What you need to know
If you're considering fertility treatment, something to be aware of is that today [17 March] the American Society for Reproductive Medicine (ASRM) has recommended that all fertility clinics in the US suspend new fertility treatment cycles. This includes "non-urgent" egg and sperm freezing, IUI, and IVF cycles. If you have already started treatment, however, there is some reassurance that it may continue. The official ASRM statement states that clinics can "continue to care" for patients who are already in treatment cycles or those who require "urgent" ovarian stimulation or freezing. Clinics in the USA that ELANZA Wellness has spoken to have confirmed that, in line with the ASRM guidance, they will not be starting new cycles for non-urgent patients until further notice.
Read the full ASRM statement below.
What's the situation globally?
Note that the ASRM's position may not be the case in other countries currently: there are different opinions among professional bodies globally and your clinic should be aware of the local guidelines as it pertains to your treatment. For instance, the UK's fertility clinic regulator, the HFEA, also released a statement today stating that "depending on the individual [UK] clinics' circumstances they can continue to treat patients at the current time." "We are also aware that some clinics have had to stop treatments for other reasons such as low staffing levels due to staff being redeployed to other areas and emergency planning measures in their hospital."
Read the full HFEA statement below.
Still There For You...
Fertility clinics have also assured us that although they are minimizing and/or eliminating non-essential visits, surgeries and diagnostic procedures in line with the ASRM advice, you should be aware that, wherever possible, they are making the shift to virtual consultations.
In other words, you can still make inquiries and seek a consultation remotely - and you are encouraged to do so if you have any questions. Minimizing in-person interactions is for the safety of everyone.
Why are new treatments being suspended?
We asked one of our experts, Dr. Diana Chavkin from HRC Fertility in Los Angeles about why her clinic has decided to follow the ASRM guidelines by not allowing any patients to start any new stimulation cycles. Here's what she said:
The reason we don’t want to start people on stimulation is that there are many unknowns and we don’t want to start people on stimulation cycle if there is a chance that they may have to stop in the middle of a cycle due to factors out of our control.
When someone undergoes stimulation they have to come to the office for monitoring and this puts them and others at risk of potentially catching the virus during their commute and also due to their time spent in the office.
With any stimulation cycle there are certain risks like ovarian hyperstimulation syndrome (OHSS) and ovarian torsion which sometimes need to be addressed in a hospital and emergency room setting and at the very least with more frequent office visits. And now more than ever we want to keep people home and out of the hospitals and emergency rooms. These resources are becoming increasingly more overwhelmed with coronavirus cases. Also having to go the hospital now is a lot more risky than it ever was in the past due to the increased risk of catching the coronavirus in the hospitals and emergency rooms.
There may be a scenario in which an individual may experience what would ordinarily be a very mild uncomplicated case of ovarian hyperstimulation; however, if they also developed the coronavirus, they may experience much more severe consequences. That's because in severe cases of OHSS, the lungs can be affected, which, in tandem with the harm that the coronavirus can cause to the respiratory system, could cause a compound affect.
While there are plenty of reasons to delay the start of an egg freezing cycle, Dr. Chavkin assures us that there is no reason to believe that coronavirus will impact one’s gametes (ie. eggs and sperm) and waiting 1-3 months to proceed with treatment will not drastically impact one’s outcomes.
STATEMENTS IN FULL:
American Society of Reproductive Medicine Recommendations on Patient Management and Clinical Recommendations During The COVID-19 Pandemic
Released: March 17, 2020
"Along with others in the global community, reproductive medicine professionals and their patients are battling an unprecedented viral pandemic.
The priority of the ASRM is to maximize the wellbeing of patients, staff, and society at large. As such, ASRM aims to provide guidance and support based on existing scientific knowledge, to its members and the patients they care for during the coronavirus (COVID-19) pandemic.
This guidance addresses a gap in current guidelines addressing COVID-19, which only indirectly mention infertility and its treatment.
The recommendations laid out in this document are guided by COVID-19’s steep daily rise in incidence, the impact of the virus on patient health and fertility care providers, and the known and unknown impact of coronavirus on fertility, pregnancy and transmission patterns. These recommendations are aimed at guarding the health and safety of patients and providers, while also recognizing that it is our social responsibility, as an organization and as a community of providers and experts, to comply with national public health recommendations and apply them to all reproductive settings during this unprecedented time.
The role of ASRM during this pandemic is to proactively do our share in blunting the impact of this pandemic, while recognizing the need to safeguard limited health infrastructure resources. However, we also understand our patients’ time-sensitive aspirations to achieve pregnancy, and so we will regularly reassess these recommendations with a hope to resume initiation of comprehensive fertility care as soon as possible.
This guidance recommends the following:
Suspend initiation 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.
Strongly consider cancellation of all embryo transfers whether fresh or frozen.
Continue to care for patients who are currently “in-cycle” or who require urgent stimulation and cryopreservation.
Suspend elective surgeries and non-urgent diagnostic procedures.
Minimize in-person interactions and increase utilization of telehealth.
Note: This guidance will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible."
HFEA Coronavirus (COVID-19) Guidance for patients:
Released: March 17, 2020
"We understand that some patients are concerned about the current situation with COVID-19 and whether this should be a reason to stop IVF treatment.
We cannot provide patients or clinics with medical guidance or make medical decisions. However, our current advice to clinics is to refer to UK professional guidance for advice when making decisions about whether to offer treatment. Patients should discuss their individual circumstances with their clinic before considering starting treatment. British Fertility Society and the Association of Reproductive and Clinical Scientists issued joint guidance on 16 March and we are in regular communication with them. We have also shared guidance from the Royal College of Obstetricians and Gynaecologists to all clinics.
However, we are aware that there are different opinions among professional bodies globally and your clinic should be aware of this, but we reiterate our advice for clinics to follow UK professional guidance only and depending on the individual clinics circumstances they can continue to treating patients at the current time.
We are also aware that some clinics have had to stop treatments for other reasons such as low staffing levels due to staff being redeployed to other areas and emergency planning measures in their hospital. These decisions are taken locally by the individual clinic and are not something that the HFEA is involved in. We have not issued guidance which says all clinics should cease providing treatment at this time.
We are closely monitoring the situation and will share any new information that we receive via our website and social media channels."
What Can You Do?
Focus on Getting Fertility Fit™
It's a stressful and uncertain time right now for everyone. We don't want your fertility to be one more thing to add to your list. In response to the suspension of fertility treatments, we are pre-releasing the beta version of our Fertility Fit™ coaching app. AND, it will be FREE for those looking to gain back some control and empowerment while awaiting egg freezing or IVF treatment. Sign up here to be notified ASAP when it goes live.