A global study across 43 countries has identified Scotland as the country with the longest delay in IVF treatment during the pandemic, with a 228 day wait.

The study, titled "What is the impact of the response to COVID-19 on the management of fertility treatments and clinical practice around the world?" and conducted by Monash University in Australia, said the delay is three times higher than the global average of 60 days – and four times higher than the UK average of 50 days.

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With the global average of 60 days, patients are likely to have missed at least two cycles of treatment. Lead author Elizabeth Cutting said this could be “vital” to their chances of parenthood and warned that delays such as these could greatly impact the chances of a live birth.


The study was published in Reproductive Medicine and was led by PhD student Elizabeth Cutting in the Department of Obstetrics and Gynaecology. It surveyed 43 IVF clinics across countries in Asia, Africa, Europe, North America and South America, focusing on the country's response to the COVID-19 pandemic.

The National: The study focused on IVF clinics across the world's response to the Covid-19 pandemicThe study focused on IVF clinics across the world's response to the Covid-19 pandemic

The introduction states: "With the limited knowledge known regarding Covid-19 and its effects on fertility and pregnancy, a cautionary approach was advised for fertility clinics.

"Living with the uncertainty of the virus, most countries cancelled or delayed assisted reproductive technology (ART) treatment in the initial months of the pandemic (Blumenfeld, 2020)."

Six countries (Austria, China, Germany, Hong Kong, Norway and Portugal) did not experience delays.

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The study found that – in 34 countries – IVF/intracytoplasmic sperm injection (when a single sperm is injected directly into the egg) and frozen embryo transfers had an average of 59 days and 60 days respectively. One clinic in Scotland registered a delay in these procedures of 228 days.

“Patients usually undergo one cycle of treatment in approximately 3 weeks (21 days). With the delays shown, patients on average missed at least two cycles of treatment. For instance, for those needing fertility preservation prior to chemotherapy, missing two cycles may be vital to their chances of parenthood," said Cutting.

According to Cutting, the early days of the pandemic saw IVF clinics adopt a cautionary approach with their patients.

“In the first months of 2020, the available knowledge regarding the effects of SARS-CoV-2 on fertility of pregnancy was based on very limited data,” she said.

“Because of this limited knowledge, most countries cancelled or delayed assisted reproductive technology treatments, opting for telehealth to at least stay in touch with their patients.”

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"The need to stop or delay treatment was guided by the uncertainty of the virus, and the need to reduce the burden of non-essential medical treatments in hospitals to allow resources to be allocated to dealing with people with COVID-19,” she added.

On March 17, 2020, the American Society for Reproductive Medicine announced a “delay (to) any but the most important reproductive care cases”.

Two days later, the European Society for Human Reproduction and Embryology advocated a "cautionary approach", recommending that all infertility patients considering treatment avoid becoming pregnant, because of the unknown effects of SARS-Cov-2 on pregnancy.

The National: The survey was sent to IVF clinics between October 2020 and September 2021The survey was sent to IVF clinics between October 2020 and September 2021

The survey was sent to clinics between October 2020 and September 2021, and found that IVF clinics in nine countries followed their government recommendations (Belgium, Canada, Iceland, Iran, Italy, Nepal, Peru, Saudi Arabia, United States of America), whilst 22 countries, including Scotland, followed a combination of recommendations.

According to Cutting, most clinics preferentially followed the advice of their professional societies, which routinely advised them to take a cautionary approach.

“However, while there was advice regarding virus exposure and transmission, there was a uniform lack of advice regarding the provision of psychological support and how to prioritize patients,” she said.

Cutting is a PhD candidate who is passionate about helping infertility patients, specifically patients with unexplained infertility. She believes fertility is a taboo subject within our society, which leads to miscommunication. Her research aim is to educate younger generations on their bodies, with the hope of prevention over cure.