Introduction
The remarkable increase in the number of infections by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) worldwide raised the prospect of massive hospitalizations that few healthcare systems would face. During the COVID-19 pandemic, the urgent need to avoid a collapse in the healthcare system has been the justification for the implemented measures, and reproductive medicine societies, as well as regulatory authorities, decisively followed by issuing guidance based on expert best judgment (1). The recommendations for practitioners include suspension of initiation of assisted reproductive technology (ART) treatments, suspension of non‐urgent diagnostic procedures, and elective surgical operations.
In the earliest stages of the pandemic, the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM) suggested discontinuing new fertility procedures, such as ovulation induction, intrauterine insemination (IUI), and in vitro fertilization (IVF), as well as non-urgent gamete cryopreservation, cancellation of all fresh or frozen embryo transfers. Exceptions were those patients who are currently ‘in-cycle’ or who require urgent fertility preservation due to cancer treatment (2). More recently, in Europe, with successful mitigation strategies in some areas and the emergence of additional data, societies have allowed gradual resumption of ART procedures (3).
Infertility is already a stressful experience. Indeed, it has been widely documented that the experience of infertility has a significant impact on the psychological wellbeing of both partners and problems such as low self-esteem, sexual distress, depression, guilt, anxiety, frustration, and relational problems within the couple frequently occur in infertile couples (4, 5). Furthermore, psychological factors play an important role in determining the success of assisted reproduction treatments, and the failure of these techniques can further impair the mental health of individuals and couples (6, 7). In addition to this stressful condition, patients who have decided to proceed with an IVF in the last couple of months also faced the psychological impact of the COVID-19 pandemic, which has drastically impacted everyone’s daily lives because of quarantine, social distancing, restrictions in traveling, treatment cancellation along with constant fear for their own and their families in danger (8). This feeling of stress, anxiety, and depression is likely to impact the emotional well-being of couples who should have undergone IVF treatment during the COVID-19 pandemic.
In light of these considerations, this cross-sectional study aimed to explore the changes in the psychological status of infertile patients whose IVF treatments have been interrupted or postponed due to the COVID-19 emergency. In particular, we hypothesized that the COVID-19 experience led to a significant increase in the anxiety and depression levels of these couples and especially of women, who are more subject to the psychological consequences of infertility and its treatments.