In March, when the COVID-19 pandemic hit Massachusetts, centers providing infertility services were forced to hit the pause button, leaving many couples in the United States in the lurch.  On March 17, the American Society of Reproductive Medicine (ASRM) issued guidelines for fertility specialists which consisted of five key recommendations, including the suspension of new treatment cycles and the cancellation of embryo transfers, as well as postponing elective surgeries.  

Given the rapidly evolving course of the pandemic, especially in the Northeast, these decisions were made hastily. It is also important to note that these recommendations were made with a rather optimistic view of the pandemic’s trajectory.  This was supposed to be a temporary pause, so that we could have some time to figure out what we needed to do in order to provide care while at the same time ensuring the safety of our patients and providers. We are six months down the road, and it is clear that we will be dealing with COVID-19 for the foreseeable future.

So What Will Happen to Fertility Treatment?

Since the initial recommendations in March, the ASRM has released six updated sets of recommendations, the last one on August 10, 2020.  While the most recent guidelines support the gradual and judicious resumption of the delivery of reproductive care, they note that many parts of the US are experiencing a rapid increase in numbers of cases and hospitalizations, which may have downstream effects for patients receiving infertility treatment.  

In some parts of the country, hospital resources, including personal protective devices,  have become strained, as was observed in the Northeastern states earlier in March and April of this year.  When these shortages occur, “essential” care is prioritised. Under these circumstances, infertility treatment may fall to the bottom of the list.  Although short-term delays in treatment may cause significant emotional distress, they are unlikely to worsen outcomes.  But how long will couples have to wait to initiate or resume treatment.  Obviously, there are no easy answers.  

In a recent article, Dr. John Petrozza, director of the Massachusetts General Hospital Fertility Center notes that their program has been able to make certain modifications allowing them to resume while maintaining the safety of patients and providers.  Some of the changes have included home delivery of testing kits, telemedicine appointments, optimization of electronic patient education modules, and at-home male specimen collection with scheduled drop-off.  Many of these innovations have streamlined care and improved accessibility and are expected to continue even after the pandemic is behind us.  

Nonetheless, this is a particularly challenging time for patients with infertility.  Under the best of circumstances, infertility treatment is a time of uncertainty and emotional challenges; the coronavirus pandemic has intensified the distress many couples experience in this setting, while at the same time cutting off access to important sources of support, including family, friends, support groups, and professional mental health services.  

 

Ruta Nonacs, MD PhD

 

Are infertility treatments ‘essential’? How to ethically determine what kind of care must go on amid Covid-19 (STAT News)

Fertility Treatment Innovations Address Care Amid COVID-19 (MGH Advances in Motion)

 

Patient Resources:

RESOLVE COVID-19 SUPPORT RESOURCE CENTER provides many resources for couples undergoing infertility treatment during the COVID-19 pandemic.  RESOLVE support groups are transitioning from in-person to virtual meetings. Please contact the hosts in your area to see if/when they are holding virtual meetings via Google Hangout or Zoom. RESOLVE is also offering monthly virtual peer-led support groups.

Inspire.com is an online platform that hosts RESOLVE’s online support community

ASRM Webinar For Patients: Taking Care of Yourself During the COVID-19 Pandemic – recorded April 14, 2020

 

Provider Resources: 

COVID-19 Updates and Resources (American Society of Reproductive Medicine)