The influence of patient education level, pregnancy/breas`efeeding, and infertility treatment on perceptions of the covid-19 vaccine: a mixed methods study

To elucidate infertile patient perceptions of the novel COVID-19 vaccine as it pertained to fertility treatments and future pregnancies. This was an IRB approved, single center mixed methods survey study. A 60-question survey was administered assessing patient perceptions regarding the novel COVID-19 vaccine as it pertained to their fertility care and future fertility treatment. The survey was offered to a total of 760 patients undergoing fertility evaluation and treatment, 192 responded (25% response rate). Fischer exact or McNemar exact tests were performed depending on quantitative data distribution. Responses to the open-ended questions were analyzed using inductive content analysis to generate qualitative themes. Quantitative: Of the 192 respondents most were white females, holding private insurance, with a college degree. Participant willingness to accept the COVID-19 vaccine was analyzed in conjunction with various demographic variables to determine trends between these variables and vaccine acceptance. Respondents’ age, marital status, income level and insurance status did not correlate with perceived willingness to accept the COVID-19 vaccine. However, respondents who reported having a college education were more likely to consider the COVID-19 vaccine when it became available to them (No Degree= 5/16 (31.3%), College Degree= 76/104 (73.1%), Post-graduate Degree= 57/67 (85.1%), N=187, P<0.001). When asked if pregnancy or breastfeeding impacted respondents' willingness to consider the COVID-19 vaccine 79 (43.9%) responded yes, while 101 (56.1%) responded no or unsure. When participants’ responses were stratified by the number of previous completed fertility treatments (either embryo transfers or intrauterine inseminations), there was a statistically significant trend of increasing willingness to receive the COVID-19 vaccine during a pregnancy or while breastfeeding (1 Treatment= 53/135 (39.2%), 2 treatments= 19/37 (51.3%), 3 treatments= 6/6(100%), N=180). Qualitative themes included participants’: fear of the unknown due to existing perceptions, beliefs, and mistrust; interpretations of medical knowledge and self-generated benefit-risk assessments, and desire for provider guidance and mindful communication. This study suggests that despite identified hesitancy of the COVID-19 vaccine, patients with higher levels of education and those who completed >2 infertility treatments were more willing to consider the COVID-19 vaccine, even with pregnancy or breastfeeding in mind. Patients unwilling to receive the vaccine reported mistrust in healthcare, lack of communication with providers, and medical misunderstanding while formulating benefit-risk assessments.