VACCINE HESITANCY AND MEDICAL MISTRUST IN WOMEN CONSIDERING OR UNDERGOING FERTILITY TREATMENTS

Objective: To evaluate perceptions of COVID-19 vaccination in women considering or undergoing fertility treatment. Materials and Methods: IRB approval was obtained. Cross-sectional anonymous surveys of patients were collected from a single academic fertility center. Participants were randomized 1:1 to receive a one-page graphic of supplemental education providing basic facts and benefits regarding COVID-19 vaccination based on the ASRM COVID-19 taskforce recommendations. Beliefs related to COVID-19 vaccination was assessed with dichotomous, Likert scale and multiple-choice questions. Assessment of trust in the medical system was conducted via the Medical Mistrust Index (MMI). Descriptive data and chi-square analysis were used to compare responses between the intervention v. no intervention groups. Results: To date, 1130/3595 surveys have been received, response rate = 31.4%. Except for age (35.87, SD=4.0 vs 35.68, SD=4.187 p<.05), both the intervention and non-intervention groups were similar in term of demographics, including education and race;participants were predominantly white (77.8%), married (89.2%), and nulliparous (68.6%). 30.3% reported that a loved one or themselves (7.5%) tested positive for COVID-19, 46.7% knew someone who had been hospitalized or who died of COVID-19, and 6.8% stated they would not get the vaccine. Most participants (54.8%) strongly disagreed or disagreed that the vaccine could affect future fertility. Among the participants who reported their vaccination status (N=790), 25.3% of the study population received one dose, 61.4% completed vaccination while 11% did not plan on getting vaccinated. Compared to those who intended to receive the vaccine, 97.9% v. 70.4% believed that the COVID-19 vaccine given during pregnancy does not cause genetic abnormalities in a fetus or infertility (98.8% v. 81.5%), that a more severe infection has been associated with pregnancy (81.3% v. 74.6%) and strongly disagreed (32.7% v. 1.7%) or disagreed (29.0% v. 1.7%) on having concerns on its impact on future pregnancies (p<.05). Similar patterns were seen with those with higher scores on the MMI and beliefs that the vaccines can cause harm. Participants in the intervention group were more likely to believe that COVID-19 vaccination does not cause genetic abnormalities in a fetus (98.0% v. 94.2%), does not cause infertility (99% v. 96.2%) and that a more severe infection has been associated with pregnancy (81.3% v. 74.6%) (all p <.05). Higher scores on the MMI but not the intervention was associated with vaccine hesitancy (p=.01). Conclusions: The majority of women in this study had received or planned to receive the COVID-19 vaccine. Participants with greater trust in the medical system were more likely to receive the vaccine. The intervention increased patient’s knowledge regarding the vaccine and most patients did not believe that COVID-19 vaccination negatively impacts infertility. Impact Statement: Vaccine hesitancy was associated with mistrust of the medical system. Efforts should be made to improve trust and thereby increase willingness to participate in recommended medical interventions.