Safe IVF during the Pandemic: Updated COVID-19 Precautions at CHR

[This article deals with a rapidly developing situation. It was written by Norbert Gleicher, MD, on June 8, 2020 and published on June 9, 2020. For a list of all COVID-19 Bulletins, scroll to the bottom.] 

While many fertility centers closed down in the first few months of COVID-19 outbreak in the United States, CHR never closed our doors, despite our location in New York City, one of the hardest-hit areas in the country. We remained open for consultations, workups and fertility treatments because most of the patients we take care of are older and/or have severely diminished ovarian reserve, which makes their need for fertility treatment quite urgent. A few months may be a no big deal for a 28-year-old woman with blocked tubes, but the same few months make a significant difference in the type of patients we treat.

Dr. Gleicher explains CHR’s decision to remain open during the height of the COVID-19 outbreak in New York City.

Obviously, the decision to remain open was not made lightly; we quickly put in place safety precautions against the spread of the novel coronavirus and updated them as more information became available. These policies—already in place by mid-March—form the basis of our current COVID-19 precautions. In late April, the American Society for Reproductive Medicine (ASRM) issued reopening guidelines for fertility centers that had closed down. We have updated our precautions based on these guidelines, those from the Centers for Disease Control and Prevention (CDC) and other government bodies, as well as newly emerging evidence in the literature.

While these precautions are constantly evolving, here is an overview of how we protect our patients, staff and the community at large:

General guidelines for consultations and appointments

  • All consultations are conducted via phone or Skype, with in-person appointments limited to necessary testing, monitoring and procedures.
  • As children were identified early on as frequent asymptomatic carriers of the coronavirus, children under age 16 have not been allowed in our facility.
  • To minimize exposure, everyone accompanying patients are asked to wait outside.

Entering the CHR

  • Patients are requested to call 212-994-4400 before entering the premise so the staff can maintain 6 feet of distance among patients.
    • Depending on the occupancy level, patients may be asked to wait outside.
  • Everyone’s temperature is checked upon entry.
    • Anyone with a fever over 100F cannot enter.
  • Front desk staff ask screening questions to assess potential exposure and symptoms consistent with COVID-19.
    • If the answer is yes to any of the questions, patients need a negative COVID-19 test to enter CHR.
    • COVID-19 test should be preferably performed by the patients’ PCP.
    • If a PCP is not available, CHR can perform the test, outside of our building.
  • Everyone should sanitize their hands before entering at the hand sanitizing station.

Inside the CHR

  • Hand sanitizing stations have been placed throughout the building for everyone’s use.
  • Patients, staff and anyone else entering the building must wear surgical masks that cover nose, mouth and chin.
    • We provide masks when necessary.
  • Only one person can use the elevate at a time. (Our antique elevator, while beloved, is not conductive to social distancing.)
  • Staff facilitates quick in-and-out for all patients who visit CHR in person.
All staff who can work from home are required to work from home to reduce density.

Staffing

  • Staff who needs to be physically present to provide patient services is placed on a reduced, rotating schedule to reduce density and exposure.
  • Work stations have been rearranged to be as far apart as possible.
  • Patient hours are limited to 9 am to 3 pm.
  • Work that can be performed from home must be done from home.
    • CHR provides IT support to facilitate remote work.

Staff training

  • All staff members are required to undergo COVID-19 training, including:
    • Proper use of PPE
    • Correct hand-washing technique
    • Appropriate cleaning of work areas

Reporting and quarantine

  • Staff is mandated to immediately report COVID-19 symptoms in themselves or members of the household.
  • Symptomatic staff is required to undergo testing and stay home, according to CDC recommendations.
  • Antibody testing is made available to all staff.

Cleaning

  • Hourly cleaning and sanitizing routines have been in place, where high-touch surfaces in public areas and individual workstations are disinfected by our staff.
  • Daily cleaning, performed by our cleaning crew, is much more in-depth than the in pre-COVID era.

We hope that these precautions will be protective for everyone, but nobody can guarantee that neither a patient nor staff member at any point will contract the COVID-19 virus. Following the April 24 guidelines from the ASRM and in the spirit of transparency, CHR has also instituted a new informed consent process to inform patients about the potential risks of fertility treatments and of pregnancy during this outbreak. For further details, please review our comments in the VOICE and COVID-19 Bulletins.

There are patients whose dream to conceive has special urgency. We are proud to have been the ultimate “fertility center of last resort” throughout this crisis period. Now that increasing numbers of fertility centers are reopening their doors, we, of course, continue to provide fertility treatments as safely and effectively as possible. Please reach out to us if you have any questions about our COVID-19 precautions or have trouble accessing fertility treatments that suit your situation and timeline. Times are difficult, but we are confident we can find a solution.

CHR’s COVID-19 Bulletins

  1. News you, likely, will not find in the media (Published on July 6, 2020)
  2. Notable reports in medical literature and the media on COVID-19 and immunity against it (Published on July 6, 2020)
  3. COVID-19 cases rapidly increase in South and Western U.S. states but that will help build herd immunity (Published on June 29, 2020)
  4. Are we witnessing a second wave of COVID-19 outbreak? (Published on June 22, 2020)
  5. WHO was wrong about asymptomatic patients being contagious & other COVID-19 fake news (Published on June 10, 2020)
  6. Updated COVID-19 precautions at CHR (Published on June 9, 2020)
  7. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  8. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  9. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  10. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  11. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  12. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  13. 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)
  14. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  15. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  16. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  17. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  18. Some IVF centers may never reopen (Published on 4/17/2020)
  19. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  20. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  21. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  22. 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)
  23. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  24. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  25. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  26. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  27. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  28. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  29. 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)
  30. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  31. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  32. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  33. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  34. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  35. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  36. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  37. 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.