CHR’s COVID-19 Bulletin, March 27, 2020

[This article deals with a rapidly developing situation. It was written by Norbert Gleicher, MD, on March 27, 2020 and published on March 27, 2020. For a list of all COVID-19 Bulletins, scroll to the bottom.] 

Debate surrounding ASRM‘s New Guidance on Fertility Care during COVID-19 Pandemic

The debate surrounding ASRM‘s New Guidance on Fertility Care during COVID-19 Pandemic, published on March 17, 2020, keeps intensifying. A newly created interest group of IVF centers, called the Fertility Providers Alliance (FPA), representing practically all of the largest IVF centers in the U.S., many investor-owned, politely but harshly criticized the New Guidance. In response to FPA’s argument, representatives of two major academic IVF centers, Weill Cornell School of Medicine in New York City and Feinberg School of Medicine of Northwestern University in Chicago, sharply criticized all proponents of continuous clinical practice as “misguided” and “self-serving,” considering current COVID-19 conditions in the nation. Suffice it to say, both of these centers have closed their doors. 

CHR’ Dr. Norbert Gleicher explains IVF centers have different responsibilities depending on the treatment urgency of their patients.

CHR aims for the middle ground based on treatment urgency

CHR will further address this debate in more detail in the upcoming April issue of CHR’s VOICE, the center’s monthly newsletter. Not wanting to be too repetitive in our Bulletins, CHR just wants to point out the unprecedented public split in opinions on this subject within the IVF community. Moreover, CHR considers both inappropriately extreme positions and proposed and follows a middle ground, based on self-determination rights of patients, concerns for the wellbeing of patients and CHR’s medical staff, societal interests as a whole and, ultimately, ethical obligations of health care providers that vary based on the “urgency” of a clinical situation. It is the last point that both sides in this dispute, quite obviously, overlook.

Coronavirus. Image by CDC via Unsplash.

CHR, therefore, fully supports all the arguments made by our colleagues at Cornell and Northwestern but cannot agree with the statement made by one of these centers that delaying treatments by one month will not hurt anybody. As we are already witnessing, the delays will be much longer than just one month and, as we previously stated in our Bulletins, once delays reach three or more months, there will be significant negative impact on pregnancy chances for a significant number of older women and younger women with low functional ovarian reserve who, still, wish to conceive with use of their own eggs. Anybody who denies this fact does not look at the problem objectively.

CHR, therefore, restates its position between above noted two extremes, that deferring routine non-urgent fertility treatments under the current COVID-19 circumstances is the right thing to do. Patients with an urgent need to receive treatments, however, should be offered the opportunity to receive those treatments in a timely fashion. This does not mean that all IVF centers must stay open, but it also does not mean that all IVF centers must close down. What it does mean is that all IVF centers do have an obligation to act in the best interests of not only their non-urgent patients but also their urgent patients. 

What this furthermore means is that IVF centers, too, have rights of self-determination: If they conclude that, overall, it is in the center’s best interest to close down, they obviously have the right to do so. They, however, do not have the right to just ignore their urgent patients. Like in other situation where medical providers decide to withhold medical treatments because of personal ethical, religious or other considerations, such providers have an ethical obligations to direct such patients toward providers that still offer such services. 

We sincerely hope that our colleagues who are proponents of closure will not interpret CHR position as self-serving because CHR is attempting to stay open and does mostly treat “urgent” cases. CHR, therefore, wishes to reemphasize that non-urgent cycles are strongly discouraged.

Other COVID-19 related articles:

  1. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  2. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  3. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  4. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  5. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  6. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  7. 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)
  8. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  9. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  10. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  11. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  12. Some IVF centers may never reopen (Published on 4/17/2020)
  13. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  14. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  15. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  16. 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)
  17. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  18. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  19. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  20. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  21. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  22. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  23. 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)
  24. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  25. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  26. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  27. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  28. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  29. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  30. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  31. 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.