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Study question Which pshycological factors have influenced the choice of infertile couples seeking for ART treatment during Phases 2 and 3 of COVID–19 pandemic in Italy? Summary answer Couples undergoing ART treatment during Phases 2 and 3 of COVID–19 pandemic in Italy show low levels of anxiety and depression and a problem-centred attitude. What is known already COVID–19 pandemic has exposed people to psychological and health safety risks, forcing acceptance of important work and social restrictions. In lockdown Phase 1, all ART procedures were suddenly suspended. This was superimposed to the already critical emotional burden carried by infertile couples undergoing ART treatments. In our analysis performed in Phase 1, couples showed a logical consciousness regarding the need of such measures, given the evident risks, but the emotional drive was towards the continuity of the ART procedure. The emotional impact linked to the obligation of ART treatment suspension was in fact superior than that due to the lockdown. Study design, size, duration From July 7th to November 28th of 2020, an online form was made available to the patients of the Biogenesi Reproductive Medicine Centre of Monza and of the Eugin Fertility Clinics in Italy (Milano, Modena and Taranto), which was filled anonymously and voluntarily by 326 subjects. Participants/materials, setting, methods The questionnaire was composed by sociodemographic data, a Zung’s scale for anxiety self-evaluation, a Zung’s scale for depression self-evaluation, the COPE-NVI–25 questionnaire, five specific questions relative to what contributed for the decision of undergoing ART treatment during Phases 2 and 3 of the pandemic, and four specific questions relative to which support measures could have been efficacious to reduce stress. Main results and the role of chance: Of the 326 subjects included in the study, 19.9% were men and 80.1% were women; 77.3% underwent homologous and 22.7% underwent heterologous treatments; 44.5% lived in Lombardy, 20.9% in Liguria and the remaining 34.6% in different parts of Italy; 75.6% were seeking for maternity/paternity for less than 5 years and 24.4% for more than 5 years. The overall level of anxiety was low, as well as the level of depression, without any particular variations for gender or treatment type. The COPE-NVI–25 questionnaire revealed that couple strategies linked to a positive attitude towards the problem prevailed. What mostly contributed to ART treatment start or continuity in Phases 2 and 3 was the support to the couple agreement, couple age and the non-renounceable desire of having a child. Among the possible supporting measures aiming to reduce ART-related stress in this context we identified: greater support from the partner and inclusion of supporting treatments such as nutritional advises, massage and specifically driven physical activity. Limitations, reasons for caution The range of the present study is limited by the number of voluntaries and possible unprecise representation of the real ART patient population in Italy. The results presented could have been affected by variables that are uncontrolled for. Wider implications of the findings: The findings contribute to understand the psychological status of infertile couples that start or resume ART treatments under stressful conditions determined by the COVID–19 pandemic. These data shall provide valuable references for multidisciplinary discussion and strategy formulation aiming to improve the overall quality of ART treatments. Trial registration number Not applicable

human reproduction

P–506 Low anxiety and depression levels and a confronting attitude characterise infertile couples undergoing ART treatments during phases 2 and 3 of COVID–19 pandemic in Italy