Practical consequences of COVID-19 for CHR’s fertility patients

We have repeatedly, and in detail, laid out in these pages and in CHR’s intermittent COVID-19 Bulletins why CHR made the decision to remain open, while most other IVF centers decided to close down. Though it was a controversial decision, we are pleased to report that CHR’s position on this matter was validated, when New York’s Governor Cuomo last month reaffirmed medical infertility services as “essential.” We are even more pleased that our field’s authoritative society, the American Society for Reproductive Medicine (ASRM), also just a few days ago, updated its formal guidance to IVF centers, encouraging their reopening. As a consequence, IVF centers in NYC and all around the country have announced resumption of patient care. We, therefore, strongly hope that during the month of May, fertility services in the nation (and elsewhere in the world) will return to normal.

For CHR patients, this is an especially important development since many of our patients (indeed, a majority) are long-distance patients, often dependent on local colleagues in their respective locations, who are gracious enough to help CHR in early-stage monitoring of these patients during IVF cycles. Since no IVF centers remained open in many U.S., Canadian and even European locales, many CHR patients who did require urgent IVF treatment could not get started locally with their cycles over the last two months. Some centers that remained open also refused to provide monitoring services. Because of COVID-19 times, our patients were often unable to come to NYC for the whole length of their IVF cycles, which would have been another option. We, therefore, over the next few weeks, expect a short-term increase in IVF cycle starts and would like to encourage our long-distance patients to let their Clinical Coordinators know as soon as they are considering starting a cycle. Because COVID-19 remains an acute issue, we here at CHR, have to maintain strict COVID-19 precautions, which means that, in the foreseeable future, we will continue to rotate our staff. This, of course, means that the number of IVF cycles we will be able to initiate in any given week/month will have to be limited. Spots will be assigned on a first-come-first-served basis.

CHR has a new informed consent, informing patients on the potential risks of COVID-19 infection during fertility treatment and pregnancy. Image by Christian Bowen via Unsplash.

We would also like to take this opportunity to address another related subject, which we have previously addressed in these pages and in CHR’s COVID-19 Bulletins: Though early reports have been reassuring, we must reemphasize that the effects of the virus on pregnancy are, still, not fully determined. Currently available studies suggest that, considering how aggressive the virus can behave in some patients, its apparent effects on pregnancy appear surprisingly minimal. There currently is, for example, no convincing evidence that the virus crosses into the fetal compartment during pregnancy and infects offspring. Yet, mothers can, of course, get infected and can, and will, experience pretty much all the potential consequences of the virus other COVID-19 patients experience (including in some cases admission to ICUs and need for respiratory support). In that sense, the virus, therefore, can affect pregnancies, though, in contrast to the influenza virus which in pregnancy causes more severe disease, COVID-19 apparently does not do that.

Patients who start fertility treatments must be aware of these facts and, following a recommendation from the field’s professional organization, the ASRM, CHR has added a special COVID-19 informed consent that patients are now asked to sign in confirmation of their understanding that a potential infection with the virus during treatment can obviously interrupt such treatment (because any treatment cycle would have to be stopped) and/or, at least potentially, can affect an already pregnant woman in her pregnancy.

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) 

This is a part of the May 2020 CHR VOICE.

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.