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How does the COVID-19 pandemic impact fertility treatments?

Here are answers to some of the top questions about fertility treatments during the coronavirus pandemic.

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The coronavirus pandemic has changed life in unimaginable ways—and coronavirus may raise a significant amount of concern for people going through fertility treatments.Treatments are regimented and the process itself can be daunting. Adding a pandemic to the mix is incredibly challenging.

As we learn about the nuances of the virus, various medical organizations are updating policies and guidelines as they apply to different groups of people. This includes people going through fertility treatments.

First, a quick note: I know this is incredibly stressful for you. Be very gentle with yourself as you go through this process. Ask your provider for specific recommendations for your individual circumstances. And never hesitate to reach out to a professional for virtual emotional support if you need it.

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Here are answers to some of the top questions about fertility treatments during the coronavirus pandemic.

What are the guidelines for fertility treatment during the COVID-19 pandemic?

On March 17, 2020, the American Society for Reproductive Medicine (ASRM) issued recommendations specifically for patients undergoing fertility treatments in the face of the current coronavirus pandemic. These recommendations are considered "best practice" recommendations and are not requirements that are to be enforced in any way. The requirements were made with a time frame of two weeks, at which time they will be reevaluated.

In short, fertility treatments may be delayed.

The concept of delaying fertility treatments can be devastating, however, "flattening the curve" by social distancing is critical to decreasing the rate of infections. Coming into a busy fertility clinic and being exposed to large numbers of patients in a waiting room could be dangerous. As you face this challenging time, remember that following these guidelines will help you to stay safe so that your pregnancy can be as healthy as possible.

Individual fertility clinics will decide how they will proceed during the pandemic depending on their local conditions, the recommendations of local authorities, and the type of clinic. Clinics that are associated with hospitals may be more likely to strictly follow the ASRM recommendations since medical resources that are needed for those treating infected patients are scarce and will need to be directed to those urgent cases.

Your best bet is to call your clinic and ask them how they are responding to the recommendations.

What happens if I'm in the middle of fertility treatment during COVID-19?

The ASRM recommends that all cycles be postponed (with a few exceptions), including the use of oral or injectable fertility medications for inducing ovulation or for an IUI or IVF cycle, and those starting a frozen embryo transfer cycle.

Those patients who are currently "in-cycle" may continue on an individual basis until the cycle is completed. Strong consideration should be given to postpone embryo transfers (both fresh and frozen) and to promote freezing all the embryos until there is some resolution of the pandemic.

Patients should have a discussion with their provider about the risks and benefits of proceeding versus canceling their cycles.

If I have cancer, can I still freeze my eggs?

Patients who are about to undergo chemotherapy for cancer who are freezing eggs or embryos for fertility preservation are exceptions and may continue as needed. In these cases, they cannot delay their treatment.

Can I still freeze my eggs during the coronavirus pandemic?

Non-urgent planned egg freezing (for reasons other than impending chemotherapy for cancer), should be postponed based on the recommendations, but check with your clinic. The ASRM also is recommending that clinics suspend all elective surgeries and non-urgent diagnostic procedures.

Can I start IVF during the COVID-19 pandemic?

If you are about to start IVF, you should speak with your reproductive endocrinologist about whether they are starting any IVF cycles at this time, and about the risks of going forward with your cycle. I would recommend that people consider freezing their embryos and not doing a fresh transfer right now—we are still learning a lot about the impacts of coronavirus on pregnancy so delaying conception a bit may decrease the chance of potential risks associated with the infection.

According to the American College of Obstetricians and Gynecologists (ACOG), little is known about the impact of COVID-19 on pregnant women and infants, and it is unclear if COVID-19 can cross the placenta. Since pregnant women are at higher risk of complications from similar respiratory infections, pregnant women are considered an "at-risk population" for COVID-19.

The data on coronavirus infections in pregnancy is minimal. Providing care for pregnant women with severe infections will possibly be more difficult and resource-intensive. Some of the drugs that are being considered for treatment may not be usable in pregnant women, for instance.

It may be best to postpone your cycle for multiple reasons, including unknown risks of infection during pregnancy, desire to minimize in-person interactions, and preserving medical resources for urgent COVID-19 patients.

When will I be able to start my IVF or FET cycle?

Unfortunately, there is no answer to this question right now. We are hopeful that the steps that are currently being taken to "flatten the curve" will successfully shorten the time for this pandemic and allow everyone to get back to their normal life as soon as possible.

Can I have any evaluation for infertility during coronavirus?

Clinics are being encouraged to minimize in-person interactions and instead utilize telehealth options, like conducting consults by phone or video chat. So it is possible to have telephone consultations and speak to your provider about questions you have, and also to plan your future treatments so that once things normalize, you may be able to start things up quickly.

What else should patients know at this time?

Although these recommendations are difficult, know that fertility patients are not being singled out for suspension of care as a group. Other specialties have also had similar recommendations to suspend elective procedures, including elective surgeries and dental care. It is critical, especially in hard-hit areas, to have materials available for those caring for the acutely ill, including masks, hospital beds and personnel.

There is some good news: While fertility treatments are by no means "elective," and we know that fertility patients feel the urgency to undergo treatment without delay. There is no evidence that delay of treatment for a short period of time (one to three months) has any detriment on success rates (other than those doing egg freezing prior to chemotherapy), so the current delay will not reduce anyone's chances of conceiving with fertility treatment.

One more note: It is clear that health care providers at fertility clinics are also at risk of becoming infected as a result of patient interactions. Infections in staff at fertility clinics could result in cancellation of cycles due to inadequate staff to work the clinic, including doctors, nurses and embryologists.

This is an unprecedented time for everyone, and we really do understand how hard this might be for you. Please know that your fertility team wants to get back to work as soon as they can and that they are very much with you. Do not hesitate to reach out to your provider as questions and concerns arise, and take excellent care of yourself.

This will pass, and you'll be back to the business of making a baby very soon.

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