s a result of the coronavirus pandemic, all UK fertility clinics were required to close their doors in early April. Fertility specialists had to inform their patients, some of whom had been on waiting lists for up to a year and others who were midway through drug cycles, that their treatments were going to be delayed or paused for an indefinite period of time. Shirin Khanjani, a consultant in reproductive medicine and surgery at University College Hospital, who underwent retraining to be redeployed to the NHS Covid-19 frontline, says these were extremely difficult conversations, and that the news was distressing for many of her patients. She explains: “They have waited for months, if not years, to have their treatment and this break in proceedings may have had a damaging impact on their emotional and physical wellbeing.” Although the clinic closures were an understandable part of coronavirus restrictions, and a necessary measure to protect NHS capacity, they left many patients facing uncertain futures. How long would men and women have to wait until they could have a chance to attempt conception? What would be the fate of those patients who found themselves “ageing out” and missing their opportunity for much-needed NHS funding for their treatments? And how about those who were told their fertility was already on a steep decline, who now feared their odds of a successful outcome might irrevocably diminish as lockdown progressed into months? A stressful and rollercoaster experience at the best of times, the pandemic has exacerbated fertility patients’ emotional turmoil, by amplifying the already overwhelming feelings of uncertainty, lack of control and isolation that are often associated with infertility and IVF treatment. As Philomena da Silva, a psychologist working in a fertility clinic told me; “The journey towards parenthood as a fertility patient can be a long, emotionally heightened and precarious experience in itself, and these feelings seemed to increase during the isolation period.” Da Silva has continued to speak to patients over the telephone since lockdown began, and some fertility counsellors have been running online counselling and daily support sessions through Zoom or Facebook. But despite these offerings, for many men and women the unforeseen disruption to their fertility plans has been heartbreaking. As such, the Human Fertilisation and Embryology Authority’s (HFEA) recent announcement that clinics could apply to reopen as of 11 May was generally welcomed by both professionals and patients across the fertility industry. In order to reopen for treatment, clinics will be required to meet the revised general direction and to reconfigure their services to ensure the safety of staff and patients, including compliance with government guidance on social distancing. However, the HFEA does not require clinics to reopen, and it is likely that some will take much longer than others to do so. As with much of the guidance around the transition out of lockdown, here too a great deal of confusion reigns and questions remain unanswered. What will the new requirements mean for the numbers of patients who can be treated at any one time, and how might this impact waiting lists? Will all clinics reopen in a matter of weeks or will some choose to take much longer, depending on local conditions and staff shortages? Can patients who were receiving treatments in clinics that remain closed transfer to alternative clinics? As yet, we simply don’t know. Plus, part of the new requirements will be for patients to actively consent to having treatment while there is a risk that they could contract Covid-19 either during the treatment or if successful, during pregnancy, adding yet another layer of potential anxiety. Some patients are, of course, optimistic and eager to resume their treatment plans as soon as possible. Others are feeling worried or cautious, concerned about a huge range of issues, from how to safely negotiate travel to their soon-to-be-open clinic, to balancing newly emerging care responsibilities or remote working arrangements with the taxing demands of a treatment cycle. And then there are those who are facing additional financial burdens, having lost significant income or even their jobs during this pandemic, and who find themselves having to recalculate the considerable expense of fertility treatment. Sally (not her real name), who was about to start her third cycle of IVF with her husband just before the clinics closed, says the lockdown has been an “incubator of frustrations” for her. She describes her experience of “still” being childless at 37 after six years of marriage as a source of loneliness and perceived exclusion. Over the past two months in particular, she says, it has created “a growing chasm” between her and the friends who’ve variously complained about the impossibilities of home schooling young children and relished the creative activities they finally had time to enjoy as a family. “It’s been quite painful to see all that on social media actually,” she says. “Everyone is doing mum challenges and posting photos of their children, and it kind of rubs it in your face.” For Sally, the reopening of clinics is good news; it gives her an opportunity to try to join the parenthood club she so much wants to become a part of. But it won’t be treatment as usual, and she is yet to find out what new measures her clinic has put in place, or whether she might have to wait longer if they can only treat a smaller number of patients each month. There is, of course, also the question of what might happen to newly reopened clinics if there is a second peak or an increase in the R number. One thing seems fairly clear: fertility patients will require additional medical, emotional and psychological care as part of their treatment during this pandemic, and clinics must build robust support systems as part of their reopening strategies. • Zeynep Gurtin is the lead researcher on a new research project organised by the Institute for Women’s Health at UCL exploring the impact of clinic closures and the coronavirus pandemic on fertility patients’ lives, relationships and feelings. Click here to learn more about this project or to take part in the anonymous online questionnaire