ASSISTED REPRODUCTIVE TECHNOLOGY PROCEDURES IN THE US PRIOR TO AND DURING THE COVID-19 PANDEMIC

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.