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. 2022 Apr;44(4):378-382.
doi: 10.1016/j.jogc.2021.10.017. Epub 2021 Nov 5.

Impact of the COVID-19 Pandemic on Access to Fertility Care: A Retrospective Study at a University-Affiliated Fertility Practice

Jennifer Sau-Gee Lam  1 , Mahvash Shere  2 , Nickan Motamedi  2 , George A Vilos  3 , Basim Abu-Rafea  3 , Angelos G Vilos  3
Affiliations

Impact of the COVID-19 Pandemic on Access to Fertility Care: A Retrospective Study at a University-Affiliated Fertility Practice

Jennifer Sau-Gee Lam et al. J Obstet Gynaecol Can. 2022 Apr.

Abstract
in English, French

Objective: To elucidate the impact of the COVID-19 pandemic on access to fertility services.

Methods: A retrospective quality improvement study was conducted at a university-affiliated fertility practice in southwestern Ontario. Annual procedural volumes for intrauterine and donor inseminations (IUI/DI), in vitro fertilization and intracytoplasmic sperm injections (IVF/ICSI), and frozen embryo transfers (FET) during the COVID-19-affected year were compared with mean annual volumes from the 2 preceding years. In addition, volumes for the same procedures were compared between the first quarter of 2021 and mean first quarter volumes from 2018 to 2019. Piecewise linear regressions were conducted to evaluate whether any changes in monthly procedural volume were attributable to the COVID-19 pandemic.

Results: In 2020, our fertility practice attained the mean annual volumes of 89.7% for IUI/DI, 69.0% for IVF/ICSI, and 60.6% for FET. In contrast, in 2021, we performed mean first quarter volumes of 130.1% for IUI/DI, 164.3% for IVF/ICSI, and 126.8% for FET. The slopes of the pre- and post-COVID-19 segments of the piecewise linear regressions were significantly different for IUI/DI (P < 0.001) and IVF/ICSI (P = 0.001), but not for FET (P = 0.133).

Conclusion: The COVID-19 pandemic resulted in decreased annual volumes of medically assisted reproductive procedures at a university-affiliated fertility practice in southwestern Ontario. Impact on monthly procedural volume was confirmed for IUI/DI and IVF/ICSI by linear regression. Local adaptations helped compensate and exceed expected volumes in 2021. As a result, the COVID-19 pandemic resulted in a short-lived limitation in access to fertility care.

Objectif: Examiner les répercussions de la pandémie de COVID-19 sur l’accès aux services de fertilité.

Méthodologie: Une étude rétrospective sur l’amélioration de la qualité a été menée dans une pratique de traitement de l’infertilité affiliée à une université dans le sud-ouest de l’Ontario. Les volumes annuels des techniques pour l’insémination intra-utérine et l’insémination avec sperme de donneur (IIU/IIUD), la fécondation in vitro et les injections intracytoplasmiques d’un spermatozoïde (FIV/IICS) et les transferts d’embryons congelés (TEC) au cours de l’année touchée par la pandémie de COVID-19 ont été comparés aux volumes annuels moyens des 2 années précédentes. De plus, les volumes pour les mêmes techniques ont été comparés entre le premier trimestre de 2021 et les volumes moyens du premier trimestre de 2018 et de 2019. Des régressions linéaires par segments ont été réalisées pour évaluer si des changements dans les volumes mensuels des techniques étaient attribuables à la pandémie de COVID-19.

Résultats: En 2020, notre pratique de traitement de l’infertilité a atteint des volumes annuels moyens de 89,7 % pour les IIU/IIUD, 69,0 % pour les FIV/IICS et 60,6 % pour les TEC. Par comparaison, en 2021, nous avons réalisé des volumes moyens au premier trimestre de 130,1 % pour les IIU/IIUD, 164,3 % pour les FIV/IICS et 126,8 % pour les TEC. Les courbes des segments pré- et post-COVID-19 des régressions linéaires par segments étaient significativement différentes pour les IIU/IIUD (p < 0,001) et les FIV/IICS (p = 0,001), mais pas pour les TEC (p = 0,133).

Conclusion: La pandémie de COVID-19 a entraîné une diminution des volumes annuels des techniques de reproduction médicalement assistée dans une pratique universitaire de traitement de l’infertilité du sud-ouest de l’Ontario. Des régressions linéaires ont permis de confirmer un effet sur le volume mensuel des techniques d’IIU/IIUD et de FIV/IICS. Des adaptations locales ont aidé à compenser cet effet et à dépasser les volumes prévus en 2021. Par conséquent, la pandémie de COVID-19 a entraîné une limitation de courte durée de l’accès aux soins de l’infertilité.

Keywords: COVID-19; coronavirus; fertility clinics; infertility; pandemics.

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Figures

None
J. Sau-Gee Lam
Figure 1
Figure 1
Piecewise linear regression models for IUI/DI, IVF/ICSI, and FET to compare the trends in monthly procedural volume before and after the onset of the COVID-19 pandemic. Pre–COVID-19 was defined as January 1, 2018, to February 29, 2020. Post–COVID-19 was defined as March 1, 2020, to May 31, 2021, to incorporate the first month affected by the pandemic. The breakpoint is delineated by a dotted line. P values refer to the comparison of pre– and post–COVID-19 slopes.
Figure 2
Figure 2
Local and systemic factors that contributed to decreased procedural volumes with COVID-19. COVID-19: coronavirus disease 2019; DI: donor insemination; FET: frozen embryo transfer; ICSI: intracytoplasmic sperm injection; IUI: intrauterine insemination; IVF: in vitro fertilization; PPE: personal protective equipment; TI: timed intercourse.
Figure 3
Figure 3
Ishikawa diagram enumerating factors that contributed to improved procedural efficiencies in the first quarter of 2021.
See this image and copyright information in PMC

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