May 5 Update
On April 24, 2020, ASRM released their third update to practice recommendations for fertility clinics in the midst of the COVID-19 epidemic. Here we discuss the new recommendations with a member of the ASRM COVID-19 task force, Dr. Eve Feinberg of Northwestern Medicine.
While previous recommendations from ASRM focused on limiting procedures to protect patients and staff from exposure to coronavirus (outlined in previous updates below), the new document provides guidance on resuming care.
The full list of recommendations is quite lengthy - here are some highpoints to know:
In some regions of the country, ASRM says it’s reasonable to resume care with precautions in place. This includes areas that experience a sustained reduction in cases and where the healthcare system is operating in a non-crises capacity. Barring restrictions from local municipalities, clinics are, in large part, responsible for performing their own formal risk assessments and determining when to begin offering care.
COVID-19 will likely continue to be present in our society for the foreseeable future. Clinics are grappling with this new reality and establishing new procedures on how to protect patients and their staff. Changes will likely include more frequent sanitization measures, mandatory use of masks, staggered appointment times, and enhanced patient screening processes.
We know many people are eager to begin treatment again. A delay in treatment can cause compounding stress in an already anxiety-producing situation. It’s important to remember that if your clinic resumes treatment, it may not necessarily feel like “business as usual.”
Consider asking your provider about:
What plans do they have in place to protect you from exposure? Hopefully, your clinic will clearly communicate this to you upfront, if not, it’s more than fair to ask. This is particularly true if you are or live with a high-risk individual.
What happens if your physician, embryologist or other critical staff member develops COVID-19? There are portions of your care team that are essential to your treatment plan. What steps will the clinic take in the case of infection and how will it impact your treatment cycle?
What will happen if your treatment needs to be cancelled mid-cycle? Unfortunately, if you contract COVID-19 or if there is a known exposure in the clinic, you run the risk of your cycle being cancelled. How will this be handled? And how will this affect you financially?
What are the pros and cons of resuming treatment right now? Have a candid conversation with your doctor and consider the impact a delay may have on your outcome, your finances, and your mental well-being. Also discuss the risk you may be taking on. Very little is known about the effects of COVID-19 in the first trimester of pregnancy, but we do know that developing a fever can negatively impact early pregnancy. (More on how COVID-19 could complicate pregnancy below in April 20th update.)
The answers here are not one-size-fits-all, for some patients in some regions, the time is right to start again, while others may benefit from holding off for the time being.
With new information coming available every day, these recommendations- as well as the policies your clinic puts in place- will likely continue to evolve. The next update from ASRM is due May 11th.
April 20 Update
We're continuing to update this page as facts & perspectives change. First off, check out our video interview (above) with Dr. Eve Feinberg, who was a part of the ASRM taskforce that determined the new guidelines. Those guidelines are currently in place until April 27th.
Next, we want to share with you that, despite the guidelines, some clinics do remain open and are willing to start new cycles.
Here are the factors that we believe you should consider if you are debating whether or not to begin a cycle with a clinic that is staying at this time:
- What are you giving up from a fertility perspective by delaying a few months? For most fertility patients, not much will be lost by waiting a period of weeks or months to begin treatment -- the likelihood of having a child through treatment will remain similar. But that's not true for everyone -- for example patients who are about to begin urgent cancer treatments, or women who are at a later point in their fertility (for example, women in their early 40's). Here's a link to more info about fertility treatment success rates.
- Are you putting yourself or your family at risk? Traveling back and forth to the clinic, riding elevators with other patients, sitting in waiting rooms -- all these situations will put you at greater risk of exposure to COVID-19.
- Your duty to society & public health. Think through your own responsibility to limit the spread of COVID-19. Staying home helps limit the spread of the virus, and helps to "flatten the curve" so that the medical system will not break under the pressure of extremely high volumes. This can save hundreds of thousands of lives.
- What is the risk to your cycle? What if you go through a retrieval cycle, but crucial members of the clinic staff are suddenly unable to work because they have become sick? That could mean understaffed embryology labs, and clinics that aren't able to give you the success rates you want.
- Pregnancies during COVID-19 are complicated. In Europe, the society that's analogous to ASRM there has called for all people to stop attempting pregnancy. The US hasn't gone this far, but it's still worth understanding the risks & unknowns of pregnancy during this time. First, this is a very stressful time to be pregnant. The unknowns far outweigh the knowns of pregnancy & COVID-19. If you become sick, you will not be able, as a pregnant person, to receive new anti-viral drugs. The strained medical system also will likely make this a difficult time to be pregnant (for example, getting in for a D&C after a miscarriage could be harder, and some hospitals are limiting the extent to which support people can be in the hospital even during labor & delivery).
As if infertility wasn’t already stressful enough, all of us here at FertilityIQ have been keeping a close eye on the COVID-19 virus situation. We know that the fallout from this pandemic has been incredibly disruptive to so many lives across the globe, and we’re also acutely aware of the impact that the virus and associated shut-downs may have on your family building plans.
On March 30th, the American Society for Reproductive Medicine (ASRM) affirmed its March 17th guidelines specifically for patients undergoing fertility treatments. Here’s what it may mean for you.
For Patients Planning on Starting a Cycle
If you are planning to begin a stimulation cycle using oral or injectable medications, or starting an IUI, IVF retrieval or a frozen embryo transfer, ASRM recommends that your cycle be postponed, with few exceptions.
For Patients Planning An IVF Transfer
If you are planning an IVF transfer, the current recommendation is for all clinics to strongly consider cancelling or postponing both fresh and frozen embryo transfers until further notice.
For Patients Who Are Currently “In-Cycle”
If you are already “in-cycle” or you fall into a very small exception category, ASRM is recommending clinics continue to provide individualized care.
For Patients with An Upcoming Scheduled Procedure
ASRM is recommending that clinics suspend all elective surgeries and non-urgent diagnostic procedures.
For Patients Who Have An Appointment Scheduled
Clinics are being encouraged to minimize in-person interactions and instead utilize telehealth options (like conducting consults by phone or video chat).
For Patients Who Are Currently Pregnant
According to the American College of Obstetricians and Gynecologists (ACOG) practice advisory very little is known about the effect of COVID-19 on pregnant women and infants, and it’s unclear if COVID-19 can cross the placenta. Since pregnant women are at greater risk of severe complications from similar respiratory infections, pregnant women are considered an “at-risk population” for COVID-19.
We know these recommendations may feel incredibly disappointing. Preparing for a treatment like IVF takes time, money, and a lot of emotional work - and having a cycle cancelled is simply heartbreaking.
We also believe that these recommendations truly are in your best interest, but we understand that it probably doesn’t feel that way.
You have our word that we have your back through all of this, and we’re monitoring the situation closely. In fact, we encourage you to bookmark this page as we’ll be bringing you the most up-to-date information as we have it available, along with interviews and advice from doctors and experts across the country. Until then, if you need us, please don’t hesitate to reach out.