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FAQs Related to COVID-19

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 area 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 also are 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 any 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?

ASRM/SART has developed guidelines to minimize risk of viral transmission while pursuing fertility care.  The most recent guidance can be found here and is updated periodically. The capacity for a clinic to continue to provide fertility care is based on local clinical, legal, and environmental factors and may vary from one clinic to another.

This recent 2020 paper in the peer reviewed article in Human Reproduction concluded,“A delay in IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation.”

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: While we are still learning about the virus and where it resides or if it is present or active in reproductive tissues/cells, there is no evidence of cross contamination of COVID-19 between samples in storage in the IVF Lab.  

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 patients right now and will resume as soon as they possibly can.

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 who 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: Infection with SARS-CoV-2 can be particularly concerning for those who are pregnant, as they may be at higher risk for severe disease. Although the effects of SARS-CoV-2 infection during pregnancy have not yet been fully elucidated, including effects of infection in the first trimester of pregnancy, infection may precipitate premature labor and/or delivery although full term newborns delivered from mothers with active COVID-19 infections have done well.

A recent report from the CDC suggests that pregnant women with COVID-19 appeared to be at increased risk of mechanical ventilation and admission to the intensive care unit (ICU) compared to nonpregnant peers, though the absolute rates were low. Pregnant women were not found to be at increased risk of death associated with COVID-19 compared with nonpregnant age-matched women.

Q: This is really hard for me to handle. What resources are available to me?

A: We know that the infertility treatment is often stressful. The conditions created by the COVID-19 pandemic certainly add to that strain, but there are things you can do to cope. First, remember that your fertility nurse is likely experienced in providing emotional support for patients coping with infertility and pregnancy loss.  Start by sharing what you are feeling with her/him.  Your nurse also can connect you with your clinic’s specialized fertility counselor.  This counselor can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. You also locate a fertility counselor through the Mental Health Professional Group of ASRM.  Click here for a directory of mental health providers The majority of these fertility counselors offer telehealth services that may be covered by your insurance carrier.  Here are some additional ideas for coping:

  • 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 are Ferticalm (for women), FertiStrong (for men), Buddhify, Headspace, MindshiftCBT, and Personal Zen.
  • Engage in pleasurable activities and hobbies.  What do you do for fun?  Taking even ½ hour per day to focus on things other than the pandemic and your fertility journey 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, either socially distanced or virtually.  Staying connected with others reduces the sense of isolation.  If you are experiencing Zoom fatigue, consider connecting on the weekend or after you’ve given yourself a break.
  • Join RESOLVE: The National Infertility Association (www.resolve.org).  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.

ReproductiveFacts.org
is a patient education website of ASRM.
 

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