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.