Fertility Implications during the COVID-19 Pandemic
As the world reacts to the growing threat of COVID-19, medical professionals across the globe are responding with courage and determination in the face of an overwhelming surge of critically ill patients.
With the majority of resources redirected to fighting the pandemic, various non-urgent fields of medicine are finding themselves facing an uncertain future as they work to protect patients, staff and the access to treatments. One field of medicine that has been uniquely impacted by the ongoing outbreak of COVID-19 is that of fertility treatment.
In response to the growing need for social distancing, as well as the direction to suspend elective medical procedures (those deemed non-critical), the American Society for Reproductive Medicine recently released guidance regarding the management of infertility treatment during COVID-19. The highlights of this guidance included:
- Suspension of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF), including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation
- Cancellation of all embryo transfers whether fresh or frozen, if possible
- Continuation of care for patients who are currently “in-cycle” or who require urgent stimulation and cryopreservation
- Suspension of elective surgeries and non-urgent diagnostic procedures
- Minimizing of in-person interaction
- Increase of telehealth use
While these guidelines are sound from a clinical and safety perspective, and seem common sense to those unfamiliar with infertility, they have vast implications for patients seeking fertility treatment.
Suspension of new treatment cycles
As hospital systems and universities across the country implement steps to mitigate the risk of exposure to staff and patients, those clinics are the first to begin suspension of new treatment cycles while also shifting monitoring and patient visits to telehealth models, where appropriate. Private fertility clinics are also implementing strict policies by screening anyone entering the clinic, and actively cycling patients trying to complete treatment.
Delays in IVF treatment
An additional consideration is the risk to individuals getting pregnant during the pandemic, as pregnancy can present a higher risk to contracting COVID-19. As a result, many practices have converted patients to egg and embryo freezing treatments versus the traditional IVF, with the hopes that once the crisis has subsided they will be able to achieve a pregnancy safely and successfully.
Less clinic access
Fertility clinics have also had to consider the safety of their staff balanced with the need for adequate care of patients still actively in treatment. Many clinics have chosen to limit the amount of staff to only those essential for safe and effective care of patients coming into the office. Areas of the country with larger numbers of COVID-19 infections have taken even more drastic steps: fertility practices throughout California, New York and Massachusetts have converted some staff to working remotely while furloughing others during the crisis. Large practices with satellite locations have consolidated to one main location while closing the doors on smaller sites in an effort to limit staff and patient exposure. All of these steps, while crucial to limiting the spread of the disease, create an uncertainty as to when and if the infertility field will return to “normal”.
A greater need for mental health support
This uncertainty has only compounded the anxiety that a fertility patient can face, furthering the need for strong mental health support. To that end, patient advocacy and support groups have adapted their usual in-person models to take advantage of the growing use of virtual meeting tools to ensure that anyone dealing with the stress of an infertility diagnosis can continue to access the support of community peers. Additionally, fertility clinics using telehealth so that mental health professionals and counselors can regularly follow-up with new and existing patients. This has allowed the infertility community to rally around one another to ensure the support and compassion so common amongst its members does not waver.
As the global community continues to fight COVID-19, the fertility community is regularly reviewing the guidelines laid out by ASRM in mid-March, while considering their individual situations. While there are fewer patients in treatment today, there is hope that once this crisis has passed, a return to regular access to treatment and fertility practices will be able to support individuals struggling to realize their dream of having a family.