A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe
Authors:   The ESHRE COVID-19 Working Group, Vermeulen Nathalie , Hambartsoumian Eduard , Nouri Kazem , Ebner Thomas , Wyns Christine , Verheyen Greta , Petrovskaya Elena , Vujnic Sasha , Sibincic Sanja , Nikolov Gueorgui , Andreeva Petya , Baldani Dinka , Stanic Patrik , Fasouliotis Sozos , Antoniadou Christiana , Agathangelou Anna , Malenovská Alice , Rezabek Karel , Bentin-Ley Ursula , Grøndahl Marie Louise , Pinborg Anja , Morin-Papunen Laure , Mäkinen Sirpa , Boyer Pierre , Rongieres Catherine , de Mouzon Jacques , Nogueira Daniela , Barbakadze Tamar , Chkonia Lika , Kupka Markus , Nordhoff Verena , Strowitzki Thomas , Tarlatzis Basil , Kovacs Peter , Szabolcs Mátyás , Björgvinsson Hilmar , Wingfield Mary , Leyden Joyce , Gennarelli Gianluca , De Santis Lucia , Lokshin V N , Magomedova Valerija , Baušytė Raminta , Masliukaitė Ieva , Schilling Caroline , Forges Thierry , Petanovski Zoran , Sotirovska Valentina , Agius Jean Calleja , Simic Tatjana Motrenko , Smeenk Jesper M J , de Sousa Lopes S M Chuva , Nap Annemiek , Romundstad Liv Bente , Janicka Anna , Spaczynski Robert , Sousa Ramos Ana Luisa , Doria Reis Isabel , Manolea Corina , Dascalescu Monica , Rugescu Ioana , Kodyleva Tatyana , Nikitin Sergei , Zakharova Elena , Šurlan Lela , Stimpfel Martin , Reljič Milan , Maršík Ladislav , Llácer Joaquin , Domínguez Hernández Francisco , Vidal Carmina , Wånggren Kjell , Streuli Isabelle , Sterthaus Oliver , Yarali Hakan , Sokmensuer Lale Karakoc , Gryshchenko Mykola , Gontar Julia , Bolton Virginia , Chetty Maya , Mathur Raj , Ata Baris , Gianaroli Luca , Lundin Kersti , Mocanu Edgar , Rautakallio-Hokkanen Satu , Tapanainen Juha S , Veiga Anna 
Published: June 2020

Abstract

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.