Attempts to Conceive Early in COVID-19 Pandemic Were Related to Education, Self-rated Social Status

Financial stability and education may affect individuals' desire to conceive and their pregnancy planning. The COVID-19 pandemic may have affected these decisions more acutely, but most research has focused on postponing pregnancy.

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Shruthi Mahalingaiah, MD, MS, a reproductive endocrinologist at the Fertility Center in the Department of Obstetrics & Gynecology at Massachusetts General Hospital and assistant professor at the Havard T.H. Chan School of Public Health, and colleagues recently published the first study that prospectively assessed monthly attempts to conceive during the pandemic. In the American Journal of Obstetrics & Gynecology, they report a noteworthy decline in attempts to conceive that seemed related to COVID-19.

Methods

The data source for the study was the ongoing Apple Women's Health Study, launched in November 2019. Women aged 18 and older who feel comfortable communicating in English complete various surveys on their Apple smartphones. The baseline date for this analysis was February 2020, and data were collected through March 2021.

The 21,616 participants enrolled between November 2019 and March 2021 and responded to at least one menstrual survey. The survey included the question, "Did you actively try to get pregnant in the previous calendar month?" Reports of attempts at either natural conception or assisted reproduction were eligible.

Participants completed the MacArthur Scale of Subjective Social Status (SSS) at enrollment. This tool asks participants to rate themselves on a "social ladder" with 10 rungs, where the top rungs represent people with the most money, the most education, and the most respected jobs.

Overall Results

In February 2020, the reference month, 6% of participants attempted conception. In comparison, the results over subsequent months were:

• March 2020—Stable (OR of attempting to conceive, 1.01; 95% CI, 0.94–1.08)
• May 2020—Still stable (OR, 1.02; 95% CI, 0.89–1.15)
• August 2020—Beginning of a sustained decrease (OR, 0.82 compared with February 2020; 95% CI, 0.70–0.97)
• October 2020—OR, 0.82; 95% CI, 0.69–0.97
• March 2021—OR, 0.88; 95% CI, 0.74–1.04

Stratified Analyses

The researchers also examined variations in the odds of attempting to conceive, compared with February 2020, according to individual-level factors:

• Participants without a college education showed a sustained reduction from June 2020 to March 2021; the nadir was in October 2020 with an OR of 0.76 (95% CI, 0.59–0.96)
• College-educated participants showed a reduction starting in July 2020 (OR, 0.73; 95% CI, 0.54–0.99) but by March 2021 had nearly pre-pandemic odds (OR, 0.91; 95% CI, 0.64–1.31)
• Participants with a graduate school degree had elevated odds throughout the study period, with an OR of 1.04 (95% CI, 0.73–1.48) for July 2020, 1.21 (95% CI, 0.83–1.77) for September 2020 and 1.16 (95% CI, 0.80–1.69) for March 2021
• Participants who rated themselves as having low social status (0–3 points on the SSS) showed a decline that began in July 2020 (OR, 0.83; 95% CI, 0.63–1.10) and continued until March 2021 (OR, 0.79; 95% CI, 0.59–1.06)

The findings may be partly attributable to the greater flexibility to work from home experienced by more highly educated and financially secure women. That may have allowed them to focus on pregnancy planning rather than daily concern about virus exposure at work.

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