One of the main problems with infertility is that the condition requires treatment in a timely manner. Delaying treatment is not an option for an increasing number of patients who are currently locked down by the COVID19 epidemic.
The initial approach to COVID19 by leading national fertility authorities was to suspend treatment until more information became available. This was a sensible approach.
At that time little was known about:
- how COVID19 might affect pregnant mothers and babies
- the epidemiology of the disease was still developing (infection rates, prevalence, mortality etc)
- how effective public disease containment measures were, the flattening of the curve that officials always mentioned.
There were other considerations too. Such as question marks over how hospitals moved staff around from elective procedures (ones deemed lower priority for, it has to be said, both right and wrong reasons) to the so-called front-line fight against COVID19.
Now, at around Week 13 of the crisis, some national authorities are taking another look at the issue. Key among these authorities is the American Society of Reproductive Medicine (ASRM), an organisation from which many other authorities take their lead. The US is also the current epicentre of the COVID19 epidemic, so the ASRM can speak from good experience.
In issuing new guidelines the ASRM has taken into account some key factors that are now apparent at this stage of the epidemic.
These are:
- Regional differences in infection patterns are now clear, basically this means that some regions (e.g. New York City) are worse hit than others. There are reasons for this, population density, access to health care resources and many other factors all play a part
- In many states and cities in the US, the rate of new infections, although high is declining. i.e. The longed-for flattening of the curve is finally happening. This means that that most patients falling ill with COVID19 will be able to access the care that they need and hospitals will not be overburdened
- At the moment there is little evidence that COVID10 poses a unique risk to pregnant mothers and babies beyond the risk that is posed by its generic symptoms (e.g. fever is a risk for all pregnant mothers irrespective of what disease caused it).
ASRM said, “In considering when and how to provide reproductive care, the risk of viral transmission to patients, physicians, and staff, and the utilization of critically needed healthcare resources must be weighed against the time sensitive nature of infertility. This calculation includes understanding the worsening prognosis of treatments with the passage of time and the threat of decreased access to care that occurs with further delays.”
The new guidelines
The good news is that IVF clinics can reopen providing that certain criteria are met:
- IVF clinics will remain subject to the rules governing healthcare facilities in their locality
- However, where clinics are allowed by law to re-open, it is up to the clinics to assess the impact that resuming operations would have on their own community’s risk and resources
- Before reproductive therapy can resume, clinics should check that there is a sustained reduction in cases in their area (e.g. for at least 14 days)
- Clinics should also, before reopening check the ability of their local hospitals to safely treat additional COVID19 patients within a comfortable margin of burden in case there is a sudden surge.
In addition, all clinics considering resumption of services MUST perform a formal documented risk assessment to determine what activities are feasible, accounting for:
– Local COVID19 prevalence and trends
– Availability of Personal Protective Equipment (PPE) for all patients, staff, and physicians and other healthcare providers
– Availability and type of selective testing, facility physical factors, and staff training.
All in all, it is very good news for patients who have been put under considerable excess stress by the closure and especially for patients with advancing maternal age.
With no vaccine or cure on the horizon for many months, the COVID19 issue is going to be with us for some time. With that in mind we have to find ways of managing it. This means finding acceptable means of balancing the risk against the requirements of living our lives in a meaningful way. The revised guidelines point the way forward as a means to achieve this for fertility patients.
Please click here to read the full guidelines.
