P–725 COVID–19: Fertility patients’ attitudes to pregnancy and implemented changes within fertility services during a pandemic
Authors: Schaler L , Glover L , Wingfield M 
Published: August 2021

Abstract

Study question
To investigate the attitudes of male and female fertility patients to risk mitigation strategies and pregnancy advice during the first wave of the COVID–19 pandemic.

Summary answer
The desire to conceive outweighed fears regarding infection. Patients felt fertility treatments should be classified as essential and were agreeable to most risk mitigation strategies.

What is known already
The effects of the COVID–19 global pandemic on fertility services became evident in early 2020. Because of possible impacts of the virus on gametes, embryos and patients and concerns over virus transmission and the ability of medical services to cope, fertility treatments were temporarily suspended, as advised by ESHRE, ASRM and others. Across Europe, services were paused for approximately 7 weeks. Patients have reported that they found this extremely stressful and in some cases, unfair. After the initial closures, many clinics re-opened but with new risk mitigation strategies regarding PPE, hygiene and reducing staff and patient footfall.

Study design, size, duration
Men and women with a scheduled appointment at a fertility clinic over a 7-week period during the first wave of the COVID–19 pandemic were asked to complete a questionnaire outlining their experience and how it affected them. Participants were recruited via email using a secure online patient portal. A standardised anonymous 25-item questionnaire was sent to 828 patients and a reminder was circulated seven days later. The questionnaire remained open for 28 days.

Participants/materials, setting, methods
Participants were invited to complete a questionnaire and assured that all data would remain anonymous. Three areas were assessed. Firstly, how the pandemic itself affected their attempts to conceive. Secondly, participant perceptions regarding the overall disruption to fertility services. Thirdly, how participants feel fertility services should be treated in the event of a future large scale global pandemic.

Main results and the role of chance
135 responses were received, giving a response rate of 16.3%. 80% of respondents were female and 20% male with no significant difference in responses between the sexes. Most participants (96%) had completed third level education and 90% were fully employed. Interestingly, 69% of participants continued trying to conceive during this time. This was despite 28% having concerns about contracting COVID–19 should they attend a clinic, 21% having concerns regarding the effect of the virus on pregnancy and 21% having concerns regarding an impact on the fetus. The majority surveyed (93%) stated that fertility treatment should be considered essential. 90% had their treatment disrupted or altered and, of these, 44% felt that this was justified, 23% disagreed and 33% were unsure. Regarding changes implemented within the clinic, 68% were satisfied with online video consultations and a further 16% would be content in certain circumstances. 92% felt privacy was maintained and 95% were happy to sign consent forms via video link. Many disagreed with the no partner policy at early pregnancy scans(57%) and embryo transfer(44%); however, they agreed with it for phlebotomy and treatment scans. In the event of a future pandemic, 79% felt fertility services should or probably should be continued.

Limitations, reasons for caution
This study focuses on the first wave of COVID–19. The long term, ongoing nature of the pandemic may influence participants’ perspectives on the areas investigated over time.
Wider implications of the findings: It is estimated that the world will face a global pandemic approximately once every generation. Fertility stakeholders must learn from these events and studies such as ours are important to ascertain the views of service users. Some policies, such as video consultations, may be of benefit even in non-pandemic times.

Trial registration number
Not applicable