Presented by ASRM and SART
We understand that it can be devastating for those who have been trying to build their families to now have to delay treatment due to COVID-19. The goal of this communication is to help give patients a clearer understanding of the ASRM COVID-19 Task Force recommendations, and to help answer questions they may have.
Q: Will postponing my care affect my ability to have a child?
A: It is extremely difficult to consider postponing your treatment. Most people have gone through tremendous loss and grief by the time they get to the place where they are doing an IVF cycle. In addition, navigating the cost and insurance coverage aspects is daunting. Now that you are at this point in your family building, you are dealt a huge unknown with the COVID-19 pandemic, and how you should proceed, or start, this medical treatment. It should be somewhat helpful to hear that there is no evidence that delaying treatment for a month or two will ultimately affect your ability to have a child, even if you have concerns about advanced age and/or diminished ovarian reserve (low egg supply). The ASRM recommendations will be continuously reviewed and updated, as we know that many people do have concerns about waiting longer than two months.
Q: I hear that elective medical procedures in my geographic are supposed to stop; are IVF and other fertility treatments considered "elective"?
A: No one providing your care believes that any fertility treatment is elective. Infertility is a disease, and treatment of infertility is medically necessary. There is a distinction between a treatment that cannot be postponed even for a few days (such as surgery for a ruptured appendix), and treatment that is time sensitive and extremely important (such as IVF) but not a medical emergency. Unfortunately, there is not a universal definition, and we have seen many misleading terms used, even by state public health agencies.
We know that other important non-emergency treatments also are being postponed during this pandemic. Fertility treatment is not being singled out. Orthopedic surgery, eye surgery, kidney stone procedures, dental procedures, and many other treatments are also being postponed due to the COVID-19 pandemic.
Q: Can my clinic prevent me from getting infected by screening patients and staff?
A: As anyone who has been through fertility treatment or has prepared to begin fertility treatment knows, multiple clinic visits and procedures are required. Unfortunately, even if a clinic tries to screen patients and staff to lower the risk of novel coronavirus exposure in the fertility clinic, there is no way to guarantee prevention of exposure. COVID-19 is now spreading through communities and is not limited to those who have traveled to certain countries. People who have the novel coronavirus are contagious days before they develop symptoms. The virus can be in the air that they breathe out and the air you breathe in. This risk is reduced by wearing masks and by increasing physical distance between people. However, even these precautions aren't foolproof and do not guarantee your safety. We wish we could screen in a way that could eliminate risk, but we honestly cannot.
Q: I want to pursue IVF or other fertility medical treatments. Should I delay care during the COVID-19 pandemic?
A: It is very hard to deal with uncertainty, especially when you are pursuing the dream of family and unexpected challenges are in the way. Currently, the U.S. is a patchwork of different federal, state and local regulations and recommendations that may make starting or continuing your medical treatment difficult. In many states, the governor or state legislature has restricted fertility clinics from performing medical procedures such as IVF during the pandemic, and have even imposed fines and penalties for healthcare providers who violate the laws.
While ASRM vigorously advocates for fertility care and reproduction as an essential right, there are considerable risks to your health should you become exposed to COVID-19. Fertility care requires interaction with many individuals and any person-to-person interactions increase the likelihood that you may become infected. In most cases, ASRM recommends postponing infertility care until after the crisis passes to reduce your risk of getting COVID-19 because the virus can cause you to become very sick, requiring prolonged hospitalization or even death. Until the peak of the crisis is past, the ASRM COVID-19 Task Force recommends:
- Postponing oocyte retrievals
- Postponing embryo transfers
- Postponing diagnostic tests
Q: Is there a risk that my cycle could be cancelled if I proceed with treatment now?
A: Some states and local governments are implementing mandatory "shelter in place" requirements, and it is likely that more restrictions are to come. A clinic that begins a treatment cycle could be forced to cancel it by the clinic's city or state regulations. Furthermore, healthcare workers who are exposed to the coronavirus may not be able to come to work. It is possible that even if you begin to invest time and money into fertility treatment now, it could be cancelled due to governmental restrictions or lack of available staff.
Q: Are my frozen embryos, eggs, or sperm safe?
A: Yes. There is no immediate threat to the safety of cryopreserved eggs, sperm or embryos. Clinics have policies and procedures to maintain the liquid nitrogen tanks containing frozen embryos, eggs and sperm. Please ask your doctor if you have any questions about the systems in place at your provider's clinic.
Q: Should I take steps to avoid pregnancy during the COVID-19 pandemic?
A: We are NOT saying that women should not get pregnant during this pandemic. We are also not saying that there is no risk. The risks of acquiring the coronavirus in the first trimester are not known and will not be known for some time. We do know that severe illness can lead to pregnancy complications. If you are already pregnant, it is important to take all precautions possible to reduce your risk of exposure to the coronavirus by following CDC current recommendations, such as hand washing with soap, not touching your face, and practicing social (physical) distancing.
