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Study question How did patients experience the delays and disruptions to their fertility treatment that occurred as a result of the Covid-19 pandemic and resulting clinic closures? Summary answer Patients reported feeling ‘powerless/helpless’ (78.3%), ‘frustrated’ (59.3%), and ‘anxious’ (54.7%), and detailed why clinic closures were experienced as a devastating double disruption. What is known already Fertility patients found clinic closures and the disruption to their treatments stressful due to uncertainty and perceived threats to their goal of parenthood, and experienced an increase in anxiety and depression. However, paper goes far beyond the mostly quantitative data that has been published by analysing patients’ detailed qualitative accounts of their feelings and experiences in their own words. Study design, size, duration A mixed-methods, anonymous, online questionnaire in English was live for 6 weeks between 19 May to 30 June 2020. All patients aged over 18, whose fertility treatment or investigations had been impacted by the coronavirus pandemic were eligible to take part. The questionnaire was widely distributed using mainstream media, social media, and the mailing lists of relevant organisations. In total 709 people began and 501 completed the questionnaire in the time available (70.7% completion rate). Participants/materials, setting, methods The questionnaire included ten parts with a mixture of quantitative and qualitative items. The responses of 457 female fertility patients who were resident in the UK were analysed. The average age was 34.6 (SD = 4.9). The majority were in a heterosexual relationship (91.0%), white (90.6%), and had no children (87.1%). Descriptive and inferential statistics were used on quantitative data, and thematic analysis used for qualitative data. Main results and the role of chance Using insights from the sociology of reproduction, including how patients face and resolve “disruption” (Becker 1997), this paper presents qualitative accounts from fertility patients regarding their feelings, reactions and experiences regarding the Covid-19 pandemic and the resulting clinic closures. Respondents highlighted the intensity of their feelings, noting that their lives seemed “paused”, “stopped” or “thrown into a state of limbo”, leaving them unable to move forward with crucial life plans. Moreover, many explained that clinics closures were not experienced simply as a disruption, but rather as an additional hurdle in what had already been a series of difficult disruptions to normalcy, including, in many cases, an unforeseen inability to conceive naturally, long waiting lists for fertility treatment, and treatment delays due to economic or other factors. The major themes to emerge from respondents’ accounts were: lack of control; lack of support; and feelings of difference, isolation and being left out. In many ways, the Covid-19 related disruptions exacerbated and added to fertility patients’ existing anxieties and frustrations. One respondent wrote, “IVF is one of the most stressful things you can go through. To then be in the middle of that during a global pandemic it makes it even more stressful.” Limitations, reasons for caution Participants were self-selecting and reporting their feelings and reactions at one particular point in time. Only responses from 457 UK-residents were included in the analyses. Wider implications of the findings These findings show that patients attending fertility clinics need additional support and care during times of uncertainty and disruption, and that many regard their treatment as an essential medical service. We encourage governments and regulators to keep fertility clinics open whenever it is possible to safely do so. Trial registration number Not applicable

O-193 A devastating double disruption: IVF patients’ feelings and experiences regarding treatment delays due to Covid-19