ABSTRACT
OBJECTIVE: The COVID-19 pandemic has created many uncertainties for those pursuing fertility care and assisted reproductive technology (ART) procedures, due to ever-changing healthcare restrictions. There is a lack of research on large-scale data for ART procedures during the pandemic. The objective of our study is to evaluate ART procedures, specifically oocyte retrieval and in vitro fertilization (IVF) cycles, prior to and during the pandemic. MATERIALS AND METHODS: Claims data from Symphony Health, one of thelargest databases of patient-level data on morethan 280 million patientsin the US, was examined from May 1, 2019 to February 28, 2021. Reproductiveaged women were included in the analysis. March - April 2020 was used as a threshold for when healthcare restrictions became widespread. We compared 10 months prior to the pandemic (May 2019 - Feb 2020) and the same time period after the start of the pandemic (May 2020 - Feb 2021). ART procedures were identified using CPT codes (58970 for oocyte retrieval, and S4011, S4015, and S4016 for IVF) under ICD-10. Data analysis was conducted in Stata, version 16.1, using 2-sided t-tests with significance set at P < 0.05. RESULTS: Our search yielded 39,087 oocyte retrievals and 14,365 IVF cycles. The average age of patients who started an IVF cycle (36±4.2 vs 35±4.4 years) as well as the age of those who had an oocyte retrieval (36.2±4.6 vs 35.3±4.7 years) prior to and during the pandemic was statistically different. Time series plots show that, after a substantial drop in focal variables in March - April 2020, ART procedures quickly recovered to pre-pandemic baseline by June 2020. Afterwards, oocyte retrievals increased from 1,703 per month pre-pandemic to 2,010 per month during the pandemic, and this difference approached significance (P=0.06). There was not a significant difference in IVF cycles (677 per month pre-pandemic vs 686 per month during the pandemic, P=0.88). CONCLUSIONS: Despite concerns regarding suspension of ART and delivery of infertility care during the pandemic, our study shows no significant difference in oocyte retrievals and IVF cycles prior to and during the COVID-19 pandemic. IMPACT STATEMENT: These results suggest reassuring outcomes despite a health crisis in the US. There was no significant delay or interruption of fertility care and ART procedures in the US. Further research should examine how other social determinants such as ethnicity, income and geographic location affected access to and utilization of infertility care.
ABSTRACT
OBJECTIVE: The delivery of women's healthcare has changed drastically with the onset of the COVID-19 pandemic. This has undoubtedly created significant uncertainties for those interested in conception counseling. In particular, fertility preservation (FP) is time-sensitive and often emergent or urgent for patients undergoing gonadotoxic therapy. ASRM provided close monitoring and guidelines during this time of crisis. Our objective was to examine the effect of the pandemic on fertility preservation counseling and family planning. MATERIALS AND METHODS: Claims data from Symphony Health, one of the largest databases of patient-level data on more than 280 million patients in the US, was examined from May 1, 2019 to February 28, 2021. Reproductive-aged women were included in the analysis. March - April 2020 was used as a threshold for when healthcare restrictions became widespread. We compared 10 months prior to the pandemic (May 2019 - Feb 2020) and the same time period after the start of the pandemic (May 2020 - Feb 2021). Fertility preservation counseling (Z31.62), FP procedures (Z31.84), and general family planning counseling (Z31.61 and Z31.69) were identified using ICD-10 codes. Data analysis was conducted in Stata, version 16.1, using 2-sided t-tests with significance set at P < 0.05. RESULTS: In our search, 14,491 FP consultations, 15,049 FP procedures, and 359,218 family planning encounters were identified. The mean age of women undergoing FP and family planning counseling decreased significantly when comparing prior to and during the pandemic (31.9±7.6 vs 31.4±7.1 years, and 32.2±6.1 vs 31.6±6 years, respectively). The average age for patients who underwent a FP procedure (33.5±6.5 vs 33±6.4 years) was also statistically different. Time series plot shows a substantial dropin focal variables in March - April 2020. Interestingly, all three variables quickly recovered to prepandemic baseline by June 2020. FP consultations increased from 542 encounters per month pre-pandemic vs 737 per month during the pandemic, P < 0.001. Similarly, FP proceduresincreased from 640 to 781, P=0.02. In contrast, family planning did not change significantly (16,376 vs 17,552, P=0.21). CONCLUSIONS: FP counseling and procedures increased during the pandemic, despite healthcare restrictions and lockdown measures. On the other hand, family planning encounters did not change. Despite barriers to care related to the pandemic, time-sensitive fertility preservation counseling and procedures continued to be utilized. Our findings also reflect ASRM recommendations regarding suspension of non-emergent fertility management at the onset of the pandemic, and continuity of urgent services afterwards. IMPACT STATEMENT: FP counseling and treatment are emergent services that were not negatively impacted by pandemic-related healthcare restrictions. Under ASRM guidelines, FP continued at an increased pace. This experience shows that, under close guidance, emergent or urgent services may be continued during a public health crisis.