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 interests: There was no funding for the study, apart from technical support from ESHRE. The authors had no COI to disclose.

Keywords: ART; COVID-19 pandemic; ESHRE; SARS-CoV-2; access to services; assisted reproduction; coronavirus disease 2019; infertility; severe acute respiratory syndrome coronavirus 2.

Figure 1

Timeline for the outbreak of COVID-19 in Europe. COVID-19, coronavirus disease 2019; MAR, medically assisted reproduction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; EU/EAA, European Union/European Economic Area; WHO, World Health Organization.

Figure 2

Overview of cessation and restart of MAR/ART activities in Europe between 1st of March and 30th of May 2020.

Figure 3

Overview of whether suspension of MAR/ART treatments was voluntary, recommended or enforced by national or local authorities.

Figure 4

Examples of the reported number of daily new cases and deaths associated with COVID-19, with an indication of the date MAR/ART activity was stopped (red) and restarted (green) for four countries. Graphs on all countries are included in Supplementary Figure S1.

Figure 5

Treatment stop and restart according to the phases in the epidemic. (A) Overview of the different graphs for a single country, including a division in four phases of the epidemiological curve, including lag, exponential stationary and decline phase. (B) The percentages of countries that stopped and restarted their activities per phase of the epidemiologic curve.