COVID-19 - Fertility Treatments Q&A
‘Flattening The Curve’
The extraordinary measures taken in Ireland in response to the Covid-19 virus seem entirely necessary to combat the spread of the disease and reduce the impact it has on our population, health service and the economy. But what does this mean for those requiring assistant reproductive techniques and IVF?
FAQ’s
What impact has COVID 19 had on fertility treatments in Ireland?
On March 14, 2020, as a precautionary measure ESHRE, the European Society for Human Reproduction and Embryology advised that;
““all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid becoming pregnant at this time”. ”
Read the full statement republished on March 19: Coronavirus Covid-19: ESHRE statement on pregnancy and conception.
The ESHRE recommendations have advised that assisted reproduction treatments should not be started for the following reasons:
- To avoid complications from assisted reproduction treatment and pregnancy
- To avoid potential SARS-CoV-2 related complications during pregnancy
- To mitigate the unknown risk of vertical transmission in SARS-CoV-2 positive patients
- To support the necessary reallocation of healthcare resources
- To observe the current recommendations of social distancing.
Upon this advice, and under government directives Fertility Centers in Ireland took the decision to suspend and defer fertility treatments until further review on 18th April 2020.
In Ireland, approximately 6,000 IVF cycles take place every year which means there are a vast number of fertility patients being affected. Since March 15th Clinics have been cancelling and deferring treatments in order to wind down their services and at present the below fertility treatments have now stopped:
· IVF (Egg Collections)
· Fresh and frozen embryo transfers
· Intrauterine Inseminations (IUI’s)
· Timed Intercourse (TI)
· Ovulation Induction (OI)
Why did they do this?
The answer to this is a little bit controversial. While there is no clear evidence that COVID-19 is transmitted vertically from mother to baby during pregnancy or indeed that COVID 19 will cause problems in the pregnancy, there are still some concerns:
· if you are severely infected with the virus at an early stage during your treatment or in pregnancy, experiencing a fever and/or respiratory difficulties could have a direct impact on your chance of success. It could be a contributor to miscarriage.
· doctors and hospitals are limited in the treatment options and medications that can be given during pregnancy as a lot of medications are contraindicated in pregnancy.
· it is impossible to do an IVF cycle while following social distancing guidelines (high risk for transmission between staff and patients).
On the basis of this, the ESHRE guidelines were put out. In addition, there also seems to be a social element and an effort to reduce the risk of infection in healthcare workers and the strain on the national health services. Fertility treatments come with some risks such as ovarian hyperstimulation syndrome (just over 1% of women will develop moderate or severe OHSS during IVF treatment) which can require hospitalisation. By removing these cases in addition to reducing down the number of women requiring hospitalisation for antenatal care during pregnancy at this time, it is reducing pressure on an already stretched healthcare system.
How long is this expected to last?
Unfortunately, we don’t know the answer to this. Based on my assessment of the current situation in Ireland, it is unlikely that fertility clinics will be operating by June. ESHRE continues to recommend a precautionary approach to assisted reproduction, which is consistent with the position of other scientific societies in reproductive medicine. Fertility Centers will continue to follow these recommendations along with government directives until the 18th of April when things will then be re-assessed.
As we know with fertility, time is of the essence. Once it is safe to do so, Fertility Centers will be reaching out to their patients to schedule their treatments. Provisional plans are already in place in order to step up capacity to work through the backlog of patients requiring treatment. Fertility Centers have several ways to increase their capacity when the green light is given. Staff dependent, there can be an increase in egg collection procedures per day. Instead of 5 egg collections (5 patients) they could increase to 8 or 10 for example which means more women can be stimulated for IVF at any one given time. Increasing clinic opening hours and working weekends are other ways to ensure that patients are not kept waiting for reasons unrelated to COVID-19.
So what can I do?
COVID-19 has everyone feeling anxious, worried and overwhelmed. Having your treatment cancelled or postponed may feel like your life is being put on hold, without any choice. This is an extremely stressful and uncertain time and it is ok to feel disappointed and angry. It is really vital however to remember that treatments will be offered again as soon as these recommendations have been lifted. Every Fertility Specialist throughout the world wants to be able to offer their care and get back to helping you on your journey to parenthood. The best advice is to use this time now to live right and prepare yourself for when that time comes, which it will. Plenty of sleep, exercise and healthy eating.
Some tips for managing during this time:
1. Have a routine. Routine is the antidote to anxiety and despite there being a complete change to the normal routine, you can consciously decide to develop a new routine that serves you. Wake up early, exercise, shower and get dressed.
2. Stay connected to your people. Connect to combat isolation. Making time to speak with your friends and family is really important. You’re not alone in this and talking through your concerns can go a long way.
3. It’s important for you to get a sense of control back in your life and the fastest way to do that is to engage in action. This might look like setting a to do list and completing those tasks. Getting some daily exercise in, cooking a nice meal and re-connecting on zoom with friends.
Remember to remain in contact with your fertility unit as they will support you and provide ongoing updates to manage your expectations and give you back some sense of control.
Keep up to date with the latest from ESHRE on www.thefertilitytalk.com.