A Message for Patients from The Society for Assisted Reproductive Technology
The goal of this communication is to help give patients a clear understanding of the March 17 ASRM COVID-19 Task Force guidance.
SART knows that it can be devastating for people who have been trying to build their families to now have to delay treatment due to COVID-19.
On March 17, 2020, recommendations were released for how physicians and their medical practices that offer fertility care should proceed with the COVID-19 pandemic. Most medical societies in the U.S. have been offering guidance to their members over the past 5-10 days. This communication from SART is a frequently asked questions (FAQ) on those recommendations for current and future patients who need fertility medical treatments. This document will be continuously updated with more FAQs and revisions to responses if new information becomes available. We encourage you to contact SART at [email protected].
Will postponing my care affect my ability to have a child?
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 Recommendations will be continuously reviewed and updated, as we know that many people do have concerns about waiting longer than two months. Right now, the Recommendations are through March 30, 2020 and will be reviewed and updated thereafter.
I hear that elective medical procedures in my geographic area are supposed to stop; are IVF and other fertility treatments considered “elective”?
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 are also 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 are also being postponed due to the Covid-19 pandemic.
Can my clinic prevent me from getting infected by screening patients and staff?
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 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 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 would make your treatment safe, but we honestly cannot.
Is there a risk that my cycle could be cancelled if I proceed with treatment now?
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 their 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.
Are my frozen embryos, eggs, or sperm safe?
Yes. There is no immediate threat to the safety of cryopreserved eggs, sperm or embryos. Clinics have policies and procedures to maintain the liquid nitrogen tanks containing frozen embryos, eggs, and sperm. Please ask your doctor if you have any questions about the systems in place at your provider’s clinic.
Should I take steps to avoid pregnancy during the COVID-19 pandemic?
We are NOT saying that women should not get pregnant during this pandemic. We also are 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 handwashing with soap, not touching your face, and practicing social (physical) distancing.
What can I do now?
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. If you prepare now, you’ll be ready to begin treatment as soon as it is safe to do so.
This is really hard for me to handle. What resources are available to me?
RESOLVE: The National Infertility Association (www.resolve.org) has resources and various ways to get support. 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.
We know that the infertility treatment 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. Your clinic can provide you with a referral to a trained mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Many of these providers are prepared to offer telehealth options that may be covered by your insurance carrier.
Here are some additional ideas:
- 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 of these apps are Ferticalm (for women), FertiStrong (for men) Headspace, MindshiftCBT, and Personal Zen.
- Distract yourself with non-COVID-19 related topics. Taking even a half hour per day to focus on other things 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. Use virtual connection via telephone or video chat to do this. Staying connected with others reduces the sense of isolation. RESOLVE is offering its peer-led support groups via virtual technology so that you can connect with others going through the same thing as you. You can also find additional resources at https://connect.asrm.org/MHPG.