STUDY QUESTION How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.

In this article, some factors were evaluated for their impact on embryo morphokinetics during assisted reproductive technology (ART) cycles. We detected significant differences in the fourth cell division time (t5) of embryos obtained after controlled ovarian stimulation in long GnRH agonists and GnRH antagonist protocols. We also found that higher gonadotropin dose may slow down the development of embryos. However, both male and female age, the number of oocytes and number of normal forms of sperm in the ejaculate did not affect the kinetic parameters of embryo development. Further research is needed to identify all the spectrum of factors, which can affect the rate of embryo development.

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Study question Is the implantation rate (IR) higher in blastocysts with trophectodermal vesicles (TVs) compared to blastocysts without TVs or euploid blastocysts with unknown spontaneous hatching status? Summary answer The blastocysts with TVs demonstrate significantly higher IR in comparison to blastocysts without TVs or euploid blastocysts with unknown spontaneous hatching status. What is known already After ICSI spontaneous hatching mainly occurs by trophectoderm cell herniation via a small slit in the zona pellucida. At the beginning of this process, TVs are formed on the outside of the zona pellucida. It was previously shown that the clinical pregnancy rate was similar after the transfer of expanded blastocysts and expanded blastocysts with TVs. But another study showed that transfer of blastocysts of more advanced hatching stages yields better pregnancy rates than expanded blastocyst transfer. It remains unclear whether there is an association between the presence of TVs and IR in the transfers of single vitrified blastocysts. Study design, size, duration This retrospective cohort study was conducted from October 2018 to November 2019 and included 477 transfers of a single vitrified blastocyst. Cases were divided into 3 groups. Group 1 included transfers of blastocysts without TVs and with assisted hatching (AH). Group 2 contained the transfers of blastocysts at TVs stage of spontaneous hatching and without AH. Group 3 consisted of transfers of the euploid blastocysts with AH performed and unknown spontaneous hatching status. Participants/materials, setting, methods The age of women was between 21 and 39. Embryo transfers following oocyte donation programs were excluded from the study. This study included only transfers of the ICSI-derived fully expanded blastocysts with top-graded inner cell mass and trophectoderm. AH was performed using laser Saturn 3. The primary outcome was the implantation rate. Statistical analysis was performed using Pearson’s chi-square test and likelihood ratio test. Preimplantation genetic testing for aneuploidy (PGT-A) was performed by next-generation sequencing. Main results and the role of chance The number of cases in groups 1,2 and 3 was 133, 49, and 295, respectively. The average age in the groups was about 32.5 and did not differ between groups. The implantation rate in group 3 with PGT-A was 60% (177 out of 295), which was insignificantly higher compared to group 1 - 55% (73 out of 133) (p = 0.34). In group 2, the implantation rate was 76% (38 out of 49), which exceeded significantly the outcomes in groups 1 and 2 (p = 0.016). Thus the transfer of expanded blastocyst with TVs gives higher IR in comparison to expanded blastocyst. Therefore TVs could be utilized as a morphological marker for embryo selection. Furthermore, according to obtained results the presence of TVs on nontested blastocysts predicts implantation better than euploidy does in blastocysts with unknown spontaneous hatching status. Limitations, reasons for caution This is a retrospective nonrandomized study with its inherited limitations. Wider implications of the findings: Based on the results of the study embryo selection practice could be optimized. To maximize the outcomes of PGT-A programs embryo culture and biopsy workflow could be modified to allow collecting data on spontaneous hatching and TVs presence before performing the biopsy. Trial registration number Not applicable