Her fertility medication had arrived and Ellen Rayment was waiting for the first day of her period so she could begin taking it. Rayment, a 40-year-old health professional from East Sussex, had been trying to conceive with her wife Debby for three years. It had been costly and emotionally draining. The Rayments were declined treatment on the NHS because they were using donor genetic material, so they had spent in excess of 20,000 on private IVF.

In November 2019, Rayment had miscarried twins at 22 weeks. After taking some time to both physically recover and grieve, Rayments doctor gave her the go-ahead to proceed with egg implantation using the final frozen embryo from their second round of IVF in March. She was waiting for her period to start before taking the medication to thicken her uterine wall, ahead of embryo implantation. But when that came it was on the same day Boris Johnson announced a nationwide lockdown to prevent the spread of coronavirus. All non-urgent medical procedures, including IVF, would be postponed. Her clinic called her to confirm the bad news.

With each month that Britain spends under lockdown, Rayment can feel her dreams of motherhood slipping away. My biological clock is ticking louder and louder, she says. Rayment is aware that, after 40, it is difficult to conceive through IVF. It just feels horrific, to be honest, she says.

Rayment is one of a number of women whose IVF treatments have been cancelled due to the coronavirus pandemic. Although many IVF clinics decided to suspend treatment after Johnsons 23 March announcement, the Human Fertilisation and Embryology Authority, which oversees all NHS IVF clinics, did not officially stop all fertility treatments until 15 April. Exceptions are being made only when women are undergoing fertility-preservation treatment ahead of radiotherapy or chemotherapy for serious diseases.

We will do all we can to lift this restriction as soon as possible but we cannot give a date when this will happen given the current situation with the Covid-19 pandemic in the UK our aim is for the UK fertility sector to restart as soon as possible and we are keeping the situation under regular review, says an HFEA spokesperson. Whereas the Scottish, Welsh and Northern Irish authorities have confirmed that fertility patients will not be disadvantaged by coronavirus when clinics reopen, meaning that clinics will pick up where they left off with patients receiving the same treatment according to the same criteria that they would have been entitled to before the pandemic England has not made the same promise. There are fears that IVF provision in England which has already been squeezed by national cuts, with some hospital trusts selling or considering closing their IVF clinics, or offering a reduced number of IVF cycles could be further cut after the coronavirus pandemic, to help rebalance the NHS funding black hole.

For women who had already started fertility treatment and were on a cocktail of fertility-boosting drugs when the pandemic hit, the IVF ban was a bitter blow. That was the hardest bit, says Kara*, a 34-year-old social worker from Sheffield. Taking all those drugs that affect you so much, for nothing. After Kara found out her NHS IVF treatment was cancelled in March, she had to continue taking oral and injectable oestrogen and progesterone for a further two weeks, to complete her monthly cycle. Kara and her husband have been trying to conceive for five years; she has miscarried five times.

IVF is a long road, littered with obstacles; now the coronavirus pandemic is one more thing thats out of your control

Being full of pregnancy-inducing hormones without being pregnant, in the midst of a global pandemic, did not do much for Karas physical or mental health. I was devastated, she says. All those hormones make you really emotional and the injectable progesterone makes your stomach sore, and you get so tired. You dont mind that when youre building up to an IVF cycle. But when it gets taken away from you youre like: Now what? Gwenda Burns of Fertility Network UK urges any women feeling distressed or overwhelmed to call the networks support line, or join one of its regional online support groups. We believe no question is too trivial or worry too small, Burns says.

IVF is, by definition, a time-sensitive endeavour: any delay diminishes the likelihood of a woman successfully conceiving, as her egg reserves drop month-on-month. Time is so precious in IVF, says Rayment. A month can make such a difference. If you have already spent years on a waiting list for NHS IVF, any further delay is agonising.

We went through a shocking number of delays until we finally got our NHS approval letter through, says Polly Towler, a 38-year-old audio typist from Bristol. Towler was due to commence her first round of NHS IVF this April, nearly four years after she first visited her GP about her fertility issues. I am very worried about my egg reserves, Towler says. I will be 39 at the end of this year. The decline will be steep from now on.

A lack of clarity from the government about when the lockdown will end adds to many womens anxiety and sense of powerlessness. So much of IVF is beyond your control, says Seetal Savla, a 38-year-old PR manager from London. Its a long road thats littered with obstacles, and now the coronavirus pandemic is one more thing thats out of your control. After her first round of NHS IVF failed in 2017, Savla and her husband Neil turned to private clinics. Savla has low egg reserves, meaning that her chances of becoming a mother are already low. If the government would say that in two or three months, IVF can start again, that would be something to count down towards, she says. Its the uncertainty thats difficult to accept.

An exit strategy for the fertility sector is needed, says Dr Geeta Nargund, a fertility expert at St Georges NHS Trust. We need a proactive approach to restarting these services, detailing which social distancing measures and safety approaches will be required, and what protective equipment will be made available for staff, she says. When the lockdown is lifted, Nargund wants priority to be given to women with low egg reserves, or those who are older. Time is of the essence for them, she explains.

All the women understand the pressures on the NHS. I get that we have to protect the NHS, says Kara. I understand why theyve cancelled all the treatments. But Im still allowed to have some personal grief about it. Even before her IVF was cancelled, Rayment felt uneasy, because her history of miscarriage and age made any pregnancy high-risk. I felt dubious, because I knew that by carrying on I could be a burden to the NHS, she says. But then I thought: no one else is being told not to procreate. It didnt seem fair that I should be told to stop whilst everyone else was carrying on regardless.

The naturally fertile aren't being asked not to try to have children, only infertile, single women and same-sex couples

Nargund argues that the IVF ban exacerbates existing healthcare inequalities. Those who are naturally fertile are not being asked not to try to have children, she says. Its only the infertile, single women and same-sex couples that are being delayed access to fertility treatment is an issue of equality, whether its a couple who delayed parenthood due to financial insecurity, or a lesbian couple. Denying them their fundamental right to parenthood exacerbates societal inequalities.

Meanwhile, for the women whose dreams of motherhood are on indefinite hold, lockdown conversations can be painful. Having to hear people make baby-boom jokes or people complaining about having kids at home is really hard, says Savla. I would love to be in the situation of having kids at home to complain about.

Many of the women I spoke to believe that coronavirus has cost them their chance of having biological children. I just feel like its not going to happen now, says Towler. I am preparing myself for the possibility of not having children. Rayment is taking things day by day, but is similarly dejected. The media is saying that we wont come out of full lockdown until we have a vaccine, says Rayment. That could take a year. I could be too old for IVF by then all my chances of having a family would be lost.

Savla has gone some way towards making peace with this. With every day that goes by I do feel my chances are shrinking of having a biological child, says Savla. But theres nothing I can do about it, so Ive come to a state of acceptance. She has started looking into surrogacy and adoption. Having been through the emotional rollercoaster that is IVF, I do feel more resilient and able to deal with coronavirus, she says. But that doesnt mean Im not hurting.

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Time is precious in IVF: the women who fear they have lost their chance to have children - The Guardian