Q: What can I do now?
A: If your practice offers a telehealth option, consider scheduling a consultation and begin to prepare for your treatment cycle. Seek insurance authorization for your treatment if possible. Some people may want to use this time to focus on improving their general health through efforts such as smoking cessation or weight loss that may improve fertility treatment success. It's a good opportunity to focus on nutrition and reduce or eliminate habits that are detrimental to overall health. If you prepare now, you'll be ready to begin treatment as soon as it is safe to do so.
Q: When can I resume fertility and medical treatment?
A: Fertility clinics will need to adhere to local, state and federal guidance as to when it is safe for medical practices to resume providing care to patients. As soon as it is deemed medically safe and the likelihood of transmission of COVID-19 is greatly reduced, most restrictions will be lifted. The fertility clinic personnel want to be helping their patient right now and will resume as soon as they possibly can.
Q: I had planned to have a surgical procedure; why has it been postponed?
A: The ASRM, American College of Surgeons, and many other organizations have recommended that surgical procedures that are not deemed urgent (urgent meaning that someone needs the surgery to avoid serious illness or death) be delayed to reduce the spread of COVID-19. Also, some fertility practices have diverted their medical equipment or supplies to help hospitals and their critical care units to fight COVID-19.
Q: I think I am pregnant; should I get the ultrasound and lab testing to confirm the pregnancy?
A: Yes! The ultrasound and lab testing are recommended at this time, since this is necessary and is considered an urgent matter. Use of face masks, hand washing, and physical spacing are recommended.
Q: I have been diagnosed with cancer and chemotherapy is recommended. Can I still attempt to freeze my eggs (or sperm if male)?
A: Yes! People facing an urgent need for fertility preservation can proceed during the pandemic, if this is deemed to be reasonable after consultation with their doctor.
Q: If I get sick or test positive for COVID-19, when is it safe to become pregnant?
A: COVID-19 infection can last for weeks. Since pregnant women are known to be at increased risk of severe complication from other respiratory infections such as influenza and novel coronavirus, it may be prudent to wait until you no longer have symptoms to attempt to get pregnant.
Q: I'm pregnant. Is there a risk that a COVID-19 infection will affect my pregnancy outcome?
A: Based on currently available information, pregnant women who become infected with COVID-19 do not appear to be at increased risk. However, pregnant women are known to be at greater risk of severe complications from other respiratory viral infections such as influenza and SARS. For that reason, pregnant women are considered an at-risk population for COVID-19. Notably, in many reports, cesarean delivery has been used for women presented in labor and needed delivery. Though evidence is limited, there are anecdotal cases where pregnant women infected with COVID-19 have encountered an exacerbation of breathing difficulties after delivery.
Q: What is the risk that a COVID-19 infection will affect my unborn child?
A: Some pregnancy complications have been reported among infants born to mothers positive for COVID-19, such as preterm delivery and low birth weight. More reports are becoming available every day. It is not clear whether these outcomes were related to maternal infection. It is possible that other unforeseen complications may be discovered in the future.
Q: This is really hard for me to handle. What resources are available to me?
A: RESOLVE: The National Infertility Association (www.resolve.org) has resources and various ways to get support. RESOLVE has an online support community, local support groups (now meeting virtually), webinars, and other content to help you connect, get support, and stay informed.
We know that the infertility treatment can be stressful. The conditions created by the COVID-19 pandemic certainly add to that stress. There are things you can do to help reduce that stress. Your clinic can provide you with a referral to a trained mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Many of these providers are prepared to offer telehealth options that may be covered by your insurance carrier. Here are some additional ideas:
- Get accurate and current information to reduce anxiety. Utilize reliable sources such as the CDC, WHO and ASRM.
- Limit your use of social media and other sources of news. Set a certain time of day for gathering news. Choose a time when you aren't likely to be triggered. Stop using tech devices an hour or more before bedtime... turn them off.
- Utilize relaxation or mindfulness apps to reduce anxiety and tension and improve sleep. Focus on the present moment. Some examples of these apps are Ferticalm (for women), FertiStrong (for men), Headspace, MindshiftCBT, and Personal Zen.
- Distract yourself with non-COVID-19 related topics. Taking even 1/2 hour per day to focus on other things will help.
- Pay attention to the messages you give yourself. Positive self-talk can be powerful. Saying things like, "This isn't the situation I expected, but it doesn't mean it won't work out eventually," can be helpful.
- Stay in touch with others in your support network. Use virtual connection via telephone or video chat to do this. Staying connected with others reduces the sensitivity of isolation. RESOLVE is offering its peer-led support groups via virtual technology so that you can connect with others going through the same thing as you.
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