CHR’s COVID-19 Bulletin, March 17, 2020

CHR posted its initial comprehensive response to the COVID-19 situation on March 13, 2020, and this position statement still stands. As COVID-19 creates rapidly changing circumstances, CHR will here, however, as long as circumstances demand, intermittently update the situation. These updates will be written by Norbert Gleicher, MD, CHR’s Medical Director and Chief Scientist, or other experts from inside or outside of CHR. If you have questions or comments to add, please send those to ykizawa@thechr.com.

A new COVID-19 guideline from the ASRM and SART

The American Society for Reproductive Medicine (ASRM) and its daughter society, the Society for Assisted Reproductive Technology (SART) today issued new guidance for member clinics, as they manage patients in the midst of the COVID-19 pandemic. Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document in principle recommends suspension of new, non-urgent treatments. The recommendations specifically suggest:

  • Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, and non-urgent gamete cryopreservation.
  • Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
  • Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
  • Suspend elective surgeries and non-urgent diagnostic procedures.
  • Minimize in-person interactions and increase utilization of telehealth.

These recommendations basically follow the accommodations CHR has made over the last few days in order to protect our patients and our staff as much as possible. Circumstances at CHR, however, vary to a degree, from those of most other IVF centers, based on the unique patient population CHR serves: CHR’s patients are much older than patients at other IVF centers (median age 43 years vs. 36 years). As widely noted, older age is a risk factor in COVID-19 infections, though of not particular severity at age 43. At the same time, older patients’ infertility treatments, of course, are more urgent and delays potentially more consequential.

CHR’s Dr. Norbert Gleicher offers a few points to consider for patients trying to make an informed decision about their fertility treatments during the COVID-19 outbreak.

In maintaining CHR’s longstanding policy of not claiming to be either qualified or able to tell patients how to live their lives, CHR continues to view the center’s responsibility, instead, to be one of offering advice about options and risk/benefit considerations for these options. It then is the patients’ right to self-determination that allows them to choose the direction they wish their treatments to take. In this case, CHR fully supports above summarized ASRM/SART guidelines but also respects our patients’ right to medical self-determination. CHR will, therefore, remain open and accessible for those patients who, still, feel they must get “urgent” services. 

Effects of COVID-19 on pregnancy

A just published study from Chines investigators again confirms that the coronavirus that causes COVID-19 apparently does not adversely affects pregnancy and does not cross the placenta into the fetus. We pointed all of this out in our March 13 statement, and this study is confirmatory.

Data are, however, still sparse and CHR, therefore, strongly emphasizes that all efforts must be made, and action taken, to prevent a COVID-19 infection in association with pregnancy. As also noted in some policy statements from authoritative bodies, women who are pregnant and have not yet been immunized against influenza should receive such an immunization immediately. Presence of endemic COVID-19 does not protect against influenza.

CHR’s COVID-19 Bulletins

  1. COVID-19 accelerating the changing practice of assisted reproduction (published on October 16, 2020)
  2. [Preprint by Norbert Gleicher, MD] COVID-10 pandemic through the eyes of a New York City fertility center (published on August 20, 2020)
  3. News you, likely, will not find in the media (Published on July 6, 2020)
  4. Notable reports in medical literature and the media on COVID-19 and immunity against it (Published on July 6, 2020)
  5. COVID-19 cases rapidly increase in South and Western U.S. states but that will help build herd immunity (Published on June 29, 2020)
  6. Are we witnessing a second wave of COVID-19 outbreak? (Published on June 22, 2020)
  7. WHO was wrong about asymptomatic patients being contagious & other COVID-19 fake news (Published on June 10, 2020)
  8. Updated COVID-19 precautions at CHR (Published on June 9, 2020)
  9. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  10. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  11. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  12. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  13. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  14. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  15. Governments worldwide should have let herd immunity develop rather than cause one of the worst recessions on wild guesses of “experts” (Published 4/27/2020)
  16. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  17. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  18. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  19. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  20. Some IVF centers may never reopen (Published on 4/17/2020)
  21. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  22. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  23. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  24. Reported death rate exaggerated by the media, shelter in place or herd immunity, first COVID-19 antibody test approved, and more (Published on 4/3/2020)
  25. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  26. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  27. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  28. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  29. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  30. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  31. What’s urgent is urgent and what’s not urgent isn’t: Explaining ASRM recommendations on fertility treatments during COVID-19 pandemic (Published 3/26/2020)
  32. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  33. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  34. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  35. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  36. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  37. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  38. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  39. Should international patients of IVF do anything differently during the outbreak? (Published 3/13/2020) 
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.