When to restart fertility treatments after COVID-19

[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.

When to restart IVF after COVID-19 is a clinical, logistical and emotional decision each patient must make.
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.

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 yours!

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!

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.