Covid-19 and How It Is Affecting Us and Your Care

By John C. Nulsen, MD
Medical Director, Center for Advanced Reproductive Services
Professor of Obstetrics and Gynecology

This is an unprecedented and challenging time, made all the worse by the fact that we do not know when the COVID – 19 pandemic will subside and come under control. As we move through this threat, please know that you are not alone. As part of a medical community, we are focused on how to best help quicken the resolution of this pandemic, so that we can get back to serving you as quickly and as safely as possible. These efforts focus on helping to bend the viral transmission curve to assist in ensuring our region’s hospitals and ICUs are not overwhelmed and have the necessary equipment and personnel, and on helping to ensure that our services to you continue uninterrupted. 

ASRM Guidelines

The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, has issued guidance for its members as we manage patients in the midst of the COVID-19 pandemic.  Many elements have contributed to the success of CARS over the years, in particular, our strict adherence to ASRM guidelines. Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the ASRM COVID – 19 guidelines, effective March 18, 2020, are as follows:

  1. Suspension of 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;
  2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen;
  3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation;
  4. Suspend elective surgeries and non-urgent diagnostic procedures;
  5. Minimize in-person interactions and increase utilization of telehealth.

In addition, as a licensed ambulatory surgery center in Connecticut, we have to be mindful of recommendations set forth by the state’s Department of Health. Connecticut Department of Health [DPH] Guidelines:

Currently the order to stop performing surgeries/procedures in outpatient surgical facilities is not addressed in the executive orders or Commissioner Orders.  There have been recommendations from the Centers for Medicare and Medicaid Services (CMS) to cease elective surgeries/procedures to stop the spread of COVID-19 and to conserve PPE.  So, the decision to cease performing procedures is a business decision for the individual facility;

  • Family planning services (including IVF) were exempted in the governor’s order.
  • DPH strongly recommends licensed Ambulatory Surgery Centers follow guidelines set forth by Center for Disease Control [CSC].

What CARS is Doing

CARS continues to be operational and is here for you. All clinical provider patient schedules have been transitioned to phone calls or video conferencing. Patients can call our main number to schedule appointments.

Each of our offices remains open with minimal staff to address urgent and emergent patient care needs such as confirmatory pregnancy scans, pain, bleeding, onco-fertility, etc. Our goal is to keep patients out of emergency rooms and the already strained regional hospital system.

All IUI and IVF services have been temporarily suspended. We continue to follow recommendations from ASRM, CT DPH and closely track regional COVID – 19 data. We hope to be able to resume treatments in at least some limited way by June 1.

The majority of our dedicated staff are working remotely from home but remain available to you throughout the day and weekends by calling our front desk. Although we remain open, all doors are locked so as to control health screening and admission into our offices. There are intercoms on front doors to call for entry. Upon entry, everyone is screened for social/health history and temperatures before being allowed into any clinical area. If you need to come to the office, we are asking that you do so alone. If a partner needs to drive, we are asking they wait in the car.

Through our partnership with Quest Diagnostics we continue to provide urgent and emergent blood draws in our Farmington location 9:30 am to 3 pm. 

Treatment Interrupted

We know it is extremely difficult to consider postponing fertility treatments. Most people have gone through tremendous loss and grief by the time they get to the place where they are doing an IUI or IVF cycle. In addition, navigating the cost and insurance coverage aspects is daunting. Many having come so far on their fertility journey are now dealt a huge unknown with the COVID-19 pandemic; wondering if they 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 anyone’s ability to have a child, even those with 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. 

How Does Covid-19 Impact Fertility and Pregnancy?

Research is still ongoing in this area. There are no studies indicating that the virus has any impact on fertility. While Coronavirus fears have caused some people to seek out egg freezing, there is no known medical indication to seek out egg freezing as a preventive measure.

If you have tested positive for COVID-19, the Society for Assisted Reproductive Technology (SART) recommends avoiding getting pregnant for now and waiting until one fully recovers before attempting conception (either naturally or via assisted reproductive technology).

According to the World Health Organization (WHO), pregnant women don’t appear to be at a greater risk for illness related to COVID-19 — and only 1% of pregnant women infected have experienced severe illness that required medical attention. However, the American College of Obstetricians and Gynecologists (ACOG) notes that very little is known about the effect of COVID-19 on pregnant women and infants. It is unclear if COVID-19 can cross the placenta. Because pregnant women are at greater risk of severe complications from similar respiratory infections, they are considered an at-risk population for COVID-19.  A study was conducted on nine pregnant women infected with COVID-19 in Wuhan, China. All women recovered from their illness and all nine had live births without any evidence of transmitting the virus to the baby. The virus was not detected in samples of cord blood, amniotic fluid, or throat swabs from the newborns, or breast milk. However, the COVID-19 infection was recently found in a newborn, so “vertical transmission” (meaning passage of the virus from mother to baby during the period immediately before and after birth) cannot be excluded at this point.

Support

Infertility treatment under the best of circumstances 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. CARS has an in-house, trained reproductive mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Dr. Kim Crone is offering telehealth options to fertility patients and is available by calling our front desk.

The National Infertility Association (www.resolve.org) and RESOLVE of New England (www.resolvenewengland.org) have resources and various ways to get support. Both have an online support community, local support groups (now meeting virtually), webinars, and other content to help patients connect, get support, and stay informed. Also, we are continually adding patient support content to our Facebook page, https://www.facebook.com/uconnfertility/.

Together, we must stay focused on fighting the present viral threat. We can do this in numerous ways – by reassuring and educating you through telehealth, helping to “bend the curve”, by implementing social distancing mechanics for patients and staff, and ensuring both our own emotional and physical well-being, as well as that of our patients, staff, colleagues, and friends and family remains a priority. At CARS we are convinced we will come out of the current test stronger; as a community of women’s health professionals, as a nation, and as a global society. 

Be healthy. Be safe.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.