reflecting a 40% increase. The primary increase in revenue in 2020 was substantially driven by an increase in new Clients and the number of new Members generating additional subscription access fees and an increase in volume associated with the COVID-19 pandemic. Subscription access fee revenue increased to $137.1 million or 29% for the quarter ended March 31, 2020. The increase in subscription access fees was due to the addition of new Clients and direct-to-consumer members, as the number of paid Members increased by 61% from March 31, 2019 to March 31, 2020. Revenue from U.S. subscription access fees was $107.9 million for the quarter ended March 31, 2020 compared to $81.0 million for the quarter ended March 31, 2019. We generated $29.1 million of international subscription access fees for the quarter ended March 31, 2020 and $25.0 million for the quarter ended March 31, 2019.
We completed approximately 2.0 million visits, representing $43.7 million of visit fees for the quarter ended March 31, 2020, compared to approximately 1.1 million visits, representing $22.6 million of visit fees during the quarter ended March 31, 2019. The increase in visit fees is associated with the aforementioned increase in paid Members as well as the impact of COVID-19.
Cost of Revenue. Cost of revenue was $72.4 million for the quarter ended March 31, 2020 compared to $44.7 million for the quarter ended March 31, 2019, an increase of $27.7 million, or 62%. The increase was primarily due to increased general medical visits and behavioral health visits resulting in increased provider fees, additional incentive fees paid to physicians and physician network operation center costs. The cost of revenue for March 31, 2020 also reflects approximately $4.0 million for additional investments in capacity expansion associated with the global outbreak of COVID-19.
Advertising and Marketing Expenses. Advertising and marketing expenses were $32.5 million for the quarter ended March 31, 2020 compared to $26.4 million for the quarter ended March 31, 2019, an increase of $6.1 million, or 23%. This increase primarily consisted of increased digital advertising, member engagement and acquisition initiatives, sponsorship of professional organizations and trade shows of $5.1 million and increases in employee-related expenses and others of $1.0 million.
Sales Expenses. Sales expenses were $17.9 million for the quarter ended March 31, 2020 compared to $16.2 million for the quarter ended March 31, 2019, an increase of $1.7 million, or 11%. This increase primarily consisted of increased staffing and sales commissions of $2.3 million and offset by a decrease to other sales expenses of $0.6 million.
Technology and Development Expenses. Technology and development expenses were $19.3 million for the quarter ended March 31, 2020 compared to $16.0 million for the quarter ended March 31, 2019, an increase of $3.3 million, or 20%. This increase resulted primarily from hiring additional personnel totaling $1.9 million and other professional expenses of $1.4 million.
Legal and Regulatory Expenses. Legal and regulatory expenses were $1.2 million for the quarter ended March 31, 2020 compared to $1.6 million for the quarter ended March 31, 2019, a decrease of $0.4 million, or 23%. The decrease in 2020 resulted primarily from timing associated with activities to support litigation.
Acquisition and Integration Related Costs. Acquisition and integration related costs, incurred primarily in connection with integration activities of prior acquisitions as well as costs associated with the pending In Touch Technologies, Inc. acquisition, were $3.7 million for the quarter ended March 31, 2020 compared to $1.0 million for the quarter ended March 31, 2019, an increase of $2.7 million. The 2020 and 2019 acquisition and integration related costs represent investment banking, financing, legal, accounting, consultancy, integration, fair value changes related to contingent consideration and certain other non-recurring transaction costs related to mergers and acquisitions.
General and Administrative Expenses. General and administrative expenses were $45.1 million for the quarter ended March 31, 2020 compared to $36.0 million for the quarter ended March 31, 2019, an increase of $9.1 million, or 25%. This increase was driven primarily by an increase in employee-related expenses of approximately $4.6 million resulting from growth in total employee headcount to 2,588 at March 31, 2020 as compared to 2,046 employees at March 31, 2019 reflecting the impact of the MedecinDirect acquisitions and to support the increase volume of activities due to COVID-19. Other expenses, which include office-related charges, professional fees and bank charges, increased by $4.6 million for the quarter ended March 31, 2020 as compared to March 31, 2019.
Depreciation and Amortization. Depreciation and amortization were $9.7 million for the quarter ended March 31, 2020 compared to $9.6 million for the quarter ended March 31, 2019, an increase of $0.1 million, or 1%. The increase was primarily due to the impact from acquisitions in 2019. Additional amortization expenses primarily related