Results
Overall, 524 (308 women; 216 men) out of 646 patients completed the questionnaire (response rate: 81.1%; 95% C.I., 77.7%-84.1%; Figure 1). The mean (± SD) age of the women and men included in the study was 37.3 (± 4.6) and 38.4 (± 6.2) years, respectively. Overall, 187 couples were included in the study analysis, with a median number of previous failed IVF cycles of 2 (range, 0-8). Fifty-six couples (29.9%) were undergoing heterologous fertilization. The other demographic characteristics of the study population are reported in Table 1.
The global prevalence of anxiety or depression or both was 38.9% (204 of 524; 95% C.I., 34.7%-43.3%). The prevalence of anxiety or depression or both was significantly higher in women than in men (45.5% vs. 31.0%; p = 0.001), in women aged more than 35 years (49.3% vs. 46.3%; p=0.036) and with a previous IVF attempt (57.7% vs. 24.1%; p<0.001).
Anxiety was detected in 114 patients (21.8%; 95% C.I., 18.3%-25.5%) with a median total score on GAD-7 of 11 (interquartile range, IQR: 8-15; Figure 2). Among these patients, the most frequent symptom severity was mild (n=58; 11.1%; 95% C.I., 8.5%-14.1%). A higher proportion of women suffered from moderate anxiety (8.8% vs. 1.3%; p<0.001; Table 2). Depression was detected in 93 patients (17.7%; 95% C.I., 14.8%-21.3%) with a median total score on PHQ-9 of 10 (IQR: 9-21; Figure 2). Among these patients, the most frequent symptom severity was moderate (n=63; 12.0%; 95% C.I., 9.2%-14.8%; Table 2). The proportion of women and men affected by mild and moderate depression was not significantly different (p=0.707 and p=0.397, respectively), whereas a higher proportion of men suffered from moderately severe depression (P=0.007). Considering all the patients, there was a significant weak direct correlation between scores obtained at GAD-7 and those obtained at PHQ-9 (R=0.214; p<0.001). Only 38 out of 524 patients (7.3%; 95% C.I., 5.2%-9.8%) had a concomitant diagnosis of depression and anxiety.
In both females and males, the occurrence of anxiety and/or depression was significantly associated with time spent on COVID-19 related news per day (> 1 hour per day, p=0.034) and partner with evidence of psychological disorder (p=0.017; Table 3). The level of instruction and a previous parity did not significantly correlate with the occurrence of anxiety and/or depression (p=0.383 and p=0.679, respectively). Specifically for females, the occurrence of anxiety and/or depression was significantly associated with poor ovarian reserve (p=0.032), diagnosis of endometriosis (p<0.001), diagnosis of uterine fibroids (p=0.040; Table 3). A previous failed IVF cycle was not associated with the occurrence of these psychological disorders (p=0.910); similarly, there was no direct correlation with the number of previous failed IVF cycles (R=0.049; p=0.388).
Overall, 196 patients (37.4%; 95% C.I., 33.4%-41.6%) declared that they would like to undergo the IVF treatment despite the COVID-19 pandemic. Three hundred ninety-one patients (74.6%; 95% C.I., 70.2%-78.2%) reported that they would be reassured if they knew when they could restart the IVF treatment; 206 patients (39.3%; 95% C.I., 35.2%-43.6%) declared that they would change the IVF center if they could restart the IVF treatment immediately.