[ASRM Guidelines] Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic

American Society for Reproductive Medicine (ASRM)The following is a summary of the recent American Society for Reproductive Medicine (ASRM) guidelines regarding the Coronavirus Outbreak. Fertility CARE: The IVF Center has enacted all measures to optimize the safety of our patients and staff. Please review below and call/message us with any questions. Our reproductive health psychologist, Dr. Judy Burnett, is also available to you as needed.

As of March 17, 2020

KEY RECOMMENDATIONS

  1. Suspend 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.
  2. Strongly consider cancellation of all embryo transfers whether fresh or frozen.
  3. Continue to care for patients who are currently “in-cycle” or who require urgent stimulation and cryopreservation.
  4. Suspend elective surgeries and non-urgent diagnostic procedures.
  5. Minimize in-person interactions and increase utilization of telehealth.

Note: This guidance 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.

BACKGROUND

While the flu causes a large number of deaths globally every year (estimated to be between 290,000 and 646,000 annually (Iuliano et al, 2018)), it should be noted that COVID-19 differs from the flu in a number of important ways:

  • The pathophysiology, epidemiology and transmission dynamics of COVID-19 are not fully understood.
  • There are currently no specific medications for the treatment of COVID-19. For example, there are no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat patients with COVID-19. Some patients have received an investigational new drug, Remdesivir, through compassionate use outside of a clinical trial setting. At this time, it is unclear whether the drug can be used safely in pregnant or breastfeeding women.
  • COVID-19 is a “novel” infection (new to humans) and host immunity is assumed to be minimal.
  • COVID-19 is more contagious than the flu.
  • COVID-19 has a 10 to 15-fold greater mortality rate than the flu.
  • COVID-19 impacts the lungs differently than does the flu.

PSYCHOLOGICAL HEALTH AND WELL-BEING OF PATIENTS AND STAFF

  • The COVID-19 pandemic presents an unprecedented threat of unimaginable proportions to the psychological and emotional wellbeing of patients and staff.
  • The invisibility and uncertainty of the pandemic may result in feelings of panic, terror, helplessness, hopelessness, and loss of control.
  • Patient concerns include cancellation of treatment cycles and/or the inability to initiate a treatment cycle, fear of running out of time and never achieving pregnancy, the potential impact of the coronavirus and COVID-19 on pregnancy and the fetus, and the risk of exposure and infection in the medical office.
  • Medical staff concerns include managing patient anxiety and questions, exposure or exposing others to COVID-19, childcare concerns with school cancellations, increased workload due to limited staffing, and financial uncertainty.

On behalf of my team, our prayers are with everyone to remain safe and healthy.