[PLEASE SEE OUR APRIL 2 UPDATE ON THIS]
These are the most recent recommendations from the American Society of Reproductive Medicine (ASRM). I have spoken with a number of reproductive endocrinologists in the area as well as Lisa Ray, our embryology director. I do realize that there are 9 cases in China where women diagnosed with coronavirus did have successful pregnancies. Unfortunately, the numbers are too small to ultimately know the risk to mother and baby with this novel coronavirus.
Therefore, based on ASRM’s recommendations, the discussion with my peers and my own concerns with potential risks in pregnancy (i.e. heightened risk to the mother of coronavirus due to pregnancy and the potential problems with diagnostic studies and treatment, if a pregnant woman has severe complications due to Coronavirus), at present, our team is proceeding as follows:
- Patients on Clomiphene Citrate and gonadotropins should stop their cycle and not attempt pregnancy either via inseminations or timed intercourse. However, if the couple is inclined to proceed with cycle completion (inseminations and timed intercourse), they must sign a waiver stating that they understand the unknown risk to mother and baby in regards to the virus. Otherwise, the cycle will be cancelled. No new cycles with Clomiphene Citrate and gonadotropins will be initiated.
- Women who are currently undergoing IVF stimulation can proceed with their cycle. We do recommend a freeze‐all with the caveat that fresh transfer can be considered if it is deemed that freezing of the embryos/eggs would be detrimental to successful pregnancy. Once again, a waiver must be signed stating that at present, the risk of subsequent transfer of coronavirus-infected embryos/eggs, although believed very low, is ultimately unknown to mother and baby. Furthermore, it must be understood that these cycles may be stopped at any time given further recommendations from the ASRM.
- Because of the anticipated increase in the coronavirus, the ASRM has recommended that no new stimulations be started. However, as this is solely a recommendation, for the immediate future, we will continue to evaluate stimulation starts on an individual basis; again, with the recommendations as outlined above (i.e. freeze‐all of embryos/eggs, waiver must be signed, cycles may be stopped, etc.). Please contact our office regarding your individual cycle concerns.
- In regards to patients who already have frozen embryos and wish to proceed to frozen embryo transfer and are currently on medication, once again, the risk of pregnancy in a patient who is positive for Coronavirus is unknown. Therefore, our recommendation is to not proceed at present. However, if a couple wishes to proceed, they need to be aware that we will support them in their decision, but will require them to sign a waiver. This decision could change at any time.
Thank you,
Charles E. Miller, MD FACOG
ASRM Issues New Guidance on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments
3/18/2020 The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, today issues new guidance for its members as they manage patients in the midst of the COVID-19 pandemic. Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document recommends suspension of new, non-urgent treatments.
Specifically, the recommendations include:
- Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
- Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
- Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
- Suspend elective surgeries and non-urgent diagnostic procedures.
- Minimize in-person interactions and increase utilization of telehealth.
The above recommendations will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible. ASRM has been closely monitoring developments around COVID-19 since its emergence. Data on its impact on pregnancy and reproduction remains limited. However, the task force used best available data, and the expertise and experience of the members to develop the recommendations. Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients. Similarly, non-medically urgent gamete preservation treatments, such as egg freezing, should be suspended for the time being as well. Clinics who have patients under treatment mid-cycle should ensure they have adequate staff to complete the patient’s treatment and should strongly encourage postponing, the embryo transfer.
Catherine Racowsky, President of ASRM, noted, “ASRM is striving, as we always do, to ensure our members have the very best information available as they care for their patients. We are all facing a great deal of uncertainty, but we do know our health care system is about to be stressed in a way it has never been stressed before. Only by working together medical professionals, patients, citizens of an inter-connected world, can we hope to meet this latest challenge.”
Ricardo Azziz, CEO of the ASRM stated, “This is not going to be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are loath to in add, in any way. to that burden. And it will not be easy for our members. The disruption to routines, the stress on staff members and the very real prospect of economic hardship loom large for ASRM members all over the world. But the fact is that given what we know, as well as what we don’t, suspending non-urgent fertility care is really the most prudent course of action at this time.”
Dr. Racowsky added, “We should recognize that the situation on the ground is fluid, and as such we will continue to revisit and review our recommendations at least every two weeks, to provide providers and their patients with the best information and support we possibly can.”
For almost a century, the American Society for Reproductive Medicine (ASRM) has been the global leader in multidisciplinary reproductive medicine research, ethical practice, and education. ASRM impacts reproductive care and science worldwide by creating funding opportunities for advancing reproduction research and discovery, by providing evidence-based education and public health information, and by advocating for reproductive health care professionals and the patients they serve. With members in more than 100 countries, the Society is headquartered in Washington, DC, with additional operations in Birmingham, AL. www.asrm.org