![ORCID Icon]({"type":"image","src":"/templates/jsp/_style2/_tandf/images/orcid.svg"} "ORCID Icon"){kind=small}
https://orcid.org/0000-0003-4117-6603
Abstract
Abstract
Purpose
To explore the psychological status of infertile women and men who had in-vitro fertilization (IVF) treatment interrupted or postponed because of the COVID-19 emergency.
Materials and methods
An electronic survey (NCT04395755) was e-mailed between April and June 2020 to couples whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. The presence and severity of symptoms suggestive of anxiety and/or depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). Subjects with preexisting psychiatric disorders were excluded.
Results
Overall, 524 out of 646 patients completed the survey. The prevalence of anxiety and/or depression feelings was significantly higher in women, mainly if aged more than 35 years and with a previous IVF attempt. The occurrence of these psychological symptoms was significantly associated with the time spent on COVID-19 related news per day and partner with evidence of psychological disorder and, in females, with a diagnosis of poor ovarian reserve, diagnosis of endometriosis or uterine fibroids.
Conclusions
The psychological impact of the COVID-19 pandemic on the infertile couples who should have undergone IVF treatment has been significant. IVF centers should systematically offer these couples adequate psychological counseling to improve mental health.
Introduction
The remarkable increase in the number of infections by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) worldwide raised the prospect of massive hospitalizations that few healthcare systems would face. The urgent need to avoid a collapse in the healthcare system during the COVID-19 pandemic has led to the reallocation of hospital staff and resources; healthcare regulatory authorities have issued a series of recommendations regarding clinical and patient management [1].
In reproductive medicine, practitioners’ recommendations included the suspension of initiation of assisted reproductive technology (ART) treatments, postponement of non‐urgent diagnostic procedures, and elective surgical operations [2]. Specifically, in the earliest stages of the pandemic, the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) suggested discontinuing new fertility procedures, such as ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF), as well as non-urgent gamete cryopreservation, cancelation of all fresh or frozen embryo transfers. Exceptions were patients currently “in-cycle” or requiring urgent fertility preservation due to cancer treatment [3]. More recently, in Europe, with successful mitigation strategies against the pandemic, societies have allowed gradual resumption of ART procedures [4,5].
Infertility is already a stressful experience. Indeed, it has been widely documented that the experience of infertility has a significant impact on the psychological well-being of both partners; in fact, problems such as low self-esteem, sexual distress, depression, guilt, anxiety, frustration, and relational issues within the couple frequently occur in infertile couples [6,7]. Furthermore, the failure of ART procedures can further impair the mental health of individuals and couples [8,9].
In addition to this stressful condition, patients who have decided to proceed with an IVF in the first half of 2020 also faced the psychological impact of the COVID-19 pandemic, which has drastically impacted everyone’s daily lives because of quarantine, social distancing, restrictions in traveling, treatment cancelation along with constant fear for their own and their families in danger [10]. This feeling of stress, anxiety, and depression is likely to have impacted the emotional well-being of couples who should have undergone IVF treatment during the COVID-19 pandemic.
This cross-sectional study aimed to explore the psychological status of infertile patients whose IVF treatments have been interrupted or postponed due to the COVID-19 emergency. In particular, we hypothesized that the COVID-19 experience has led to a significant increase in feelings of anxiety and depression of these couples and especially of women, who are more subject to the psychological consequences of infertility and its treatments.
Materials and methods
This cross-sectional study enrolled all couples referring to our institution (Piazza Della Vittoria 14 Srl; Genoa; Italy) whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. Patients were identified, and demographic data were prospectively collected using dedicated software (Gineko, Cosa Srl, Rome, Italy) between 1 April 2020 and 10 June 2020.
The local Ethical Committee approved the study protocol (415/2020, CER Liguria), and all research was performed following relevant guidelines and regulations. All the women gave their informed consent to collect and use their data for conducting this study. The trial was registered in ClinicalTrials.gov (NCT04395755).
An anonymous electronic survey on Google Forms web application (Mountain View, California, United States) was e-mailed to infertile couples referring to our institution. A reminder e-mail was sent every week until the end of the study period. The purpose of this survey was explained to all participants with a brief introduction. Participants were asked to sign a privacy policy consent at the beginning. Survey participation was voluntary, and no incentives were offered. We included in the analysis the answers obtained from all the members of couples, also in case of a single response.
