Coronavirus pandemic: Women advised not to undergo IVF as experts call for suspension of non-urgent treatments
Women have been advised not to undergo in-vitro fertilization (IVF) during the coronavirus pandemic and suspend new treatments as a precautionary measure. The advisory came from top US and European medical bodies.
The American Society for Reproductive Medicine (ASRM) has issued guidelines on fertility care during the COVID-19 pandemic, calling for the suspension of most treatments.
The new document recommends suspension of new and non-urgent treatments. The recommendations specifically suspend initiation of new treatment cycles including ovulation induction, intrauterine inseminations (IUIs) and IVF, retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
In a statement issued by ASRM, experts say, "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 the 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 amid a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients."
The guidance, which is developed by an expert task force comprising physicians, embryologists and mental health professionals, suggests minimizing in-person interactions and increasing usage of telehealth.
The experts 'strongly' recommend considering the cancelation of all embryo transfers, whether fresh or frozen. They, however, add that clinics and doctors should continue to care for patients who are currently 'in-cycle' or who require urgent stimulation and cryopreservation.
"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," say experts. They add, "Suspend elective surgeries and non-urgent diagnostic procedures."
ASRM says that the guidelines will be revisited 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 CEO Ricardo Azziz acknowledges that 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 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," says Azziz.
While not much is currently known about how COVID-19 can impact pregnant women and newborns, a recent study of four infants suggested that newborns might not get the virus from their infected mothers. The research team from China found that three infants did not test positive for the virus even though they were born to women who tested positive for COVID-19 in Wuhan. The study is the second out of China within the last month to confirm that pregnant women infected with COVID-19 did not infect their babies.
The European Society of Human Reproduction and Embryology (ESHRE) has issued similar guidelines, advising women not to undergo IVF during the coronavirus pandemic.
ESHRE says that currently, there is no strong evidence of any negative effects of COVID-19 infection on pregnancies, especially those at early stages, and that the guidelines are being issued as a precaution.
"As a precautionary measure and in line with the position of other scientific societies in reproductive medicine, we advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid becoming pregnant at this time," says a statement issued by ESHRE.
The experts say there are a few reported cases of women who tested positive for COVID-19 but delivered healthy infants free of the disease. "There have been reports of adverse neonatal outcomes (premature rupture of membranes, preterm delivery) in infants born to mothers positive for COVID-19 during their pregnancy, but the reports were based on limited data. Similarly, one case report has been published of an infected infant, but again there was no strong evidence that this was the result of vertical transmission," they say.
"These data, although encouraging, only report small numbers and must be interpreted with caution. They refer to pregnancies in their final stages, but we have no information on the possible effect of COVID-19 infection on pregnancies in their initial stages," they explain. Accordingly, ESHRE says that it continues to recommend a precautionary approach.
For those patients already undergoing treatment, ESHRE suggests considering deferred pregnancy with oocyte or embryo freezing for later embryo transfer. The guidelines further advise that patients who are pregnant or those (men and women) planning or undergoing fertility treatment should avoid travel to known areas of infection and contact with potentially infected individuals.
"ESHRE will continue to monitor the scientific literature, especially in relation to ART and pregnancy. And reaffirms the view that all medical professionals have a duty to avoid additional stress to a healthcare system that in many locations is already overloaded," a statement said.
The Human Fertilisation and Embryology Authority (HFEA) in the UK says it is aware that there is a confusing picture of the effect of COVID-19 on fertility treatment with advice and guidance coming out from several different sources. "Our current advice to clinics is to refer to UK professional guidance for advice when making decisions about whether to offer treatment. Only professional guidelines, not the HFEA, can inform local medical decisions," it says in a statement.
British Fertility Society and Association of Reproductive and Clinical Scientists have issued a joint statement, stressing that their priority as fertility professionals must be to keep patients, their gametes and embryos and staff safe.
"As these change, we need to ensure that we respond appropriately, including decisions around completing or canceling current fertility treatment, not starting new treatments, considering follow-up arrangements and changing face-to-face consultations to phone or video calls. There should be an ongoing dialogue with patients and regard to their choices," says the statement.
Experts say while there is much uncertainty around the progress of COVID-19 in the UK, the advice for pregnant women is the same as for the general public. "There do not appear to be extra precautions required," they add.
HFEA says it is aware of the limitations of the evidence that has been published so far and advises clinics to be cautious when interpreting it. Those clinics proceeding with treatments should discuss this with patients, so they fully understand the situation, they recommend.
"In addition, we are aware that some clinics have had to stop treatment cycles for other reasons such as staffing levels and emergency planning measures in their hospital. These decisions are taken locally by the individual clinic. We have not issued any guidance to advise that treatments should not continue," HFEA said in a statement.