185 Impact of the COVID-19 pandemic on infertility and endometriosis patients 8 In the current study, the use of video consultations was limited in both patient groups while 39% of the healthcare providers reported using video consultations. A possible reason for this difference could be that the questionnaire for healthcare providers was distributed 3 months later than the questionnaire for patients. After the first lockdown an increased use of video consultations may have occurred as hospitals were developing strategies to continue consultations without inviting patients to their clinics. Another possibility for this difference is that healthcare providers have multiple appointments a day, so an overestimation of the number of video consultations by recall bias cannot be excluded. In accordance with both patient groups, the healthcare providers reported that video consultations are a good addition to regular care for the future, and this is also in line with other recent studies (15, 16). The benefit of video consultations compared with telephone consultations lies in the visual aspect, which aids non-verbal communication and gives a more personal interaction (16). During the same period that this study was being conducted, the Dutch Institute for Public Health and the Environment reported that 23.9% of Dutch citizens were experiencing high levels of stress (17). This is much lower than the 76.7% of the infertility patients who reported stress in the current study. Unfortunately, the specific reasons for this increase of stress were not explored. Earlier studies showed that women with infertility experience a high sense of urgency to obtain treatment (1). The current delay in treatment due to the pandemic could intensify feelings of stress and urgency, as treatment cancellation has previously been negatively associated with quality of life in infertility patients (18). A recent study by Boivin and colleagues found similar results: 11% of participants reported feeling unable to cope with the stress caused by fertility clinic closure (19). Another study investigating the perceptions and psychological impact of the COVID-19 pandemic on infertile patients identified that feeling helpless and having lower self-control and less social support were correlated with higher psychological distress (20). In the current study, women with endometriosis experienced less stress than those with infertility. This may be related to the chronic nature of their illness in comparison to the more time-sensitive issues that patients with fertility problems face. In addition, even though continuous endometriosis care is valued as important, endometriosis patients might be able to accept a temporary decrease of care possibilities or a delay in their yearly appointment. A study performed in Turkey during the first peak of the COVID-19 pandemic showed that 83.9% of responders were afraid of experiencing endometriosisrelated problems during the pandemic, and 63.0% were afraid that their healthcare professional might be unavailable to them during the pandemic (21). In the current study, only 33.1% of patients actually experienced changes in endometriosis-related complaints,
RkJQdWJsaXNoZXIy MTk4NDMw