The survey was composed of two distinct sections: the first part assessed the presence and severity of symptoms suggestive of anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9); the second part evaluated the perspective of patients about restarting IVF treatment, even changing referral ART center. Subjects with psychiatric disorders previously diagnosed by using DSM-V were excluded from the analysis [11].
The GAD-7 is a validated questionnaire based on seven items referring to DSM-IV criteria for assessing anxiety symptoms. The whole scale score can range from 0 to 21, and cutoff scores for mild, moderate, and severe anxiety symptoms are 5, 10, and 15, respectively [12]. The PHQ-9 is a validated tool based on nine items referring to DSM-IV criteria for assessing depression symptoms. The whole scale score can range from 0 to 27, and cutoff scores for mild, moderate, moderately severe, severe depression symptoms are 5, 10, 15, and 20, respectively [13]. For both questionnaires, response options are “not at all,” “several days,” “more than half the days,” and “nearly every day,” scored as 0, 1, 2, and 3, respectively.
After the closing date for questionnaire submissions, results were downloaded as a CSV (comma-separated values) file categorized via Excel (version 16.39; Microsoft Corporation, Redmond, USA). Statistical analysis was carried out using Statistics Package for Social Sciences (SPSS, version 24.0 Chicago, IL, USA). Results of the survey were reported according to the CHERRIES Guidelines [14].
Data analysis
Continuous data were verified for normality using the Kolmogorov–Smirnov test. According to the variables’ distribution, descriptive statistics were reported as mean ± standard deviation or median and interquartile range (IRQ). Unpaired or paired t-test was employed for analyzing continuous data and the chi-squared test for categorical data. The Mann-Whitney U test was employed to compare the differences between two independent groups in dependent variables, which were not normally distributed. Logistic regression analysis was used to examine the odds ratio (OR) with a 95% CI of (categorical or continuous) independent variables with one dichotomous dependent variable. Correlation measurements were tested using Spearman’s Rho test. A two-sided p-value ≤ of 0.05 was considered statistically significant.
Results
Overall, 524 (308 women; 216 men) out of 646 patients completed the questionnaire (response rate: 81.1%; 95% C.I., 77.7–84.1%; Figure 1). The mean (± SD) age of the women and men included in the study was 37.3 (± 4.6) and 38.4 (± 6.2) years, respectively. One hundred eighty-seven had a median number of previous failed IVF cycles of 2 (range, 0–8); 56 couples (29.9%) were undergoing heterologous fertilization. The other demographic characteristics of the study population are reported in Table 1.
Published online:
30 November 2020![]({"type":"image","src":"/na101/home/literatum/publisher/tandf/journals/content/ipob20/0/ipob20.ahead-of-print/0167482x.2020.1853095/20210508/images/medium/ipob_a_1853095_f0001_c.jpg"})
Figure 1. Venn diagram showing the responders to the survey.
Table 1. Demographic characteristics of the study population.
The prevalence of feelings of anxiety or depression or both was 45.5% (140 of 308; 95% C.I., 39.8–51.2%) in women and 31.0% (67 of 216; 95% C.I., 24.9–37.7%) in men. This prevalence was significantly higher in women than in men (p = 0.001), in women aged more than 35 years (49.3% vs. 46.3%; p = 0.036) and with a previous IVF attempt (57.7% vs. 24.1%; p < 0.001).
Feelings of anxiety was detected in 75 women (24.4%; 95% C.I., 19.7–29.5%) with a median total score on GAD-7 of 11 (interquartile range, IQR: 8–15) and in 39 men (18.1%; 95% C.I., 13.2–22.9%) with a median total score on GAD-7 of 9 (interquartile range, IQR: 7–13; Figure 2). In majority of cases, anxiety was moderate in women (n = 46; 61.3%; 95% C.I., 49.4–72.4%) and mild in men (n = 32; 82.1%; 95% C.I., 66.5–92.5%; Table 2).
Published online:
30 November 2020Figure 2. Mean values of answers to specific items at GAD-7 and QHP-9 questionnaires.
![]({"type":"image","src":"/na101/home/literatum/publisher/tandf/journals/content/ipob20/0/ipob20.ahead-of-print/0167482x.2020.1853095/20210508/images/medium/ipob_a_1853095_f0002_c.jpg"})
Figure 2. Mean values of answers to specific items at GAD-7 and QHP-9 questionnaires.
Table 2. Symptom severity of anxiety and depression in the study population.
