CHR’s COVID-19 Bulletin, March 22, 2020

[This article deals with a rapidly developing situation. It was written by Norbert Gleicher, MD, on March 22, 2020 and published on March 23, 2020. For a list of all COVID-19 articles, scroll to the bottom.]

We in our March 18 bulletin addressed the new ASRM guidelines regarding management of infertility patients during the COVID-19 crisis. We in this bulletin want to extensively quote from a circular a colleague from Texas sent out two days ago to offer a diverging opinion. As readers will notice, many of her points are similar to CHR’s arguments in the March 18 bulletin that what can and must be done for infertility patients must depend on who these patients are and what their special circumstances are.

CHR’s Dr. Norbert Gleicher offers some guidance on how patients can make informed treatment decisions during the COVID-19 outbreak.

Here are a few examples from the circular of Beverly G. Reed, MD, a colleague from the Dallas-Fort Worth area of Texas:

The principle of justice dictates that we should treat others equitably and distribute burdens fairly. Despite the COVID-19 outbreak, no guidelines or organizations have asked fertile patients to avoid pregnancy or to use contraception. Our infertility patients are now asking us: ‘Why are we the only ones being asked to make a sacrifice to avoid pregnancy?’ And this does not only affect infertility patients. What about same sex couples and single mothers by choice? Are they being treated equitably? Our patients’ desire to conceive should be respected and they should have the same opportunities to conceive that any other person would have in the U.S. (or even the world). They feel discriminated against and it is our duty to remedy this for them. Infertility is already an isolating diagnosis and the new ASRM recommendations have caused them to feel even more isolated. As fertility physicians, we should be our patients’ biggest advocates. They deserve the right treatment and evaluation.”

She followed up by saying:

The principle of autonomy dictates that we have an obligation to respect the decisions made by other people concerning their own lives. Throughout history, women have been vulnerable to oppression. In modern times, one would hope that this is no longer an issue that women face. But here we are again; women are being told they do not currently have the right to make the decision for themselves on whether it is safe to attempt fertility treatment or pregnancy. How can an organization meant to support women not realize that women are completely capable of deciding for themselves their own next steps?”

The principle of nonmaleficence dictates that we should do no harm to patients. For women with infertility, we know that their chances for success are inversely correlated with age. It is such a time sensitive and urgent issue that even ASRM’s Committee Opinion 589 says ‘In women older than 40 years, immediate evaluation and treatment are warranted.‘ By delaying treatment and evaluation in women over the age of 40 or in women with diminished ovarian reserve, we are causing harm to them. In fact, some women may lose their chance to ever have a child with their own eggs. It is unacceptable to abandon a group of women at the time in their life when they need us the most. For a woman in her 40s trying to have a family, every single month counts. There are certainly risks of proceeding with treatment such as concern for cycle cancellation due to COVID-19 illness or need for quarantine. But there are also risks in not proceeding with treatment. We should not be the cause for the harm that comes with waiting. Our patients feel like they have already done their duty. These are women who spent their lives being responsible and following the rules. Many put themselves through medical school, law school, college, etc. And now is their narrow window to try for a baby. We cannot let them down. How can we have told women for years that time is of the essence and then turn our backs on them now?”

These words reflect very well why CHR will continue in its efforts to remain open for services to our patients.

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.