A picture of medically assisted reproduction activities during the COVID-19 pandemic in Europe

Abstract

STUDY QUESTION How did coronavirus disease 2019 (COVID-19) impact on medically assisted reproduction (MAR) services in Europe during the COVID-19 pandemic (March to May 2020)? SUMMARY ANSWER MAR services, and hence treatments for infertile couples, were stopped in most European countries for a mean of 7 weeks. WHAT IS KNOWN ALREADY With the outbreak of COVID-19 in Europe, non-urgent medical care was reduced by local authorities to preserve health resources and maintain social distancing. Furthermore, ESHRE and other societies recommended to postpone ART pregnancies as of 14 March 2020. STUDY DESIGN, SIZE, DURATION A structured questionnaire was distributed in April among the ESHRE Committee of National Representatives, followed by further information collection through email. PARTICIPANTS/MATERIALS, SETTING, METHODS The information was collected through the questionnaire and afterwards summarised and aligned with data from the European Centre for Disease Control on the number of COVID-19 cases per country. MAIN RESULTS AND THE ROLE OF CHANCE By aligning the data for each country with respective epidemiological data, we show a large variation in the time and the phase in the epidemic in the curve when MAR/ART treatments were suspended and restarted. Similarly, the duration of interruption varied. Fertility preservation treatments and patient supportive care for patients remained available during the pandemic. LARGE SCALE DATA N/A LIMITATIONS, REASONS FOR CAUTION Data collection was prone to misinterpretation of the questions and replies, and required further follow-up to check the accuracy. Some representatives reported that they, themselves, were not always aware of the situation throughout the country or reported difficulties with providing single generalised replies, for instance when there were regional differences within their country. WIDER IMPLICATIONS OF THE FINDINGS The current article provides a basis for further research of the different strategies developed in response to the COVID-19 crisis. Such conclusions will be invaluable for health authorities and healthcare professionals with respect to future similar situations. STUDY FUNDING/COMPETING INTEREST(S) There was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.

Twinning during the pandemic

“…Interventions in Norway intended to increase social distancing early in the pandemic included suspending medically assisted reproduction (MAR) services [ 51 ]. Twins, therefore, could appear less frequently among cohorts conceived from mid-March through April 2020 because gestations begun in assisted reproduction clinics produce more than their proportional share of twins.…”

A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

“…The eventual resumption of ART and fertility care worldwide was in line with the decline phase of local epidemiologic curves of incidence, as well as, a reduction of the impact of COVID-19 on healthcare resources [2,[110][111][112][113]. In Canada, the guidance on reopening of fertility clinics was given by the local provincial reopening strategies and outlined in the CFAS COVID-19 Update # 5 from April 29th, 2020, which was supported by two guiding CFAS documents "Guiding Principles to assist Canadian ART clinics to resume services and care" [114] and "Recommendations related to IVF Laboratory shutdowns and start-up during a Pandemic" [115] to assist clinics in their preparations for resumption of care.…”

A qualitative study examining transgender people’s attitudes towards having biological children and pursuing fertility treatments in Greece

“…Note however that while there is not pause in these services for cancer patients receiving gonadotoxic therapies, 'in practicality, loss of general IVF may impact practices' standard operations' [71]. In the same vein were the recommendations of the European Society of Human Reproduction and Embryology (ESHRE) [70] Note, however, that in European countries fertility preservation treatments remained available during the pandemic [72]. Nevertheless, these treatments in a given society may be distributed unevenly in the context of the strategies that have been developed in response to the COVID-19 crisis (i.e.…”