Depression was detected in 65 women (21.1%; 95% C.I., 16.7–26.1%) with a median total score on PHQ-9 of 4 (IQR: 3–13) and in 28 men (13.0%; 95% C.I., 8.8–18.2%) with a median total score on PHQ-9 of 3 (IQR: 3–9). In majority of cases, depression was characterized by moderate intensity in both women (n = 46; 70.1%; 95% C.I., 58.2–81.4%) and men (n = 17; 60.1%; 95% C.I., 40.6–78.5%) without inter-group differences (p = 0.397); a higher proportion of men suffered from moderately severe depression (n = 3 vs. n = 0; 60.1% vs 0%; p = 0.007; Table 2).
Women had a moderate positive correlation between scores obtained at GAD-7 and those obtained at PHQ-9 (R = 0.339; p = 0.05); otherwise, men had a very weak positive correlation between these scores (R = 0.110; p < 0.001). Moreover, 25 women (8.1%; 95% C.I., 5.3–11.8%) and 13 (6.0%; 95% C.I., 3.2–10.1%) men had a concomitant feeling of depression and anxiety. Women with a female factor of infertility had a higher prevalence of anxiety and/or depression in comparison to women without the female factor of infertility (46.7% vs. 21.8%, p < 0.001); similarly, this was observed in men with and without male infertility factor (29.2% vs. 16.5%, p = 0.036).
In both females and males, the occurrence of feelings of anxiety and/or depression was significantly associated with time spent on COVID-19 related news per day (> 1 h per day, p = 0.034) and partner with evidence of psychological disorder (p = 0.017; Table 3). The level of instruction and a previous parity did not significantly correlate with the occurrence of anxiety and/or depression (p = 0.383 and p = 0.679, respectively). For females, the occurrence of symptoms suggestive of anxiety and/or depression was significantly associated with poor ovarian reserve (p = 0.032), diagnosis of endometriosis (p < 0.001), diagnosis of uterine fibroids (p = 0.040; Table 3). A previous failed IVF cycle was not associated with the occurrence of these psychological symptoms (p = 0.910); similarly, there was no direct correlation with the number of previous failed IVF cycles (R = 0.049; p = 0.388).
Table 3. Significant variables associate with anxiety/depression at binomial logistic regression.
Overall, 121 women (39.3%; 95% C.I., 33.8–45.0%) and 75 men (36.6%; 95% C.I., 30.1–43.4%) declared that they would like to undergo the IVF treatment despite the COVID-19 pandemic. Two hundred thirty-nine women (77.6%, 95% CI, 72.5–82.1%) and 162 men (70.1%, 95% CI, 63.8–76.1%) reported that they would be reassured if they knew when they could restart the IVF treatment; 118 women (38.2%, 95% CI, 32.9–44.0%) and 88 men (40.7%, 95% CI, 34.1–47.6%) declared that they would change the IVF center if they could restart the IVF treatment immediately.
Discussion
Discontinuation of IVF cycles has been part of the radical transformation of healthcare provision to enable the reallocation of staff and resources to deal with the COVID-19 pandemic. To the best of our knowledge, this is the first study investigating the psychological status of infertile patients whose IVF treatments have been interrupted or postponed due to the COVID-19 pandemic. This survey revealed that the COVID-19 epidemic caused a not negligible detection of anxiety and depression symptoms among infertile patients undergoing IVF. Our analysis demonstrated that more than one-third of patients referring to our IVF center had symptoms suggestive of anxiety or depression. Furthermore, a higher proportion of patients were anxious than depressed (women: 24.4% vs. 21.1%; men: 18.1% vs. 13.0%). Anxiety was more often moderate in women (61.3%) and mild in men (82.1%); differently, depression had moderate intensity in both sexes (women: 70.1%; men: 60.1%). Nevertheless, only about 1% of women and men with evidence of these psychological disorders showed severe symptoms (Table 2).
These results are in line with the existing literature according to which depression and anxiety are frequently associated with infertility, and they may worsen during ART [8]. Interestingly [15], it has been reported that low perception of personal control and avoidant coping style might be positively associated with fertility-related stress and state anxiety. In contrast, a problem-appraisal coping style may be negatively related to fertility-related stress and depressive symptomatology scores.
