key: cord-0871146-v59ec1rq
authors: Bergin, Keri; Levin, Isabelle Kate; Duvall, Daniel W.; Penzias, Alan S.; Sakkas, Denny; Vaughan, Denis A.
title: COVID-19 VACCINATION AMONGST INFERTILITY STAFF: HOW CAN WE DO BETTER?
date: 2021-09-30
journal: Fertility and Sterility
DOI: 10.1016/j.fertnstert.2021.07.792
sha: 967af388e6003cfd3cb3034d9026492733b6fcfe
doc_id: 871146
cord_uid: v59ec1rq

nan

that even with easy access to information, women are still unclear about the importance of medical guidance regarding the use of contraceptives. Finally, we observe a change in the behavior of women who take contraceptives in their relationship of trust with the doctor, demonstrating that social media have a fundamental role for patients today.

IMPACT STATEMENT: This study can contribute to better understand the behavior of patients and, with that, generate new strategies for conduct that establish a greater connection with the patient.

SUPPORT: This study was financed in part by the NeoVita Clinics OBJECTIVE: To prospectively evaluate the dynamics of pregnancy intention and incidence of pregnancy among professional women.

MATERIALS AND METHODS: We followed 11,276 pre-menopausal non-pregnant women aged 19-45 years participating in the Nurses' Health Study 3 (2010-2021). Pregnancy intention and pregnancy status were assessed at baseline and every 3 months thereafter. Women who became pregnant during follow-up were asked to report their pregnancy intention at the time they conceived in a follow-up questionnaire administered at gestation week 20-25.

RESULTS: At baseline, 898 (8%) women self-reported they were actively trying to conceive, 1285 (11%) self-reported they were not actively trying to conceive but thought they would be pregnant within 1 year, and the remaining 9093 (81%) self-reported they were neither trying to conceive nor thought they would be pregnant within 1 year. Women actively trying to conceive were more likely to be married or in a domestic partnership, nulliparous, and to have a higher educational achievement than women in the other two groups. We documented 870 self-reported pregnancies within 12 months of pregnancy intention assessment. The crude rates of pregnancy were 45%, 28%, and 1% for women in the three pregnancy intention groups, respectively. About 1 in 7 women changed their intention status during follow up. Among women reporting at baseline being actively trying to conceive who did not become pregnant during follow-up, 27% subsequently reported that they were neither trying nor thought they would become pregnant soon. The corresponding figure for women reporting at baseline they thought they might become pregnant soon was 33%. Conversely, among women reporting at baseline that they were neither trying nor thought they would become pregnant soon, 9% reported that they were either actively trying to conceive or thought they would become pregnant soon. Among women who became pregnant during follow-up, 79% reported that they were actively trying to get pregnant when they conceived, including 50% of women who at baseline reported they were not trying to conceive.

CONCLUSIONS: Pregnancy intention is highly fluid among nurses and nursing students of reproductive age. Unsurprisingly, pregnancy intention is strongly associated with incidence of pregnancy.

IMPACT STATEMENT: Our findings suggest that pregnancy intention is highly fluid, and current approaches to assess this construct may not fully capture this fluidity. OBJECTIVE: There has been significant uncertainty surrounding the COVID-19 pandemic and its effect on human reproduction which resulted in a temporary suspension of ART treatments in early stages of the pandemic. The ACE2 receptor used by the virus to infect pulmonary cells is also found in reproductive organs and has fueled speculation as to whether the disease can be sexually transmitted and whether it can cause infertility. Non-viral issues (e.g., pandemic related psychological stress, alternate methods of communication and interaction, and new clinic procedures) may also worsen outcomes. We sought to determine whether clinical outcomes following the frozen embryo transfer (FET) of a euploid embryo were different during the COVID-19 pandemic in 2020 when compared to prior to the pandemic in 2019.

MATERIALS AND METHODS: Patients who tested negative for COVID-19 and underwent FET of a single euploid embryo at NYU Fertility Center in NYC over January 2020 through September 2020 were separated by treatment month and compared with patients from the corresponding month in 2019. Patient's age at cycle start and age at freeze were compared using Student's T-Test. Potential cycle outcomes included intrauterine pregnancy (IUG), biochemical pregnancy (Biochem), and no pregnancy, and outcomes were compared between the two years using contingency Chi Square.

RESULTS: 1,044 patients were compared over the corresponding months. 558 transfers from 2019 and 486 patients from 2020, with no patients in April of 2020. There were no differences noted in patient's age at cycle start, or age at cryopreservation, between any of the months across the two years. Analysis of outcomes following FET further revealed no statistically significant differences between any of the months over the two years, X 2 ¼ 14.64, p > 0.05. Post hoc analyses comparing the combined months of March, April and May, or the combined 9-month periods, were also not statistically significant (X 2 ¼ 0.042, p > 0.05; X 2 ¼ 1.68, p > 0.05; respectively). OBJECTIVE: To examine COVID-19 infection rates, vaccination rates, and attitudes towards the COVID-19 vaccine amongst the staff at a large, university-affiliated center with sites in six different states.

