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

Abstract

Background On March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness. Methods Cross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore’s Institute for Reproductive Medicine and Health in NY). Data from multiple choice and open response questions collected demographic, reproductive history, experience and attitudes about Covid-19, prior infertility treatment, sense of hopefulness and stress, coping strategies for mitigating stress and two validated psychological surveys to assess anxiety (six-item short-form State Trait Anxiety Inventory (STAl-6)) and resilience (10-item Connor-Davidson Resilience Scale, (CD-RISC-10). Results Seven hundred thirty-four patients were sent invitations to participate. Two hundred fourteen of 734 (29.2%) completed the survey. Patients reported their fertility journey had been delayed a mean of 10 weeks while 60% had been actively trying to conceive > 1.5 years. The top 5 ranked coping skills from a choice of 19 were establishing a daily routine, going outside regularly, exercising, maintaining social connection via phone, social media or Zoom and continuing to work. Having a history of anxiety (p < 0.0001) and having received oral medication as prior infertility treatment (p < 0.0001) were associated with lower resilience. Increased hopefulness about having a child at the time of completing the survey (p < 0.0001) and higher resilience scores (p < 0.0001) were associated with decreased anxiety. Higher reported stress scores (p < 0.0001) were associated with increased anxiety. Multiple multivariate regression showed being non-Hispanic black (p = 0.035) to be predictive of more resilience while variables predictive of less resilience were being a full-time homemaker (p = 0.03), having received oral medication as prior infertility treatment (p = 0.003) and having higher scores on the STAI-6 (< 0.0001). Conclusions Prior to and in anticipation of further pauses in treatment the clinical staff should consider pretreatment screening for psychological distress and provide referral sources. In addition, utilization of a patient centered approach to care should be employed.

The impact of the COVID-19 pandemic on women seeking fertility treatment: the patient’s perspective

“…Furthermore, the demographic information of our sample is similar to that of the German population seeking fertility treatment [25]. Although the overall response rate (participants that clicked on the link and then completed the questionnaire) of 42% is relatively low, it is similar to other studies conducted on the same subject [8,9,17]. Additionally, our response rate is likely to be an underestimate, as people were able to click on the link multiple times or could have clicked on it and decided that they were not eligible.…”

“…While there have been studies concerning the emotional impact of the suspension of treatments [7][8][9][11][12][13], this is the first to have been conducted in Germany where, in 2020, incidence and case fatality rates were relatively low compared to many other European countries [14]. To our knowledge, it is the first study to assess the possible worries that fertility treatment patients might have concerning an infection with SARS-CoV-2.…”

“…Other studies in Israel [7], Italy [8], Northeast America and Canada [9,11] and UK [12,13] have also reported that the suspension of fertility treatment has caused substantial distress. Unexpectedly, no demographic factors such as age or education status were significantly associated with the level of distress felt.…”

“…Thus, it is important that psychological effects of the postponement of fertility treatments are studied within this already vulnerable population. Previous studies in Canada and the United States, Italy and Israel have shown that postponing fertility clinic appointments can cause psychological distress, with most patients in those studies saying that they would have preferred to continue treatment despite the potential risk of infection from meeting other patients and clinic staff and travelling to clinic appointments [7][8][9]. To date, no similar studies in Germany have been reported.…”

Psychological impact of suspension/postponement of fertility treatments on infertile women waiting during COVID pandemic

“…Our study reported significantly lower PSS scores among women who received social support from their spouses. Similarly, a survey of American women whose fertility treatment was paused during the pandemic showed that those with stronger support systems and who employed effective coping strategies to deal with the treatment delay demonstrated more resilience, less perceived stress, and less anxiety [ 23 ]. Coping strategies can be taught to affected women by creating liaisons with mental health professionals in anticipation of further treatment interruptions.…”