Many infertile women in the general population are likely to have experienced depression and anxiety but do not seek medical care and treatment [16]. In a large nationwide register-based cohort study published by [17], major depression was the most common mood disorder in 23,557 women undergoing their first IVF cycle and was prevalent in 10.9% of females and 5.1% of males; any anxiety disorder was encountered in 14.8% of females and 4.9% of males. In another study enrolling 1090 consecutive women and men referred to a fertility clinic, the major depressive disorder was present in 8.5% of females and 2.2% of males, whereas anxiety in 14.8% and 8.9% of cases; around 35% of women and men had a concomitant diagnosis of at least two psychiatric disorders [18]. More elevate prevalence of depression (65.9%), and anxiety (75.9%) was found in another observational trial on 352 women and 274 men seeking treatment for infertility in five fertility practices; these psychological disorders were higher for women who did not have a successful ART procedure [19].
COVID-19 disease is an unprecedented global situation that is drastically changing everyone’s daily life and perspective. The stress caused by the COVID-19 pandemic is unprecedented in modern history. Indeed, it was an unexpected event whose consequences continue to threaten everyone’s present life and future, including losing everyday life due to the lockdown, financial insecurity, and social isolation. In this regard, recent studies confirmed the severe psychological repercussions of the emergency linked to the spread of COVID-19 in many sections of the population, such as healthcare professionals and students [10,20–22].
In this scenario, it is reasonable to hypothesize that the feelings of stress, anxiety, and depression related to the COVID-19 pandemic can have had a significant impact on the emotional well-being of couples who should have undergone IVF treatment during the emergency. In this regard, a short communication published during the COVID-19 pandemic presented data about an anonymous cross-sectional online survey sent to 10,481 patients who attended a large university-affiliated infertility practice in the USA. At three different time-points, respondents indicated infertility as the most frequent top stressor, causing anxiety and depression. COVID-19 was the third most common stressor among the respondents in the early stages of the pandemic (first days of March); nevertheless, in the latest period (first days of June), COVID-19 was responsible for stress with an incidence similar to infertility (63% and 66%, respectively). In this study, only 6% of patients stated that infertility treatment (including IVF) should not be offered during the COVID-19 pandemic [23]. In agreement with this data, our study showed that the occurrence of anxiety and/or depression was significantly associated with time spent on COVID-19 related news per day.
Some studies have recently investigated the impact of COVID-19 on patients referring to IVF centers during the pandemic. In a large Italian observational study, an online survey was sent to 627 infertile couples who were candidates to ART and whose treatment was interrupted due to the COVID-19 lockdown. The pandemic demonstrated a moderate/severe psychological impact on infertile patients. Similarly to our data, women were more emotionally distressed, anxious, and depressed than men [24].
Another Turkish online survey was completed by 101 women whose ART cycles were postponed due to the COVID-19 outbreak, showing that state-anxiety levels were significantly higher in women above 35 years. As in our study, diminished ovarian reserve and a previous ART failure significantly predicted the presence of clinical state-anxiety [25].
A recent study examined the psychological impact of fertility treatment interruption due to the COVID-19 pandemic in 92 women from Canada and the United States. The study also investigated psychosocial predictors of better or worse mental health. More than 50% of respondents endorsed clinical levels of depressive symptoms. The authors showed that several psychosocial variables (such as lower levels of defensive pessimism, greater infertility acceptance, better quality social support, more social support seeking) were positively correlated to a better psychosomatic status during this period [26].
A cross-sectional questionnaire study included 168 patients whose fertility treatment was suspended following the COVID-19 pandemic in a tertiary hospital. Whereas demographic characteristics (such as age, marital status, parity, economic level, or duration of treatments) did not have a significant contribution, feeling helpless following the suspension of treatments was associated with higher distress; higher self-mastery and more significant perceived social support were associated with lower distress [27]. Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal. Nevertheless, most patients have been able to cope using thought-management (e.g. distraction, focusing on positives), getting mentally and physically fit for the next treatments, strengthening their social network, and keeping up-to-date [28]. In our study, more than two-thirds of women and men reported that they would be reassured if they knew when they could restart the IVF treatment. Similarly to our research, other authors demonstrated how a relevant proportion of patients would resume IVF treatment despite the COVID-19 pandemic [24,27].
It is known that men undergoing fertility treatment may also experience anxiety and stress [29]; the lockdown of andrological services may have a further psychological impact on men undergoing ART treatment. In fact, our study showed that 30.6% of men experienced anxiety and/or depression; for this reason, during COVID-19 lockdown, the health and psychological consequences of not offering andrological services should be considered.
