Europe is now seeing a second wave of COVID19. As we head into winter in the northern hemisphere, European Society of Human Reproduction and Embryology (ESHRE) has now upgraded safety guidelines for fertility clinics. This adds two further measures to complement the guidance issued last April on the reopening of clinics:
- More testing in addition to the triage questionnaires
- A requirement to provide greater information to patients on COVID-19 and its prevention before and during pregnancy.
The new guidance advises that measures should depend on the level of infection in a region and suggests a two-step approach:
To recognise the local epidemiological status of the pandemic. Assess its likely impact on the internal resources of staff and equipment and on patients. One aspect of epidemiological status is the infection rate, which is categorised as follows:
- Light impact: less than 20 cases per 100,000 population
- Moderate impact: 20 – 60 cases per 100,000 population
- Major impact: 60 – 120 cases per 100,000 population
- Critical impact: more than 120 cases per 100,000 population
To reduce the risks identified in Step One.
For instance, a local rate of 20 to 60 cases per 100,000 population is moderate impact. This may not require further measures than those already applied routinely.
However, an area of major impact or critical impact would require more intensive measures:
– More routine testing of patients and staff
– Remote/telehealth consultations
– A ban on accompanying persons
– Routine use of PPE.
Will clinics have to close again?
The worry for clinics and patients in Europe is whether the second wave of infection will become so critical that fertility centres might have to close once again.
But the guidance provided by ESHRE, and the American Society for Reproductive Medicine allows for the continued safe provision of fertility services. For instance, the UK’s Human Fertility and Embryology Authority said, “With such professional (ESHRE) guidelines in place a new national closure of fertility clinics shouldn’t be necessary.”
In addition, we now know more about the disease than we did when the pandemic started. For instance, patients and staff can be further reassured by results from a case report from Spain. Two asymptomatic oocyte donors tested positive for COVID19 infection before egg collection. Testing of the eggs failed to detect the presence of any viral RNA in the cells. The authors of the case report wrote, “Our report suggests that vertical transmission in these women may not occur through their oocytes during treatment. Handling of this material in the clinical embryology laboratory may not constitute a hazard for healthcare professionals.”
The new guidelines continue to allow clinics to move forward cautiously, while remaining flexible and responsive to the situation as it develops.
Please read the updated guidelines here.