To investigate the impact of the COVID-19 pandemic on the care received by patients with recurrent pregnancy loss (RPL) in British Columbia, Canada. To explore the differential impact of socioeconomic status on health care utilization outcomes during the COVID-19 pandemic for patients with RPL.
Methods
This is a retrospective cohort study of patients from an RPL clinic located within a tertiary referral centre. Patients were divided into 2 groups based on the date of their initial visit to the clinic: (1) pre-pandemic group (March 1, 2018-February 28, 2020) and (2) pandemic group (March 1, 2020-February 28, 2022). Data were sourced from the RPL Clinic Database and Population Data BC. Outcomes assessed included visit trends, immediate pandemic impact, and socioeconomic effects.
Results
Demographic and clinical characteristics were not significantly different between study groups, except for increased referral rates to fertility clinics by the RPL clinic during the COVID-19 pandemic (4.90% vs. 9.50%). The mean number of visits per patient was comparable between pre-pandemic (3.50 ± 2.00) and during the pandemic (3.40 ± 3.40). However, monthly initial visits were lower during the pandemic (12.50 ± 3.10) compared with pre-pandemic (14.40 ± 4.83). Telehealth was rare in the pre-pandemic period and increased dramatically during the pandemic, with virtual visits reaching up to 64% of total and 94% of initial visits. The pandemic's onset caused immediate drops in total (38.80%) and initial visits (51.70%). Health care utilization was higher among those with less material deprivation, whereas contrasting effects were observed in those with less social deprivation.
Conclusions
The COVID-19 pandemic impacted the care received by patients with RPL within a tertiary care centre. There was a shift in how services were provided to patients, uniquely impacting specific populations within the community.
Rojas HE et al., 2026·Journal of women's health (2002)
To characterize differences between individuals with and without mid-cycle pain in a registry cohort with endometriosis. Prospective analysis of data from the Endometriosis Pelvic Pain Interdisciplinary Cohort Data Registry (Clinicaltrials.gov #NCT02911090) at a tertiary referral center in Western Canada. Three hundred forty-five individuals aged 18-49 years who: (1) had at least one episode of menstrual bleeding in the last 3 months, (2) attended a baseline initial visit, and (3) subsequently had surgery with histological confirmation of endometriosis between January 2018 and December 2023. Exclusion criteria included (1) previous hysterectomy; (2) hormonal suppressive therapy use in the last 3 months; and (3) missing data on mid-cycle pain, history of hormonal therapy use, or menstrual cycle regularity. N/A. Mid-cycle pain in the last month versus No mid-cycle pain in the last month. Of the 345 participants, 67% (n = 232) reported mid-cycle pain in the last month. Mid-cycle pain in the last month was significantly associated with higher mean Central Sensitization Inventory score (48 ± 17 versus 36 ± 16, p < 0.001) and more months of prior hormonal suppressive therapy use (58 [14-120] versus 26 [0-109], p = 0.012). Abnormal anatomy at the time of surgery (e.g., endometrioma, ovarian adhesions) was not associated with mid-cycle pain in the last month. In this endometriosis cohort at a tertiary referral center, most participants reported mid-cycle pain in the last month, which was associated with central sensitization but was not clearly related to endometriosis anatomical distortion.
Bouchard TP et al., 2026·Reproductive biomedicine online·Free to read
Do quantitative urinary hormone measurements on the Mira monitor predict and confirm ovulation accurately compared with ultrasound in women with regular menstrual cycles? Do Mira urine hormones correlate with serum hormones?
This was a prospective, single-centre, blinded diagnostic accuracy study with 52 women aged 19-44 years with regular cycles (24-38 days) who tracked 153 cycles over 18 months. Daily first-morning urine was tested with the Mira monitor for follicle stimulating hormone (FSH), oestrone-3-glucuronide (E13G), luteinizing hormone (LH) and pregnanediol glucuronide (PDG). Serial transvaginal ultrasounds (890 scans) confirmed the day of ovulation. Serum hormones were measured twice per cycle. The 121 ovulatory cycles from 49 participants with sufficient index test and reference standard data were included in the final analysis.
The Mira LH peak day strongly predicted ultrasound-confirmed ovulation (R² = 0.96, P < 0.001; intraclass correlation coefficient = 0.971), with 96% of ovulations occurring within ±1 day. The Mira PDG increase was also strongly associated with ultrasound-confirmed day of ovulation (R² = 0.87, P < 0.001). First-morning urine hormones were significantly associated with serum hormones when collected within 90 min (LH: R² = 0.92; E13G: R² = 0.73; R² = 0.61; R² = 0.75). Anovulatory cycles were identified in 11% of regularly cycling participants.
Quantitative urinary hormone monitoring with the Mira monitor provides accurate prediction and confirmation of ovulation, with strong urine-serum associations supporting reduced reliance on serial serum draws in select patients. These findings support clinical adoption of quantitative urinary fertility monitoring.
