 2009. His research interests include sperm biology and perinatal outcomes in ART