Psychological interventions may have a critical role in lowering psychological distress in patients referring to IVF centers [30], in particular, during the COVID-19 pandemic. A cognitive-behavioral may be the most efficient way to achieve both goals. Even more so, during the COVID-19 epidemic, IVF center must strengthen the psychological counseling for couples to improve their quality of life and mental health [31,32]. To this purpose, specific strategies may support multiple times across the treatment trajectory by various methods (i.e. handouts, website, personal referral) and multiple providers (i.e. psychologists, physicians, medical assistants, nurses).
Our study has some important strengths. As already underlined, it is one of the first studies investigating the psychological impact of the COVID-19 emergency on the infertile patients whose IVF treatments have been interrupted or postponed. Furthermore, our sample is relatively large, and consequently, our results can be considered significant.
However, there are also some limitations. First, subjects with preexisting psychiatric disorders diagnosed using DSM-V have been excluded from the sample, as we aimed to evaluate the impact of the COVID-19 pandemic in a healthy mental population of patients undergoing IVF. Nevertheless, it cannot be completely excluded that the patients did not have experienced anxiety or depression symptomatology before. At our institution, couples undergoing IVF are routinely submitted to psychological evaluation and counseling, and, in case of suspicion of psychiatric disease, patients undergo psychiatric assessment following the standardized DSM-5 criteria. However, we did not analyze the prevalence of anxiety and/or depression in patients undergoing IVF at our institution before the COVID-19 pandemic; thus, we cannot establish an exact causal relationship between the investigated variables.
Furthermore, we used an internet-based questionnaire with self-reported measures, so it was impossible to exclude a potential influence of self-report bias on our results. Finally, despite many respondents, our population may not be a general representative sample. The survey was distributed in our local community; thus, the responses may not be generalizable in all the Italian regions or different countries. A longitudinal follow-up would help track the changes in anxiety and depression levels at various epidemic stages in the next months.
Conclusions
In conclusion, according to this study’s results, the psychological impact of the COVID-19 pandemic on the infertile couples whose IVF treatments were postponed or interrupted because of the emergency has been significant. For this reason, it is essential that IVF centers systematically offer these couples adequate psychological counseling to improve their quality of life and mental health as well as to reduce the psychological impact of the COVID-19 pandemic as much as possible.
| Females (n = 308) | Males (n = 216) | |
|---|---|---|
| Age, mean (±SD) | 37.3 (±4.6) | 38.4 (±6.2) |
| BMI, mean (±SD) | 24.5 (±3.1) | 24.2 (±3.3) |
| Smoking, n (%) | 56 (18.2) | 37 (17.2) |
| Ethnicity, n (%) | ||
| White | 279 (90.6) | 198 (91.7) |
| Asian | 9 (2.9) | 4 (1.9) |
| Hispanic | 13 (4.2) | 8 (3.7) |
| Black | 7 (2.3) | 6 (2.8) |
| Previous children, median (range) | 0 (0-3) | 0 (0–2) |
| Highest education n (%) | ||
| Postsecondary and tertiary | 124 (40.3) | 81 (37.5) |
| Upper secondary | 146 (47.4) | 112 (51.9) |
| Lower secondary of less | 38 (12.3) | 23 (10.6) |
| Couples (n = 187) | ||
| Heterologous fertilization n (%) | 56 (29.9%) | |
| Previous failed IVF cycle, median (range) | 2 (0–8) | |
| Duration of infertility, mean (%) | 3.6 (±2.1) | |
| Etiology of infertility, n (%) | ||
| Female factor | 81 (43.3) | |
| Male factor | 62 (33.2) | |
| Mixed | 26 (13.9) | |
| Unexplained | 18 (9.6) | |
| Symptom Severity | Females (n = 308) | Males (n = 216) | Patients (n = 524) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Number | Absolute % | Cumulative% | Number | Absolute % | Cumulative % | p* | Number | Absolute % | Cumulative % | |
| ANXIETY (GAD-7) | ||||||||||
| Mild | 26 | 8.4 | 8.4 | 32 | 14.9 | 14.9 | <0.001 | 58 | 11.1 | 11.1 |
| Moderate | 46 | 14.9 | 23.3 | 7 | 3.2 | 18.1 | <0.001 | 53 | 10.1 | 21.2 |
| Severe | 3 | 1.1 | 24.4 | 0 | 0 | 18.1 | 0.206 | 3 | 0.6 | 21.8 |
| TOT | 75 | 24.4 | – | 39 | 18.1 | – | – | 114 | 21.8 | – |
| DEPRESSION (PHQ-9) | ||||||||||
| Mild | 19 | 6.2 | 6.2 | 7 | 3.2 | 3.2 | 0.707 | 26 | 5.0 | 5.0 |
| Moderate | 46 | 14.9 | 21.1 | 17 | 7.9 | 11.1 | 0.397 | 63 | 12.0 | 17.0 |
| Moderately severe | 0 | 0 | 21.1 | 3 | 1.4 | 12.5 | 0.007 | 3 | 0.6 | 17.6 |
| Severe | 0 | 0 | 21.1 | 1 | 0.5 | 13.0 | 0.123 | 1 | 0.1 | 17.8 |
| TOT | 65 | 21.1 | – | 28 | 13.0 | – | 93 | 17.8 | ||
GAD-7: Generalized Anxiety Disorder-7; PHQ-9: Patient Health Questionnaire-9.
