COVID-19 case reporting

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* 1. In which country do you work?

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* 2. Are you reporting a case from a private or a public centre?

Public centre

Private centre

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* 3. Your profession is:

Gynaecologist

Reproductive Urologist/Andrologist

ART clinician

Nurse

Embryologist

Lab technician

Quality manager

Other (please specify)

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* 4. Please enter a patient reference number from your clinic. The patient reference number can be used for submitting further details of the case at a later stage via email to (please specify). Please note that this reference number should not contain any patient identifiers.

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* 5. Please add your email address so we can contact you for further updates on this case

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* 6. Was the COVID-19 infection in the patient confirmed with laboratory tests?

Yes, by RT-PCR

Yes, by antibody test

No, but there is a strong suspicion of a COVID-19 infection

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* 7. At what stage of the pregnancy did the patient have symptoms and was tested?

During the MAR treatment (including 15 days after embryo transfer)

First trimester

Second trimester

Third trimester

At delivery

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* 8. Which symptoms did the patient have (check all that apply)?

High fever (>37,5°C)

Cough

Pneumonia

Anosmia (no smell)

Ageusia (Loss of taste)

Gastrointestinal symptoms

No symptoms

Other symptoms (please specify)

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* 9. Was the patient hospitalized?

Yes, in a general ward

Yes, with respiratory support

Yes, in the intensive care unit

Yes, in the intensive care unit with respiratory support

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* 10. Are you aware of antiviral treatments used?

I do not have this information

Yes (please specify)

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* 11. Did the patient recover?

No, the patient died

No, the patient is/was still in recovery

Yes

If she was hospitalized, please specify duration (in days):

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* 12. How did the patient achieve pregnancy?

Ovulation induction

IUI

IVF

ICSI

Donor IUI

Donor sperm IVF/ICSI

Oocyte donation

FER (frozen embryo replacement)

FOR (frozen oocyte replacement)

PGT-A

PGT-M

PGT-SR

Surrogacy

Embryo donation

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* 13. Please provide any relevant medical background history for the patient (what diseases did she suffer from?)

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* 14. Where there any pregnancy complications (check all that apply)

No pregnancy complications

Miscarriage

Ectopic pregnancy

Excessive bleeding

Pre-eclampsia

Intrauterine growth restriction

Stillbirth

Preterm birth (< 37 weeks)

Very preterm birth (< 32 weeks)

Extremely preterm birth (< 28 weeks)

Maternal death

Other (please specify)

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* 15. What was the mode of delivery?

Vaginal

Emergency C-section

Scheduled C-section

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* 16. What was the gestational age at delivery (in weeks)?

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* 17. Where there any neonatal complications? (check all that apply)

There were no neonatal complications

Respiratory symptoms

Fever

Other (please specify)

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* 18. What was the birth weight of the newborn?

Normal (> 2500g)

Low (< 2500g)

Very low (< 1500g)

Extremely low (< 1000g)

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* 19. What were the APGAR scores at 1 minute?

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* 20. What were the APGAR scores at 5 minutes?

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* 21. Was the COVID-19 infection tested in the newborn?

Yes, Positive test result

Yes, negative test result

Not tested

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* 22. What was the COVID-19 infection test result in the newborn? (Mark all that apply)

IgM antibody test Positive test result

IgM antibody test Negative test result

IgM antibody test not tested

IgG antibody test Positive test result

IgG antibody test Negative test result

IgG antibody test not tested

RT-PCR test Positive test result

RT-PCR test Negative test result

RT-PCR not tested

Please comment or provide further details

COVID-19 case reporting

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* 1. In which country do you work?

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* 2. Are you reporting a case from a private or a public centre?

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* 3. Your profession is:

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* 4. Please enter a patient reference number from your clinic. The patient reference number can be used for submitting further details of the case at a later stage via email to (please specify). Please note that this reference number should not contain any patient identifiers.

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* 5. Please add your email address so we can contact you for further updates on this case

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* 6. Was the COVID-19 infection in the patient confirmed with laboratory tests?

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* 7. At what stage of the pregnancy did the patient have symptoms and was tested?

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* 8. Which symptoms did the patient have (check all that apply)?

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* 9. Was the patient hospitalized?

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* 10. Are you aware of antiviral treatments used?

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* 11. Did the patient recover?

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* 12. How did the patient achieve pregnancy?

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* 13. Please provide any relevant medical background history for the patient (what diseases did she suffer from?)

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* 14. Where there any pregnancy complications (check all that apply)

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* 15. What was the mode of delivery?

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* 16. What was the gestational age at delivery (in weeks)?

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* 17. Where there any neonatal complications? (check all that apply)

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* 18. What was the birth weight of the newborn?

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* 19. What were the APGAR scores at 1 minute?

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* 20. What were the APGAR scores at 5 minutes?

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* 21. Was the COVID-19 infection tested in the newborn?

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* 22. What was the COVID-19 infection test result in the newborn? (Mark all that apply)

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* 23. Please make any further comments with regards to this case

* 19. What were the APGAR scores at 1 minute?

* 21. Was the COVID-19 infection tested in the newborn?