MATERIALS AND METHODS: An 18-question email questionnaire was distributed to all employees at Boston IVF between April 6 -April 13 th , 2021. Surveys were sent to staff in Massachusetts, Indiana, Maine, New Hampshire, New York and Rhode Island. The primary outcome was vaccination rate. Secondary outcomes included rates of COVID-19 infection. Results were stratified by age, gender, and geographical location. Reasons behind vaccination reluctance were explored. RESULTS: A total of 515 surveys were sent out; 340 employees initiated the survey and 243 completed the survey (response rate 47%). Among the 243 completed surveys, 20 (8.2%) reported a history of ) employees received the COVID-19 vaccine. The age group with the best vaccination rate was the > 65 group (13/13; 100%). The majority of vaccinated staff members belonged to the 25 -54 age group (153/205; 74.6%). However, the majority of unvaccinated individuals also fell into the 25-54 age group (35/38; 92.1%). White/Caucasian staff represented the highest number of vaccinated staff members (163/205; 79.5%) as well as the highest vaccination rate (171/194; 88%) while Haitian/Caribbean/African American staff had the lowest (7/12; 58.3%). Staff members whose highest level of education was a graduate degree had the highest vaccination rates (47/49; 95.9%) while staff with a high school diploma or trade school/associate degree had the lowest vaccination rates (61/85; 71.8%). There was a 100% vaccination rate among physicians, the endocrinology team, human resources, IT department, and research team. The phlebotomy team had the lowest vaccination rate, 50%. For those who did not receive the COVID-19 vaccine, the majority of staff members sighted ''concerns that production was rushed'' (19/74; 25.7%); concerns about the vaccine's side effects and effectiveness were sighted as the 2 nd and 3 rd most popular reasons respectively (13/74; 17.6% and 12/74; 16.2%).

CONCLUSIONS: Overall vaccination rates among staff members of Boston IVF are high compared to the national average, however, there is geographical and racial variability. In addition, those with lower formal education are less likely to receive the vaccine. Continued efforts should be made to educate and encourage the COVID-19 vaccine amongst staff at infertility clinics.

IMPACT STATEMENT: The COVID-19 pandemic has dramatically changed the health care system and medical field in a short time. It is particularly important to understand vaccination rates among health care workers and identify any barriers there to becoming vaccinated. OBJECTIVE: The strain on the healthcare system and attempts to limit virus transmission during the COVID-19 pandemic reduced patients' access to healthcare services, particularly those seeking specialized or elective health services such as infertility treatment. Mandatory fertility clinic closures prolonged conception efforts and further complicated the already arduous family building journey. This study investigates the incidence of assisted reproductive technology (ART) delay or abandonment during the COVID-19 pandemic and assesses whether these rates varied by U.S. geographic region.

MATERIALS AND METHODS: A survey was administered to users of Ovia Health's Fertility mobile application in the United States from March 2020 to April 2021. A Chi-squared test was performed to assess differences in ART delay or cancellation and geographical region. A p-value of < 0.05 was considered statistically significant.

RESULTS: A total of 20,047 respondents qualified for inclusion in this analysis. Of the 16,527 respondents currently or formerly trying to conceive within the last six months, 16% reported utilizing intrauterine insemination (IUI), in vitro fertilization (IVF), or another form of ART. Though the majority of treatments proceeded as planned, almost one in five (17%) were delayed or cancelled between March 2020 and April 2021. Main contributors to the decision to delay or cancel ART efforts were temporary fertility clinic closures (28%), concern about the impact of COVID-19 on pregnant people or fetuses (28%), attempting to avoid healthcare facilities (22%), lack of availability of support people during pregnancy and labor (17%), and concerns about finances or job security (16%). ART delay or cancellation did not differ by geographic region (p > 0.05).

CONCLUSIONS: Our results demonstrate how the closure of fertility clinics during the COVID-19 pandemic and concern about COVID-19's detrimental impact during pregnancy pushed people seeking these services to delay indefinitely or altogether abandon their family building efforts. These trends were similar across the United States, regardless of geographical region. As ART treatments and care plans resume, reproductive medicine specialists should reinforce safety mitigation strategies to reduce the risk of COVID-19 transmission, foster COVID-19 vaccination discussions, and empower and restore patients' confidence with the latest COVID-19 research findings.

IMPACT STATEMENT: Clinical service models resuming ART services should center around addressing patients' main concerns for delaying or abandoning ART efforts, especially focused on empowering patients whose family building journeys were interrupted by fertility center closures during the COVID-19 pandemic. SUPPORT: None.

P-448 6:30 AM Wednesday

RATES OF COVID-19 INFECTION IN A FERTILITY TREATMENT POPULATION. Leah M

at a University-affiliated IVF center was performed. Testing was performed on medication start date, and regularly throughout the treatment cycles, approximately once a week. Social distancing, mask use, and temperature and symptomatic screening was implemented early in the process. Rates of infection were calculated by dividing COVID-19 positive patients (whether symptomatic or asymptomatic) by total number of patients in care. This was then multiplied by 100,000, in order to compare our rates to the rate of cases in the state. Information on the general population's COVID-19 positivity rate was obtained from the State Department of Health

Rates of infection in the general population ranged from 167 per 100,000 to a high of 1367 in Nov of 2020. Our rates of infection did see a trend that was consistent with the curve of infections seen in the general population in the state (Table 1). Year Month Clinic COVID-19 rate per

State COVID-19 rate per

where we suspect that patients undergoing treatment were more likely than the general population to receive testing due to the center's testing policies compared to the lack of tests for the general population. Indeed, throughout the studied period, the patients receiving fertility treatment were much more likely than the general population to receive a test, as they were undergoing testing while asymptomatic. Additionally, the rate in February of 2021 was higher than that of the general population. IMPACT STATEMENT: The Covid-19 pandemic was unprecedented in the history of gynecologic endocrinology and infertility, and impacted the ability of patients to access fertility care worldwide. Our findings reveal that with proper mitigation techniques