Balachandran S et al., 2026·Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
To assess the impact of the COVID-19 pandemic on reproductive outcomes in patients with recurrent pregnancy loss (RPL) and the influence of material and social deprivation on these outcomes.
This retrospective cohort study included RPL patients seen at a specialized clinic between March 1, 2018, and February 28, 2022. Patients were categorized into two groups based on care period: pre-pandemic (March 1, 2018-February 29, 2020) and pandemic (March 1, 2020-February 28, 2022). Cumulative probabilities of birth were estimated using the cumulative incidence function within a competing risk framework, treating pregnancy loss as a competing event. Fine and Gray regression models calculated sub-distribution hazard ratio (sHR) of birth.
544 patients were included in the study, with 255 in the pre-pandemic group and 289 in the pandemic group. Individuals in the pandemic group were less likely to achieve pregnancy than those in the pre-pandemic group (relative risk = 0.50, 95% confidence interval [CI] 0.39 - 0.66). Among those who conceived, the cumulative probability of live birth was 0.77 in both groups. Relative to individuals residing in high-social deprivation neighborhoods, those living in moderately deprived areas had higher sub-distribution hazards of live birth (adjusted sHR = 1.97, 95% CI 1.25 - 3.10; P = 0.003).
Within specialized RPL care and a universal maternity care system, pregnancy rates were lower during the first two years of the COVID-19 pandemic. However, among those who conceived, the probability of achieving a live birth remained similar between the pre-pandemic and pandemic periods.
Bouchard TP et al., 2026·Reproductive biomedicine online·Free to read
Does formation of the corpus luteum help to identify the day of ovulation on ultrasound when follicular collapse is missed, and how reliable are sonographers versus a review panel in identifying the day of ovulation on ultrasound? Sonographers in a clinic in Canada performed serial endovaginal ultrasound scans (six to eight per cycle) to identify the day of ovulation in regularly cycling women (n = 40) who were followed for one to five cycles (n = 85). The day of ovulation was identified by: (i) identification of the dominant follicle; (ii) disappearance of the dominant follicle; and (iii) identification and dating of the corpus luteum. The main outcome measures were inter-rater reliability between two sonographers, and Bland-Altman agreement between the supervising sonographer and a panel that reviewed each scan to identify the day of ovulation. Of the 85 menstrual cycles reviewed, two cycles did not have sufficient data to date ovulation, one cycle showed an incidental dermoid cyst, and 11 cycles showed anovulatory patterns. This left a total of 71 cycles (84%) for which intra-rater reliability between two sonographers for identifying the day of ovulation was high (intraclass correlation coefficient = 0.99, P < 0.0001), and Bland-Altman agreement showed no significant difference in the estimated day of ovulation between the supervising sonographer and the panel (t = -0.28, P = 0.78). Corpus luteum criteria were necessary to help identify the day of ovulation in 14 of 71 cycles (20%). The estimated day of ovulation can be determined reliably on ultrasound by trained sonographers using collapse of the dominant follicle and formation of the corpus luteum based on six to eight scans per cycle.
Eckler R et al., 2025·PloS one·Free full text on PubMed Central
To investigate the impact of the COVID-19 pandemic's onset on clinical and demographic characteristics, pregnancy complications, and monthly conception rates resulting in births through spontaneous conceptions and in-vitro fertilization (IVF) in British Columbia (BC), Canada.
This retrospective population-based cohort study examined individuals who gave birth (both live births and stillbirths) in BC between June 1, 2010, and March 31, 2021, with estimated conception dates from January 1, 2010 to June 30, 2020. Data were obtained from the BC Perinatal Data Registry. Two groups were identified based on the estimated conception date: the pre-pandemic conception group (conception from January-1-2010 to February-29-2020) and the pandemic conception group (conception from March-1-2020 to June-30-2020). A time series forecasting method (ARIMA) was employed to observe trends in conception rates during the study period.
304,244 individuals with pregnancies resulting in live births or stillbirths during the study period were evaluated. A total of 429,843 such conceptions were included in the study: 417,753 (97.2%) occurring before the onset of the pandemic and 12,090 (2.8%) in the pandemic period. In June 2020, conceptions resulting in births decreased by 26.6% compared with June 2019. Trends in conceptions resulting in live births were similar, with a conception rate of 235.2 per 100,000 women of reproductive age in June 2020, compared with the expected rate of 305.0 per 100,000. In March 2020, 0.5% of conceptions that resulted in births ended in stillbirths, compared to 1.7% in March 2019. IVF conceptions ending in births declined during the pandemic, dropping to 2.5 and 2.8 per 100,000 in March and April 2020, respectively, compared with the expected 13.1 per 100,000. However, by June 2020, these rates began to recover toward the expected levels. Rates of gestational diabetes mellites (GDM), gestational hypertension (GHTN), and postpartum intensive care unit (ICU) admissions were similar before and during the COVID-19 pandemic.
During the challenging period of the COVID-19 pandemic in BC, couples may have chosen to delay conception. Rates of conceptions resulting in stillbirths remained relatively unchanged. IVF conception rates were impacted by the suspension of elective procedures. Preterm birth rates slightly exceeded expected levels but remained within normal fluctuations, and small increases in GDM and GHTN prevalence were also observed.
