O-195 The impact of the COVID-19 outbreak on psychological distress due to the cancellation of ART. A systematic review and meta-analysis
Authors: Donarelli Z , Lo Coco G , Gullo S , Oieni V , Volpes A , Allegra A 
Published: August 2021

Abstract

Study question
Is there evidence that infertile patients have been more likely to experience distress during the COVID-19 outbreak with the consequent interruption of treatment plans?

Summary answer
High levels of psychological distress among infertile patients have been found during the COVID-19 pandemic, greater than that reported in the general population.

What is known already
Preliminary research on the negative consequences of the COVID-19 outbreak on mental health evidenced heightened levels of anxiety, depression and post-traumatic stress in some clinical populations as well as in community samples. However, little is known about the impact of COVID-19 on psychological distress of infertile patients who have been forced to suspend infertility treatment and postpone parenthood goals during the pandemic. The aim of this meta-analytic review is to summarize extant literature on the prevalence of psychological distress symptoms in infertile patients during the COVID-19 pandemic.

Study design, size, duration
A systematic review and meta-analysis were conducted following the PRISMA guidelines on PsycInfo, PubMed, Embase, Web of Science, MedRxiv from March 2020 to mid-December 2020. Study inclusion criteria were specified according to the PICOS guideline. All naturalistic or RCT studies published in 2020 that examined infertility as the primary diagnosis and had a quantitative measurement of distress, were eligible. The primary outcomes were symptoms of psychological distress and secondary outcomes were indicators of psychological health.

Participants/materials, setting, methods
The database search identified 144 papers. Two reviewers independently screened potential studies by title and abstracts based on the inclusion criteria. The full texts were then screened for eligibility. The Newcastle-Ottawa Scale was used to judge the methodological quality of the studies. In order to estimate the pooled prevalence of distress, Odds Ratios with 95% Confidence Interval were calculated as the effect size by using a random-effects model. Heterogeneity was tested using I2 statistics.

Main results and the role of chance
Fourteen studies met the inclusion criteria and were summarized for the systematic review (N = 6473). Only six studies did not include males although, in the surveys, females made up 92% of the total sample. Ten studies adopted a cross-sectional study design. 100% gathered data through an online survey. Nine studies showed a high risk of bias, and five had a moderate risk. Review results showed that 56,4% of patients wished to resume treatment; participants were mostly worried about the delay in treatment because of their age (&gt;35 years) or diminished ovarian reserve, or money constraints and low education level. Only five studies examined the role of protective factors such as social support, coping, optimism trait and intolerance of uncertainty. Nine studies were included for meta-analysis. The prevalence of psychological distress was 0.58 (95% CI 0.32÷0.84). The pooled point estimates of prevalence for anxiety (N = 6) were 0.56 (95% CI 0.24÷0.88), whereas the prevalence for depression (N = 5) was 0.46 (95% CI 0.15÷0.77). There was significant heterogeneity among studies to estimate the prevalence (I² ranging from 99% to 100%).

Limitations, reasons for caution
Results are preliminary, given the small number of studies and their cross-sectional data.
The risk of bias was high or moderate across studies.

Wider implications of the findings
Infertile couples reported high levels of distress due to cancellation of their diagnostic procedures or treatment; they would benefit from information, appropriate support and advice from healthcare professionals, with an important role in maintaining the wishes of infertile couples to continue their parenthood goals.

Trial registration number
not applicable