Fertility patients under COVID-19: attitudes, perceptions and psychological reactions

Abstract

Study question What are the perceptions of infertility patients and the factors correlating with their psychological distress, following suspension of fertility treatments during the COVID-19 pandemic? Summary answer Most patients preferred to resume treatment given the chance regardless of background characteristics; higher self-mastery and greater perceived social support were associated with lower distress, while feeling helpless was associated with higher distress. What is known already Infertility diagnosis and treatment frequently result in significant psychological distress. Recently published data has shown that clinic closure during the COVID-19 pandemic was associated with a sharp increase in the prevalence of anxiety and depression among infertile patients undergoing IVF and was perceived as an uncontrollable and stressful event. Personal resources play an important protective role in times of crisis, helping reduce levels of distress. Study design, size, duration This cross-sectional questionnaire study included patients whose fertility treatment was suspended following the COVID-19 pandemic, in a tertiary hospital. The survey was delivered to 297 patients within 12 days at the beginning of April 2020. Participants/materials, setting, methods The self-administered questionnaire included items addressing: 1. patients' demographic characteristics, 2. anxiety related to COVID-19 infection risk and level of social support, 3. patients' perceptions of the new guidelines and description of subsequently related emotions, and 4. two validated scales assessing levels of emotional distress and self-mastery. Multivariate analysis was conducted to assess factors alleviating or increasing emotional distress during the COVID-19 pandemic. Main results and the role of chance There were 168 patients who completed the survey, giving a response rate of 57%. Study variables in the regression model explained 38.9% of the variance in psychological distress experienced by patients during treatment suspension. None of the background characteristics (e.g. age, marital status, parity, economic level or duration of treatments) had a significant contribution. Feeling helpless following the suspension of treatments was associated with higher distress (P < 0.01). Higher self-mastery and greater perceived social support were associated with lower distress (p < 0.01). Despite the ministry of health’s decision, 72% of patients wished to resume treatment at the time of survey. Limitations, reasons for caution This was a cross-sectional study, thus information about patients’ characteristics prior to the COVID-19 pandemic was not available. The length and implications of this pandemic are unknown. Therefore, the ability to draw conclusions about the psychological consequences of the crisis is limited at this point of time. Wider implications of the findings Personal resources play an important protective role in times of crisis, helping to reduce levels of distress. Study findings suggest that attention should be paid to strengthening and empowering patients’ personal resources together with directly confronting and containing feelings of helplessness. In line with the ESHRE guidelines, especially at this time of high levels of distress, it is imperative to offer emotional support to reduce stress and concerns. Furthermore, as the pandemic is stabilising, resumption of treatment should be considered as soon as appropriate according to local conditions. Study Funding/Competing interest(s) This study was funded by the IVF unit of the Shamir Medical Center. All authors declare no conflicts of interest.

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

“…In our study, more than two-thirds of women and men reported that they would be reassured if they knew when they could restart the IVF treatment. Similarly to our research, other authors demonstrated how a relevant proportion of patients would resume IVF treatment despite the COVID-19 pandemic [24,27].…”

“…A cross-sectional questionnaire study included 168 patients whose fertility treatment was suspended following the COVID-19 pandemic in a tertiary hospital. Whereas demographic characteristics (such as age, marital status, parity, economic level, or duration of treatments) did not have a significant contribution, feeling helpless following the suspension of treatments was associated with higher distress; higher selfmastery and more significant perceived social support were associated with lower distress [27]. Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal.…”

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

“…The response rate of 29.2% was comparable to previous response rates reported on this topic ranging between 17 and 57% ( 22 – 24 ). Other studies utilizing social media recruiting strategies have reported higher response rates ( 5 , 25 ).…”

“…While quarantine (shelter in place) can be a necessary preventative measure during an infectious disease outbreak, it is often associated with a negative psychological impact ( 27 ). According to data published by Ben-Kimhy et al ( 24 ), Covid-19 has introduced new stressors and levels of anxiety for infertility patients. Closures of clinics, which resulted in deferred fertility treatments, led to a sharp increase in anxiety and depression among patients undergoing IVF ( 24 ).…”

Unexplained infertility and expectant management in women aged 39 or above: is it acceptable to ask couples to wait one year before receiving IVF? A retrospective cohort study

“…Moreover, concern about delayed access to IVF treatments has become dramatically topical following the outbreak of the COVID-19 pandemic [17], which prompted the temporary suspension of treatments due to the limited knowledge on SARS-CoV-2 effects in pregnancy [18][19][20], generating higher distress in couples on the possible consequences that such "waiting period" could have on treatment outcomes [21,22].…”