Infertility is multidimensional and is universally perceived to be a stressful life event.  From familial and societal pressures to have children to uncertainty surrounding treatment outcomes, infertility-related anxiety can be triggered by almost any aspect of a woman’s life. Infertility is as stressful as experiencing a severe medical condition, like cancer, HIV or heart disease.  Yet, there is limited research on the psychological impact of infertility and its treatment, which is even more limited with the emergence of the COVID-19 pandemic. At the outset of the pandemic, there was little data on the transmission of virus between mother and child and the impact of maternal COVID infection on fetal and perinatal outcomes. Due to strict regulations that followed the quarantine mandate, infertility treatment centers shut down.  

To better understand the psychological impact of COVID-19 on the psychological health of pregnant and non-pregnant women undergoing infertility treatment, a team of researchers including Alice Domar, PhD assessed patients from a university-affiliated infertility practice throughout the first COVID-19 surge. The study was conducted from April 2020 to June 2020. (In the Boston area, this time period represents the height of the pandemic where hospitals suspended non-urgent medical care.) Participants were asked to list their top stressors and completed questionnaires assessing anxiety, loneliness, depression, and coping strategies at three timepoints. A total of 443 pregnant women and 1,476 women still experiencing infertility completed all three questionnaires. 

For pregnant patients who conceived after infertility treatment, COVID-19 was the top stressor, with 40% of participants placing it at the top of their list. For non-pregnant patients, infertility was the top stressor (29%). Pregnant patients had lower sadness scores than non-pregnant patients and lower anxiety levels. In addition, pregnant patients participated in less stress-reducing activities than non-pregnant patients. Lastly, when asked about becoming pregnant during the pandemic, pregnant patients were more worried about contracting COVID-19 and experiencing worse pregnancy outcomes.  

The impact of the COVID-19 pandemic on pregnant women is understandable given how COVID-19 has affected all aspects of our lives.  Risk factors for adverse mental health effects included being ?40 years old, female, having lower socioeconomic status, and having a medical condition. Infertile women fit most of these categories, making them the most at risk.  For women undergoing infertility treatment,   health professionals should encourage pregnant women and those attempting to conceive in this ongoing pandemic to engage in stress-reducing activities by providing written and online resources alongside treatment plans.   

 Abibatu Giwa-Osagie

Patient Resources: 

RESOLVE COVID-19 SUPPORT RESOURCE CENTER provides many resources for couples undergoing infertility treatment during the COVID-19 pandemic. RESOLVE support groups are transitioning from in-person to virtual meetings. Please contact the hosts in your area to see if/when they are holding virtual meetings via Google Hangout or Zoom. RESOLVE is also offering monthly virtual peer-led support groups.  Inspire.com is an online platform that hosts RESOLVE’s online support community.

ASRM Webinar For Patients: Taking Care of Yourself During the COVID-19 Pandemic– recorded April 14, 2020 

 References:

 Luk B.H., Loke A.Y. The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: a systematic review. J Sex Marital Ther. 2015;41:610–625. [PubMed] [Google Scholar] 

 Domar A.D., Zuttermeister P.C., Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. J Psychosom Obstet Gynaecol. 1993;14(Suppl):45–52. [PubMed] [Google Scholar] 

 Vaughan D.A., Shah J.S., Penzias A.S., Domar A.D., Toth T.L. Infertility remains a top stressor despite the COVID-19 pandemic. Reprod Biomed Online. 2020;41:425–427. [PMC free article] [PubMed] [Google Scholar] 

 Rasmussen S.A., Smulian J.C., Lednicky J.A., Wen T.S., Jamieson D.J. Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know. Am J Obstet Gynecol. 2020;222:415–426. [PMC free article] [PubMed] [Google Scholar] 

Domar, A. D., Shah, J. S., Gompers, A., Meyers, A. J., Khodakhah, D. R., Hacker, M. R., Penzias, A. S., Sakkas, D., Toth, T. L., & Vaughan, D. A. (2022). The psychological impact of the coronavirus disease 2019 pandemic on women who become pregnant after receiving treatment for infertility: A longitudinal study. F&S Reports, 3(1), 71–78.

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