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Study question What are the effects of the initial COVID–19 response on the management of fertility clinics and clinical practice around the world? Summary answer In the COVID–19 outbreak, the large majority of fertility clinics worldwide suspended fertility treatments. In cycles that continued, there was a shift to frozen embryo-transfer. What is known already After the initial months of 2020 showed a rapid spread of the new Coronavirus SARS-CoV–2, the World Health Organisation declared a global pandemic on 11 March 2020. Occupation of health care facilities with acutely sick patients and the need to reduce infection transmission led to a reduction in capacity to perform elective medical procedures. Little was known on the global impact of COVID–19 on fertility care. With the implication of ‘lockdowns’ in different countries around the world to stop the spread of the virus, the question was posed on how fertility clinics and treatments would proceed moving forward. Study design, size, duration We surveyed fertility clinics with an online questionnaire developed through the platform RedCap (HELIX). The questionnaire contained 33 questions focused on the differences of country responses to different body guidelines including American Society for Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE). Fertility clinic associates were contacted through the use of a known contact list comprising scientific directors, medical directors and lab managers. Participants/materials, setting, methods Study participants were individuals associated with fertility clinics around the world with at least one representative from each country. The questionnaire was active from 13th October 2020 until 21st January 2021. The time frame was specific to the country’s response to their first lockdown. The survey was approved by Monash Health Human Research Ethics Committee(#65223). All survey answers were anonymous with only the countries’ name as a reference for analysis. Main results and the role of chance There were 34 individual country responses,Asia(11), Europe(10), Africa(3), North America(3), Oceania(2) and South America(5). Of the 34 countries, 7 countries did not experience a complete stop of all procedures. Most countries (18) followed their government body recommendations. One country followed local recommendations, 3 followed local and international recommendations, 3 countries changed by clinic initiative and 7 countries did not specify. ASRM and ESHRE were the two most common guidelines mentioned. IVF/ICSI treatment had delays in 28 countries ranging from 14 (Scotland) to 160 (Egypt) days. FETs were delayed in 29 countries ranging from 15 (Pakistan) to 228 (Scotland) days. Couples undergoing timed intercourse experienced the least delay in treatment (13 countries). AI/OI (artificial insemination/ovulation induction) patients were delayed treatment in 25 countries, fertility consultations were delayed in 20 countries. During the quarantine period, the amount of freeze-all cycles increased in 16 countries with the ratio of IVF-ICSI remaining constant pre and post lockdown. Patients were reported to undergo a SARS-CoV–2 test in 17 countries. 11 countries reported having a procedure in place for patients whom tested positive, 6 countries reported no procedure in place for positive patients. Additional support counselling was offered for patients during the pandemic in 22 countries. Limitations, reasons for caution Our survey does only represent a minute sample of countries. As only one representative from each country was used, the results obtained are specific to the individual’s anonymous clinic. However, the questionnaire includes questions that specifies if the clinic was performing outside the country’s scientific society recommendations. Wider implications of the findings: During the COVID–19 pandemic most fertility services were suspended, providing insight to the implications of a shutdown and whether a protocol for scenarios of this nature could benefit outcomes for future events. A protocol that allows continuation of care,including telehealth and guidelines for prioritizing couples who need care most urgently. Trial registration number

P–790 Effects of COVID–19 quarantine period on Fertility Treatment and IVF Clinic management