* Comparison of symptom severity between males and females.
| Variable | B | S.E. | Wald | Odds ratio | 95% CI | p |
|---|---|---|---|---|---|---|
| Females/males | ||||||
| Time spent on COVID-19 related news per day (> 1 hour per day) | 0.548 | 0.259 | 4.496 | 1.730 | 1.042–2.017 | 0.034 |
| Partner with evidence of psychological disorder | 0.699 | 0.293 | 5.709 | 2.012 | 1.134–3.569 | 0.017 |
| Females | ||||||
| Age | 0.523 | 0.259 | 4.090 | 1.687 | 1.016–2.801 | 0.043 |
| Poor ovarian reserve | 0.508 | 0.261 | 3.789 | 1.661 | 0.997–2.770 | 0.052 |
| Diagnosis of endometriosis | 0.598 | 0.287 | 4.351 | 1.819 | 1.037–3.192 | 0.037 |
| Diagnosis of uterine fibroids | 1.116 | 0.293 | 14.478 | 3.051 | 1.718–5.421 | <0.001 |
Disclosure statement
No potential conflict of interest was reported by the authors.
References
- Armocida B, Formenti B, Ussai S, et al. The Italian health system and the covid-19 challenge. Lancet Public Health. 2020;5(5):e253. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- ESHRE Covid-19 Working Group, Vermeulen N, Ata B, et al. A picture of medically assisted reproduction activities during the covid-19 pandemic in Europe. Hum Reprod Open. 2020;2020:hoaa035. [Crossref], [PubMed], [Google Scholar]
- Veiga A, Gianaroli L, Ory S, et al. Assisted reproduction and covid-19: a joint statement of asrm, eshre and iffs. Fertil Steril. 2020;114(3):484–485. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Andrabi SW, Jaffar M, Arora PR. Covid-19: new adaptation for ivf laboratory protocols. JBRA Assist Reprod. 2020;24(3):358–361. [PubMed], [Web of Science ®], [Google Scholar]
- 5. ESHRE Covid-19 Working Group. Eshre guidance on recommencing ART treatments. 2020. [Published 2020 Apr 23; Last 2020 May 05]. Available from: https://www.eshre.eu/Home/COVID19WG [Google Scholar]
- La Rosa VL, Barra F, Chiofalo B, et al. An overview on the relationship between endometriosis and infertility: the impact on sexuality and psychological well-being. J Psychosom Obstet Gynaecol. 2020;41(2):93–97. [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Vitale SG, La Rosa VL, Rapisarda AMC, et al. Endometriosis and infertility: the impact on quality of life and mental health. J Endometriosis Pelvic Pain Disord. 2017b;9(2):112–115. [Crossref], [Web of Science ®], [Google Scholar]
- Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41–47. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Vitale SG, La Rosa VL, Rapisarda AM, et al. Psychology of infertility and assisted reproductive treatment: the Italian situation. J Psychosom Obstet Gynaecol. 2017a;38(1):1–3. [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Torales J, O’higgins M, Castaldelli-Maia JM, et al. The outbreak of covid-19 coronavirus and its impact on global mental health. Int J Soc Psychiatry. 2020;66(4):317–320. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Association; 2013. [Crossref], [Google Scholar]
- Jordan P, Shedden-Mora MC, Löwe B. Psychometric analysis of the generalized anxiety disorder scale (GAD-7) in primary care using modern item response theory. PloS One. 2017;12(8):e0182162. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Maroufizadeh S, Omani-Samani R, Almasi-Hashiani A, et al. The reliability and validity of the patient health questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility. Reprod Health. 2019;16(1):137. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (cherries). J Med Internet Res. 2004;6(3):e34. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Gourounti K, Anagnostopoulos F, Potamianos G, et al. Perception of control, coping and psychological stress of infertile women undergoing IVF. Reprod Biomed Online. 2012;24(6):670–679. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Herbert DL, Lucke JC, Dobson AJ. Depression: an emotional obstacle to seeking medical advice for infertility. Fertil Steril. 2010;94(5):1817–1821. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Cesta CE, Viktorin A, Olsson H, et al. Depression, anxiety, and antidepressant treatment in women: Association with in vitro fertilization outcome. Fertil Steril. 