Mental Health

The Psychological Impact of Covid-19 on Women Pregnant after Fertility Treatment

by Alice Domar

A number of factors consistently affect a country’s birth rate. For example, a country’s birth rate often rides the wave of its economy: When the economy prospers, the birth rate increases and during recessions, it declines. Birth rates also tend to drop during public health crises, which is what happened across the globe during the Spanish Flu.

Since the COVID-19 pandemic began, birth rates in many wealthy countries have dropped significantly. In 2020, the United States’ fertility rate cratered at its lowest ever, Chinese births plunged by 15 percent, and France saw the fewest babies born since WWII.

Previous generations have seen moments of worry and uncertainty, like the infamous “Black Tuesday,” when the U.S. stock market crashed setting off events that led to the Great Depression. The Covid-19 pandemic has instilled in us a longer lasting effect; it has most likely changed us forever. 

How have we changed?

A recent study—“The psychological impact of the COVID-19 pandemic on women pregnant following ART: A longitudinal study” published by Fertility & Sterility Reports, by co-authors including Denny Sakkas, PhD and senior author Alice D. Domar, Ph.D.—delves deeper. 

Dr. Sakkas is a scientific advisor to Rita Health, and Dr. Alice D. Domar is a pioneer in the application of mind/body medicine to infertility care.  Dr. Domar focuses her research on the relationship between stress and a variety of women's health conditions. She has conducted groundbreaking research on infertility, breast cancer, menopausal symptoms, ovarian cancer, and premenstrual syndrome, earning her an international reputation as one of the country's top female health experts. She and her team have created innovative programs that help women alleviate the physical and psychological symptoms associated with infertility.

This recent COVID-19 study highlights the significant impact the pandemic has had on the psychological health of infertility patients who became pregnant just before the pandemic began.

The study

This study was part of a larger study on pregnant patients, of more than 3,000 women who were current or previous Boston IVF patients. Data was collected in the spring of 2020. It involved both women pregnant after going through ART processes and women actively seeking infertility treatments. ART (Assisted Reproductive Technology) refers to fertility treatments where either embryos or eggs are involved. The most common type of ART is in vitro fertilization (IVF). IVF involves extracting a woman’s eggs, fertilizing the eggs in the laboratory, and then transferring the resulting embryos into the woman’s uterus through the cervix.

During the first few months of the pandemic, COVID-19 remained the pregnant women’s  top stressor. However, women still experiencing infertility ranked infertility as their greatest stressor. It’s important to note that infertility patients were unable to receive treatment during the study period as the board of public health in Massachusetts closed all clinics, deeming the treatment nonessential.

Respondents were presented with surveys in April, May, and June.

April’s study was collected during the first surge of the pandemic in the United States and at the height of the first surge in Boston. 

  • 30% of pregnant and 34% of non-pregnant women reported a pre-existing diagnosis of anxiety with 6% of pregnant and 11% of non-pregnant women taking anxiolytic (anti-anxiety) medication.

  • Pregnant women reported higher levels of anxiety than the non-pregnant women but lower levels of sadness. More non-pregnant women reported they were actively taking antidepressants.

In May, the same women were presented with the second survey. 

  • In survey 1 and 2, more pregnant women cited COVID-19 as their most significant stressor than non-pregnant women still seeking infertility treatment.

  • Pregnant women reported being significantly less sad but reported to have moved down to the same anxiety level as non-pregnant women.

The third and final survey was sent in June:

  • Pregnant women reported significantly less sadness and anxiety than the non-pregnant participants.

  • Levels of loneliness for each participant group did not differ.

  • Pregnant women rated their job as their top stressor while non-pregnant women rated infertility as their top stressor. 

  • Pregnant women were more concerned about contracting COVID-19 than non-pregnant women.

One of the biggest disparities observed in the survey:  Although pregnant women were more anxious about COVID-19 than currently infertile participants, the pregnant women were engaging in significantly fewer self-care activities such as seeing a counselor, talking with family or friends, exercising, cooking/baking, using relaxation strategies, reading or watching tv. 

This study illustrates what many of us know either from personal experience or witnessing the experience of women close to us: COVID-19 has had a significant psychological impact on both pregnant women following ART and non-pregnant women who were actively seeking fertility treatments. But if pregnant women are more anxious about COVID, why aren’t they doing more to help themselves feel better?

Innovative research leads to better future for fertility

Given how challenging it was for the women in the study to achieve pregnancies—prior to, during, and beyond the pandemic—we should continue to expand and tailor stress reduction strategies for women now, and for future global challenges. This study has identified a clear disconnect- women pregnant after infertility need to become more aware of the wide variety of things they can do to help themselves feel physically and emotionally healthier. 

Countries would also do well to recognize all women’s health services as essential, especially knowing that during a crisis the burden of caretaking often falls on women who aren’t able to receive or prioritize adequate care for themselves.

Pioneers such as Dr. Alice D. Domar and her groundbreaking research show the importance of recognizing the challenges women face, listening to their needs, and working to find innovative ways to achieve better health and reproductive experiences.