HOW MUCH LONGER? RATES OF ART DELAY OR CANCELLATION DURING THE COVID-19 CRISIS

ABSTRACT

OBJECTIVE: The strain on the healthcare system and attempts to limit virus transmission during the COVID-19 pandemic reduced patients' access to healthcare services, particularly those seeking specialized or elective health services such as infertility treatment. Mandatory fertility clinic closures prolonged conception efforts and further complicated the already arduous family building journey. This study investigates the incidence of assisted reproductive technology (ART) delay or abandonment during the COVID-19 pandemic and assesses whether these rates varied by U.S. geographic region. MATERIALS AND METHODS: A survey was administered to users of Ovia Health's Fertility mobile application in the United States from March 2020 to April 2021. A Chi-squared test was performed to assess differences in ART delay or cancellation and geographical region. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 20,047 respondents qualified for inclusion in this analysis. Of the 16,527 respondents currently or formerly trying to conceive within the last six months, 16% reported utilizing intrauterine insemination (IUI), in vitro fertilization (IVF), or another form of ART. Though the majority of treatments proceeded as planned, almost one in five (17%) were delayed or cancelled between March 2020 and April 2021. Main contributors to the decision to delay or cancel ART efforts were temporary fertility clinic closures (28%), concern about the impact of COVID-19 on pregnant people or fetuses (28%), attempting to avoid healthcare facilities (22%), lack of availability of support people during pregnancy and labor (17%), and concerns about finances or job security (16%). ART delay or cancellation did not differ by geographic region (p > 0.05). CONCLUSIONS: Our results demonstrate how the closure of fertility clinics during the COVID-19 pandemic and concern about COVID-19's detrimental impact during pregnancy pushed people seeking these services to delay indefinitely or altogether abandon their family building efforts. These trends were similar across the United States, regardless of geographical region. As ART treatments and care plans resume, reproductive medicine specialists should reinforce safety mitigation strategies to reduce the risk of COVID-19 transmission, foster COVID-19 vaccination discussions, and empower and restore patients' confidence with the latest COVID-19 research findings. IMPACT STATEMENT Clinical service models resuming ART services should center around addressing patients' main concerns for delaying or abandoning ART efforts, especially focused on empowering patients whose family building journeys were interrupted by fertility center closures during the COVID-19 pandemic.