Human Fertilisation and Embryology Authority, 2021
# Impact of COVID-19 on fertility treatment 2020
UK statistics for IVF and DI treatment, storage and donation
Published: May 2022
[Download the underlying dataset as Excel Worksheet](https://www.hfea.gov.uk/media/rhih4yyx/impact-of-covid-19-on-fertility-treatment-2020-underlying-dataset.xlsx "Impact of COVID-19 on fertility treatment 2020 - Underlying dataset").
## Table of contents
- [Main points](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#main-points)
- [Foreword](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#foreword)
- [HFEA regulatory response to the COVID-19 pandemic](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#hfea-regulatory-response-to-the-covid-19-pandemic)
- [1\. NHS-funded IVF treatment slower to recover](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#section-1)
- [2\. Treatments decreased by 20% from 2019 to 2020](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#section-2)
- [3\. Greater decrease in IVF cycles among younger patients and patients in heterosexual relationships](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#section-3)
- [4\. Egg donor registrations decreased by 23% from 2019 to 2020](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#section-4)
- [5\. Impact of COVID-19 varied by nation and English region](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertility-treatment-2020/#section-5)
- [6\. COVID-19 caused delays in GP appointments and fertility treatment](https://www.hfea.gov.uk/about-us/publications/research-and-data/impact-of-covid-19-on-fertil...
Wikarek A et al., 2022·Journal of clinical medicine·Free full text on PubMed Central
The COVID-19 pandemic undoubtedly had significant effects on women's health and the course of pregnancy. The aim of this single-center study was to explore the impact of the COVID-19 pandemic on adult pregnant and postpartum women's mental health, as well as to identify factors associated with depressive symptoms, anxiety and fear of delivery. The 465 women included in this questionnaire-based cohort study were divided into two groups: one (controls) of women who gave birth before (n = 190), and the second who were pregnant and delivered during the pandemic (n = 275). The COVID-19 pandemic affected the severity of self-reported anxiety regarding childbirth (mean scores 2.7 vs. 2.36, p = 0.01). The depression (19.84 ± 13.23) and anxiety (16.71 ± 12.53) scores were higher in pregnant women during the COVID 19 pandemic, compared to women who gave birth before the pandemic (8.21 ± 7.38 and 11.67 ± 9.23, respectively). These findings demonstrate the magnitude of the pandemic's impact on women's mental health, and actions to improve the mental health of pregnant women in Poland may be crucial for maternal and fetal well-being.
Zabochnicki M et al., 2024·Annales Academiae Medicae Silesiensis·Free to read
Wprowadzenie Objawy lękowe i depresyjne są powszechnymi objawami w okresie ciąży. Wystąpienie pandemii wirusa COVID-19 jest wyjątkowym stresorem, który wpłynął na psychologiczny aspekt przebiegu porodu. Celem pracy jest ocena wpływu pandemii COVID-19 na przebieg ciąży i porodu w populacji polskiej. Materiał i metody Grupę badawczą stanowiło 2186 kobiet. Badanie ankietowe zostało przeprowadzone w okresie od listopada 2020 r. do grudnia 2020 r. za pośrednictwem Internetu. Kryterium włączenia do badania były ciąża i poród w okresie pandemii COVID-19. Do oceny stopnia poziomu strachu i obaw wykorzystano pytania stworzone przez autorów z zastosowaniem pięciostopniowej skali Likerta. Wyniki U kobiet hospitalizowanych w czasie ciąży występował większy poziom strachu i obaw związanych z ciążą (średnia 30,9 vs 29,6; p = 0,007). Podobną zależność stwierdzono w przypadku kobiet, u których wykonano cesarskie cięcie (30,6 vs 29,5; p = 0,006) lub które były hospitalizowane > 7 dni (31,8 vs 29,7; p = 0,012). Stwierdzono również istotną statystycznie, choć słabą korelację pomiędzy średnimi wynikami pytań dotyczących obaw a liczbą hospitalizacji w czasie ciąży (współczynnik korelacji Pearsona r = 0,1654; p < 0,000). Wnioski Badanie wykazało alarmująco wysoki poziom lęku u kobiet w ciąży podczas pandemii COVID-19, co może mieć długoterminowe konsekwencje dla ich dzieci.
Infertility › Recurrent Pregnancy Loss › Immune and Thrombophilia Factors · Cost and Access › Access and Coverage › Workforce and Availability
Savitha Balachandran, Bahi Fayek, Sabina Dobrer, Amr O Abdelkareem, Paul J Yong, Mohamed A Bedaiwy
S Balachandran, B Fayek, S Dobrer, A Abdelkareem, P Yong, M Bedaiwy
PMID 40090485 40090485 DOI 10.1016/j.jogc.2025.102817 10.1016/j.jogc.2025.102817 Balachandran et al. 2025, Balachandran 2025