2016;105(6):1594–1602.e3. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Volgsten H, Skoog Svanberg A, Ekselius L, et al. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23(9):2056–2063. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Pasch LA, Holley SR, Bleil ME, et al. Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services? Fertil Steril. 2016;106(1):209–215.e2. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Montemurro N. The emotional impact of covid-19: from medical staff to common people. Brain Behav Immun. 2020;87:23–24. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Ramaci T, Barattucci M, Ledda C, et al. Social stigma during covid-19 and its impact on hcws outcomes. Sustainability. 2020;12(9):3834. [Crossref], [Web of Science ®], [Google Scholar]
- Sandhu P, De Wolf M. The impact of covid-19 on the undergraduate medical curriculum. Med Educ Online. 2020;25(1):1764740. [Taylor & Francis Online], [Web of Science ®], [Google Scholar]
- Vaughan DA, Shah JS, Penzias AS, et al. Infertility remains a top stressor despite the covid-19 pandemic. Reprod Biomed Online. 2020;41(3):425–427. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Esposito V, Rania E, Lico D, et al. Influence of covid-19 pandemic on the psychological status of infertile couples. Eur J Obstet Gynecol Reprod Biol. 2020;253:148–153. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Tokgoz VY, Kaya Y, Tekin AB. The level of anxiety in infertile women whose art cycles are postponed due to the covid-19 outbreak. J Psychosom Obstet Gynaecol. 2020;19:1–8. [Taylor & Francis Online], [Google Scholar]
- Gordon JL, Balsom AA. The psychological impact of fertility treatment suspensions during the covid-19 pandemic. PloS One. 2020;15(9):e0239253. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Ben-Kimhy R, Youngster M, Medina-Artom TR, et al. Fertility patients under covid-19: attitudes, perceptions, and psychological reactions. Hum Reprod. 2020. doi:10.1093/humrep/deaa248 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Boivin J, Harrison C, Mathur R, et al. Patient experiences of fertility clinic closure during the covid-19 pandemic: appraisals, coping and emotions. Hum Reprod. 2020;35(11):2556–2566. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Esteves SC, Lombardo F, Garrido N, et al. 2020. Sars-cov-2 pandemic and repercussions for male infertility patients: a proposal for the individualized provision of andrological services. Andrology. 2020. doi:10.1111/andr.12809 [Crossref], [Web of Science ®], [Google Scholar]
- Peterson B, Boivin J, Norre J, et al. An introduction to infertility counseling: a guide for mental health and medical professionals. J Assist Reprod Genet. 2012;29(3):243–248. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Peterson BD, Sejbaek CS, Pirritano M, et al. Are severe depressive symptoms associated with infertility-related distress in individuals and their partners? Hum Reprod. 2014;29(1):76–82. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
- Rodriguez-Rey R, Garrido-Hernansaiz H, Collado S. Psychological impact and associated factors during the initial stage of the coronavirus (covid-19) pandemic among the general population in spain. Front Psychol. 2020;11:1540. [Crossref], [PubMed], [Web of Science ®], [Google Scholar]
Current knowledge on the subject
During the COVID-19 emergency, the majority of IVF treatments have been interrupted or postponed.
Patients who have decided to proceed with an IVF in the last couple of months also faced the psychological impact of the COVID-19 pandemic.
The feelings of stress, anxiety, and depression can impact the emotional well-being of couples who should have undergone IVF treatment during the COVID-19 pandemic.
What this study adds
The study population demonstrated a significant prevalence and severity of anxiety.
In particular, the prevalence was higher in women with >35 years and a previous IVF attempt.
IVF centers should systematically offer these couples adequate psychological counseling to improve mental health.