Today’s episode centers around the impact on fertility treatments due to coronavirus, which is the virus manifesting as the respiratory illness called “COVID-19.”

On St. Patrick’s Day, the American Society for Reproductive Medicine (for short known as ASRM) released recommendations for managing fertility treatments during the pandemic. These recommendations came from the evidence we currently have on COVID-19. ASRM will update their position by March 30th or earlier as more information comes in. The link to the recommendations is available on my website, “yourfertilitypharmacist.com”

After listing their major recommendations from the eight-page document, I’ll go over the rationale for these momentous statements.

#1, no more new treatment cycles for the foreseeable future. By new treatments, they explicitly call out ovulation induction, in vitro-fertilization – including retrievals and frozen embryo transfers, intra-uterine inseminations, and non-urgent gamete cryopreservation.

#2, in quotes, is “consider cancellation of all embryo transfers whether fresh or frozen.”

#3, keep caring for a patient is already “in cycle” or requires urgent stimulation for cryopreservation. Now, caring for is a gray area, which I will come back to later in this episode.

#4 stop any non-urgent diagnostic procedures and elective surgeries.

And the last one, #5, minimize in-person interactions in favor of telehealth.

These recommendations are… extreme, but not shocking, given the surreal times that we are now living in. ASRM laid out how COVID-19 is more contagious and kills 10-15 times more people compared to the flu. There is a scary shortage of personal protective equipment for healthcare workers, so there is a suggestion that the gloves, masks, and other personal protective equipment used by the staff at fertility clinics could be rerouted to healthcare systems directly addressing COVID-19. Since the U.S. is severely deficient in testing and screening capabilities for coronavirus, staff at reproductive centers could unknowingly come into contact with the infection; if reproductive staff come down with the illness, this could easily impair the quality of care needed to treat patients. Most importantly, we still don’t know how COVID-19 infection will impact pregnant women; it’s unclear if a mother can directly pass the virus onto a baby in utero. A recent publication discussed the outcomes of nine pregnant Chinese women who tested positive and showed symptoms for COVID-19. Six out of ten babies born to these COVID-19 infected moms experienced intrauterine fetal distress and met criteria for critical illness. (More details about this publication from China can be found on the study link located on this episode’s webpage).

With the concern for negative impact to babies, women, and healthcare staff, ASRM’s recommendations to stop any non-urgent fertility treatments makes sense. I live in an area where coronavirus has really taken hold, and I’m seeing the uptake of the ASRM recommendations vary based on the local reproductive clinic. Deciding what is urgent and what is not is such a gray area. While a couple of sites haven’t seemed to alter their practices significantly, others are going on a case-by-case basis on whether or not to proceed with a stim cycle or transfer. Many women are feeling heartache over having to delay treatment in the face of a ticking biological clock. Other women are nervous that their cycle will be cancelled at the last-minute as more restrictions come into play. My advice to any active patients at a reproductive clinic would be to touch base with your clinic to know their stance on treatment during this pandemic and how they personally plan to attend to your case. For women who may have the possibility of conceiving naturally, please practice social distancing and keep taking your prenatal vitamins!

That’s the end of today’s episode of “Your Fertility Pharmacist.” In the next episode, I’ll discuss the medications being used experimentally to treat COVID-19 and what we know about how they impact pregnancy. All related links discussed in these episodes will be posted on the website “yourfertilitypharmacist.com.”