WHAT PREDICTS DESIRE TO PROCEED WITH FERTILITY TREATMENT DURING A PANDEMIC? A RETROSPECTIVE COHORT STUDY FOLLOWING THE COVID-19 SHUTDOWN

ABSTRACT

Objective: We sought to identify factors that contributed to proceeding with ART following the COVID-19 shutdown. Design: Retrospective cohort study. Materials and Methods: Patients who had planned an IVF cycle or frozen embryo transfer between March 2019 and April 27th, 2020, but had not yet undergone their treatment prior to the COVID-19 shutdown were included in this study. Patient demographics were collected including age, parity, AMH, AFC, history of prior IVF cycles or transfer, and number of frozen blastocysts. Data on gamete source and use of a gestational carrier was included. When IVF was resumed, patient decision to move forward with treatment or delay was recorded. Chi-square tests and Wilcoxon rank sum tests were used to assess the association between proceeding with ART treatment for categorical variables or non-parametrically distributed continuous variables, as appropriate. Results: A total of 145 patients planning FET and 133 patients planning a fresh cycle were offered the option to restart treatment. In total, 62% of all patients desired to initiate treatment. Of the 133 fresh cycles, 69 (52%) patients proceeded immediately, compared to 104 of the 145 FET cycles (72%). Among the fresh cycles, there was a trend toward older age among those who moved forward (37 vs 35;p=0.05). FET cycles using a gestational carrier were more likely to continue to delay treatment (7% vs 1 % p=0.04). Conclusions: The majority of patients whose IVF treatment was delayed with the COVID-19 pandemic shut down desired to resume treatment immediately when able. Those proceeding and delaying were similar with regards to most prognostic factors. Older age, however, showed a trend towards moving forward with a fresh IVF cycle and gestational carrier use was associated with continuing to pause on a transfer. While some patients voiced financial or health related concerns, the majority did not provide concrete reasons why they chose to delay or forgo treatment. Further research is needed to understand the reasons patients choose to proceed with fertility treatment in the setting of a pandemic, including more robust data on financial and personal or family health concerns. [Formula presented]