Recently, the American Society for Reproductive Medicine (ASRM), a global leader in reproductive medicine, issued guidance for its members on how to manage patients with infertility during the COVID-19 pandemic. For the physicians in Cleveland Clinic’s Fertility Center, that means fewer procedures and more virtual visits, and a near constant reassessment of the situation.
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“All of my visits are now virtual and we’re doing everything we can to keep consultations moving forward so that when the time comes that we can start cycles and perform nonurgent procedures again, our patients are ready,” says Staff Physician Stephen Mooney, MD. As it currently stands (on March 24, 2020), that may not be until sometime in May.
Right now at Cleveland Clinic, all new, nonurgent treatments for infertility are suspended. That means no elective surgeries or nonurgent diagnostic procedures, fewer in-person interactions between physicians and patients, and more use of telehealth. All of these measures are in keeping with the guidance from ASRM, which was developed by an expert Task Force of physicians, embryologists and mental health professionals.
“The key recommendation from ASRM is the suspension of new, nonurgent treatment cycles,” says Dr. Mooney. “That includes giving medications for ovulation induction and performing intrauterine insemination, in vitro fertilization, egg retrieval, frozen embryo transfer and gamete cryopreservation.”
Care is continuing, however, for patients who were in the midst of an infertility treatment cycle when the COVID-19 pandemic hit and for those who have an urgent need for gamete cryopreservation, such as patients with cancer.
“Elective surgery is cancelled, but if not doing a procedure would threaten a patient’s life or the function of an extremity or organ, we would perform it,” says Dr. Mooney. Examples of such situations include an ectopic pregnancy or a surgery that is time-sensitive because of risk of metastasis or progression of malignancy.
Patients with infertility who were in the midst of a treatment cycle when the ASRM guidance was issued were given two options. “Depending on what stage they were in, they could discontinue treatment or complete the cycle,” says Dr. Mooney. “By now those who wanted to complete cycles have done so.”
Ensuring safety of gametes and embryos
Fortunately, none of the patients treated by the Fertility Center have tested positive for COVID-19. But if that were to happen, any gametes or embryos they had cryopreserved would immediately be moved to a separate storage area.
Cleveland Clinic also is committed to ensuring the safety of cryopreserved gametes and embryos by meeting ASRM’s minimum guidelines for personnel performing quality control activities on the storage tanks. Staff members are being cross-trained so they can rotate, in the event that someone becomes ill or must be quarantined because of exposure to COVID-19
Calling the COVID-19 pandemic “unprecedented times,” Dr. Mooney notes how difficult the suspension of nonurgent care is for patients with infertility. “These individuals are already frustrated and emotionally and psychologically stressed. It’s common for them to have feelings of panic and helplessness, hopelessness and loss of control,” he says. “We’re doing our best to validate their feelings and help them understand that the ASRM recommendations are in place for the welfare of everyone — caregivers, patients, loved ones and family members.”