When to restart IVF after COVID-19 is a clinical, logistical and emotional decision each patient must make. Image by DrKontogianniIVF via Wikimedia Commons, under Creative Commons Zero license.
[This article deals with a rapidly developing situation. It was written by Norbert Gleicher, MD, on April 16, 2020 and published on April 17, 2020. For a list of all COVID-19 Bulletins, scroll to the bottom.]
Since CHR has been fully functioning throughout the crisis, though, of course, at a much lower patient volume, we have had daily contact with patients. The question we have been asked most often, likely, has been this: When can I--should I--resume my fertility treatment after COVID lockdown is eased?
CHR’s answer to most patients has been “that depends.” Many variables come into play and must be considered. Likely the most important one we have discussed here and in our monthly newsletter, the VOICE, repeatedly: Patients have different urgency in their need for fertility treatments. Some are “urgent”; others are more or less elective. To differentiate between those two circumstances, a good example is a 45-year-old woman who still wants to conceive with use of her own eggs vs. another 45-year-old woman who has decided to pursue IVF with donor eggs. The first patient, of course, has no time to lose; the second 45-year-old will see absolutely no impact on her pregnancy and delivery chances if she waits 3 or even 6 months.
A second important consideration, especially here at CHR, is the patients' need for travel. Over half of our patients must travel in order to have their IVF cycles performed at CHR. While we do offer remote consultations and manage fertility workup and cycle monitoring close to our patients' locations (and we have done so for over a decade), egg retrieval and embryo transfer still must be done at our NYC facility. A good portion among our long-distance patents, indeed, have to travel from outside the U.S. For patients who must travel to NYC, there is obviously the concern over getting infected in a plane or train ride. Especially for overseas patients, it also frequently requires a U.S. visa for entry into the country and, in the current COVID situation, this may either not be possible or may require two weeks of quarantine before they can even enter the CHR. When they return to their home country, similar quarantine rules may also apply, further complicating their treatment logistics.
For all of these reasons (and many others), we have from the beginning supported the _ASRM’_s guidance that only “urgent” treatments should be provided to fertility patients while most of the population must practice social distancing. With talk about removing at least some of the restrictions, and with local hospitals also having started discussions about reopening for elective procedure and surgeries, the scenario, likely, will start changing very soon. We would not be surprised if most hospitals in NYC had returned to relatively normal pre-COVID-19 scheduling by May 1.
For the fertility field this, hopefully, also will mean that IVF centers that closed in the past weeks will reopen. Every center can initially expect some pent-up demand, but, if prior economic recessions are an example, we can expect that this pent-up demand will be taken care of relatively quickly and patient volume thereafter will decline. Our prediction is that this decline will last well into 2021.
When you should restart your fertility treatments fully depend on what your fertility history dictates, but it also depends on where you emotionally stand about having a baby in the midst of what may turn out to be the most significant economic crisis of our lifetime. Finally, like everything in this world, it also depends on everybody’s economic circumstances. The decision, therefore, can only be _your_s!
But remember, in many cases, you cannot just start fertility treatments right away. Before a fertility treatment cycle can be started, tests may have to be updated and/or ovaries must be prepared with supplements like DHEA, and those can take some time. Please take all of this into account when deciding your timing to restart your IVF journey. We are here to help you make this complicated decision--let us know if you have any questions!
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.
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