| USA TODAY
For Lisa and Travis Bonner, the process of conceiving was stressful enough, but bringing a pandemic into the process overwhelmed the couple who were ready to undergo their fertility treatment. The 27-year-olds from West Jordan, Utah, were beginning their journey into parenthood after trying to conceive for two years and being diagnosed with unexplained infertility. However, after visiting their local clinic in February, the couple was told their fertility treatment should halt until the COVID-19 outbreak mitigated. “We were told they (the clinic) weren’t doing anything for fertility during COVID, and if we couldn’t get pregnant, they wanted it to stay that way,” Lisa Bonner said.This is why clinics turned to at-home fertility tests. Products such as Proov help women measure progesterone, the hormone linked to the potential of pregnancy after ovulation. Other kits, such as YO Sperm and Fellow, help men with semen analysis. “We saw an increase in sales, and people wanted to continue with fertility,” said Amy Beckley, CEO of Proov. The company experienced a 234% increase between January and October compared to the same period last year. The Bonner family was among the couples who used at-home fertility tests, indicating it was a relief to see some type of progress. The American Society for Reproductive Medicine issued guidance in March urging healthcare providers to suspend the initiation of all new treatment cycles, including ovulation induction, intrauterine inseminations, in vitro fertilization and egg freezing, as well as to consider the cancellation of all embryo transfers. This created a backlog in treatments, leaving many couples uncertain on when they might be able to get pregnant. The new guidance was met with opposition from fertility specialists across the country. The Fertility Providers Alliance criticized the ASRM’s recommendations, claiming it violated the principles of justice, autonomy, and nonmaleficence. The petition by the Alliance garnered over 20,000 signatures. For the Bonner family, bloodwork and hysterosalpingograms were canceled in March, when they were beginning their fertility tests, a month after their initial visit. Cancellations have distressed women who feel they are racing the clock and do not want to risk a decrease in fertility while they wait for treatment. As cases of the virus continue to surge in the United States, some clinics across the nation remain closed, while others have opened depending on their local restrictions or pivoted to virtual appointments. Fertility doctor Aimee Eyvazzadeh runs a clinic in San Ramon, California, where she had to cancel appointments and medications for women in mid-treatment once the guidelines were published. She explained this can cause a financial strain on patients. “Medication costs even more than the medical treatment in many situations,” Eyvazzadeh said. “Imagine you spent all this money on medication, started your cycle and then found out you’re positive for COVID or your clinic shut down. You are out all that money.” The doctor said at-home fertility tests came in handy after her ability to examine a man’s sperm diminished because of the guidance. “These tests helped tremendously,” said Eyvazzadeh. “Now I can check a man’s sperm without any difficulty.” The fertility doctor also explained that at-home fertility tests proved to be the cheaper option for patients, costing over $6 per test instead of higher prices for blood work and a doctor’s visit, which can range from $100 to $200. Clinics began opening after the ASRM released new guidelines in April, stating reproductive care practices can safely resume if their area experiences a sustained reduction in cases for at least 14 days. The Bonners’ clinic reopened in July, creating a four-month delay for the couple. “Many clinics were short-staffed, and they couldn’t accommodate all the cycles at the same time,” Eyvazzadeh said. Backlogs depend on where patients live. In more urban and populous areas, such as the Bay Area, patients won’t experience much trouble getting into an IVF cycle, which usually lasts over 60 days, due to the number of clinics available. “In more remote areas, patients might not get an appointment for another two or three months,” Eyvazzadeh said.Patients such as the Bonner couple felt overwhelmed by the abrupt changes to fertility treatments. Besides experiencing a change in plans, the guidance took an emotional toll on many patients. In April, a survey published in the journal Fertility and Sterility studied the emotional impact of the new guidelines on fertility patients. Of those who had a cycle cancelled, 85% of respondents found it to be moderately to extremely upsetting with 22% rating it to be equivalent to the loss of a child.Clinics are trying to reduce the number of in-person meetings couples must have when going through an IVF treatment, which means that couples must go to the doctor’s office one at a time and must bear any bad news that comes their way without their partner. “Everything is alone, which is really hard,” Bonner said. “It’s lonely because they can’t give you a hug and you’re sitting there crying on your own.” Eyvazzadeh echoed this sentiment, saying she often allows her patients to FaceTime with their partners while they are in her office. The Bonner family is currently testing intrauterine insemination at their clinic, which involves placing sperm inside a woman’s uterus to facilitate fertilization. “If the treatment works out, we’re hoping to be pregnant next year and have a baby by 2022,” said Bonner.