In line with the stabilisation of the virus across Europe and the lack of reports of harmful effects in the first trimester such as miscarriage or foetal abnormalities, the IVF community internationally is looking at slowly restarting services. On 23rd and 24th April respectively, ESHRE (European Society for Human Reproduction and Embryology) and ASRM (American Society for Reproductive Medicine) published guidance for clinics regarding slowly recommencing treatments.
Both acknowledged that Infertility is a disease that is time sensitive and, therefore, should be regarded as a necessary medical treatment. They advocated that, once the risk of COVID-19 infection was decreasing, Assisted Reproductive Technology (ART) treatments be restarted, in line with local regulations.
However, this is not ART treatment as we did in the past; rather, vigilance and measured steps must be taken to protect patients, staff and the wider community. These steps will require significant alterations to the way clinics operate and the recommencement of services will need to be done in a careful, measured manner.
At Merrion Fertility Clinic
We are watching all of these events extremely closely and it is our hope that we will be able to open our clinic to some patients in mid-May. This will depend on the situation in Ireland at that time but we are optimistic.
We are currently working on our procedures and practices to ensure that we can provide a safe service in a responsible but patient-friendly manner. Changes will include:
Triaging patients and staff
- Monitoring staff and patients for any signs of infection
- Screening questionnaires
- Temperature checks
- COVID-19 screening when available
- Cleaning regimes
- Hand sanitisers
Social distancing through
- Reduced clinic visits
- Staggered appointments
- Restricting partners
- Increased use of tele-health
- Reduced numbers of staff in clinic
Use of PPE
- Masks, gloves, aprons, gowns
These remain very uncertain times and, when we do open, the new required practices, combined with the need to accommodate patients who have had their treatment cancelled in March and April, will mean that some of our patients will continue to experience frustration and disappointment for a while but please rest assured, we are doing everything possible to minimise this.
Background – Why Treatments Were Stopped
As you all know, COVID-19 has taken the world by storm and left even very developed economies struggling. Back in early to mid-March, the virus was out of control in Italy and Spain and Ireland was facing a potential similar surge in cases and in deaths. There were very legitimate concerns about the ability of our health system to cope.
Very little was known about the virus in general and even less was known about its effect on pregnancy and particularly early pregnancy. For this reason, international medical and scientific communities dealing with infertility such as ESHRE, ASRM and the British Fertility Society cautioned against fertility treatments at this time and recommended that clinics stop any treatments that could lead to pregnancy. At the same time Ireland, like other countries, introduced very strict social distancing and lockdown measures.
In mid March 2020, therefore, all fertility clinics in Ireland decided to postpone fertility treatments. This was never done lightly and we were always conscious of the huge distress it would cause our patients, particularly those who do not have time on their side. However, it was genuinely done in what at that time was very much the best interest of patients, our staff and our nation.
Thankfully, the future is looking much brighter than it did a month ago. The effect of the virus in Ireland has been tragic but it has not been as devastating as in other countries and the lockdown measures definitely seem to be working. We are all hoping that these restrictions will be eased somewhat in early May.
In addition, the evidence regarding pregnant women is reassuring.
Effect of the Virus on Pregnancy/Pregnant Women
As a group, pregnant women seem to be no more at risk of contracting the virus than non-pregnant women. The virus does not seem to be transmitted from mother to baby in the bloodstream, amniotic fluid or breast milk and there has been no evidence of any increase in fetal abnormalities. There may be a slight increase in premature deliveries but this is not certain.
However, the evidence to date is still predominantly for women diagnosed with the virus in late pregnancy. The most recent study of 116 cases from China only included 8 women in early or mid-pregnancy.
We also know that any severe infection or illness can have an adverse impact on pregnancy and COVID-19 is no exception. Pregnancy of itself produces changes in the woman’s cardiovascular, respiratory and blood clotting systems, which make ventilation and ICU care for any condition difficult. The majority of women who developed severe symptoms of COVID-19 worldwide were delivered early by Caesarean section, many of those prematurely.
With this in mind, over the coming weeks MFC will be:
- ensuring that no high-risk patients begin treatment until it is deemed safe to by the relevant healthcare bodies
- offering patients the option to postpone treatment should they wish to
- providing advice and education on COVID-19 risk and prevention
- having all patients sign a Code of Conduct which gives instruction on best practices during treatment
- having patients fill out a COVID-19 triage questionnaire before and during treatment
- following up with patients in the weeks after egg collection and embryo transfer to identify potential COVID-19 positive patients and implement necessary measures
We will be contacting people very soon to arrange appointments and start some treatments. In the meantime, our staff are available to answer queries and to provide support by phone or email (Ph. 01 663 5000 or firstname.lastname@example.org)
The situation is a lot brighter than it was six weeks ago and we look forward to seeing all of our patients again soon.