Research question: What are the patients' views and emotional reactions towards fertility treatment suspension during the COVID-19 pandemic as well as the factors affecting their psychological distress? Design: A cross-sectional study conducted in an academic fertility center. Online questionnaires were distributed between April 18 th to April 23 rd 2020 to patients whose treatment cycle had been postponed or discontinued. The outcome measures included (a) Agreement with the reproductive society guidelines to postpone treatments (b) Willingness to resume treatments, given the choice (c) Patients' emotional reactions (d) Psychological distress level, measured by the Mental Health Inventory validated scale. A multivariate linear regression was conducted to identify factors associated with psychological distress.Results: Due to the small number of male respondents, only female patients were included in the analysis (N=181). 43% expressed disagreement with the guidelines and 82% were willing to resume treatments, given the choice. Sadness and anxiety were the most common emotional reactions expressed towards the guidelines. In the multivariate analysis, COVID-19 related anxiety and disagreement with treatment suspension were found to be significantly associated with patients' psychological distress. Patients' background characteristics did not contribute significantly to their distress.Conclusions: Fertility treatment suspension during the initial phase of the COVID-19 pandemic was associated with patients' negative emotional reactions. Anxiety related to COVID-19 and disagreement with treatment suspension were found to be significantly associated with psychological distress among female fertility patients, regardless of their background characteristics. Our findings suggest the need to monitor patients' mental health and provide psychological support should a shutdown of fertility care re-occur.

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