SART appreciates that implementation of the March 17, 2020 Guidance from the ASRM COVID-19 Task Force has been extremely difficult for patients and practices. The purpose of this message is to communicate with SART members directly about the ASRM recommendations.
The ASRM guidance recommends that we wind down all new treatments in all parts of the country except those treatments that are especially urgent. SART recognizes that some communities are not yet impacted greatly by this virus. Local governments in areas that are not yet greatly impacted have not yet required closure of restaurants, gyms, salons and other public-facing businesses. SART was represented on the ASRM COVID-19 Task Force and did express the view that geographic location might be considered in determining best practice for a given region – and it was considered by the Task Force. The consensus view, however, was that it is necessary to implement the recommendations in all geographic regions – at least right now, as the virus is spreading rapidly. It was a tough call for the Task Force to make. At this time, SART fully supports the final published recommendations.
Delay in fertility evaluation and treatment is disappointing and devastating for patients. None of us want this. But we recognize that compliance with this guidance is necessary at this time to protect our patients, our patients’ families, our staff, and their families. We want to resume caring for our patients as soon as possible.
The decision to comply with the ASRM recommendations was a difficult decision for practices to make and in no way implies that these practices are not strongly committed to their patients and to their staff. No communication from a SART practice that is continuing to offer fertility treatment should in any way imply that they are “more committed” to patients than practices that are complying.
SART has long advocated that fertility testing and treatment is NOT elective. Infertility is a disease. Treatment of infertility is medically necessary. In many cases, time is of the essence and delay of more than a few months could impact our patients and treatment outcomes negatively. Indeed, it can be quite urgent to proceed with some treatments. Balancing the true emergency that our country is facing with these needs is difficult. During this pandemic, other non-emergency medical and surgical treatments are being curtailed on a large scale. Fertility care is not singled out. The ASRM COVID-19 guidance allows for initiation of treatment cycles in the most urgent cases. We will advocate for the restraint on initiation of IVF cycles in women of advanced age and diminished ovarian reserve to be removed as soon as is feasible. We want to respect patient autonomy and support our patients.
Practices are facing big challenges handling this crisis. How do we pay our staff and maintain our facilities if revenue is not coming in? Curtailing fertility testing and treatment has serious financial consequences for practice directors, owners and employees. The specific challenges may differ depending on the practice size and setting, but all practices are being affected. We are all asking ourselves the same questions. How do we get through this? When will we come out on the other side and our life and practice be normal again? We need to deal with this uncertainty by focusing on our near-term actions. We can’t predict day to day what actions our governments will take, and we certainly can’t predict how this virus will impact us personally beyond the next few days. Many of us are small to medium size businesses. Others are part of a university or other large institutions. Whatever our setting, it is important that we make sure our employees are safe and able to weather the storm. The federal government is now considering big actions to support citizens. Perhaps this will be in the form of direct payments to everyone, or through requirements that landlords and lending agencies halt their normal actions due to lack of payment. Both of these may occur. We don’t have answers yet. One thing we can do now is to communicate with our staff frequently and transparently. They will appreciate this. It is also important that we communicate with existing and new patients effectively. SART has a statement for patients on the SART website at https://www.sart.org/patients/covid-19-alert-for-patients/. SART members are our own special community. We need to support each other in this time of crisis. We should share ideas with each other. We all want to protect our families, our staff and our patients to the best of our ability.
Patients need to be informed that their treatment could be stopped at any time. Some states are implementing mandatory “shelter in place” requirements, and it is likely that more restrictions are to come. A clinic that begins a treatment cycle could be forced to cancel it. Furthermore, healthcare workers who are exposed to COVID-19 may not be able to come to work. Patients need to be informed that even if they begin to invest time and money in fertility treatment at this time, it could be cancelled due to governmental restrictions or lack of availability of staff.
Is the Task Force suggesting that people should stop trying to become pregnant?
The COVID-19 Task Force does not make a recommendation one way or the other as to whether women should avoid pregnancy. The risks associated with acquiring the Coronavirus in the first trimester are not known. We do know that high fever in early pregnancy could increase the risk of birth defects and miscarriage. If your patient is already pregnant, it is important that she take all precautions possible to reduce her risk of exposure to the Coronavirus by following CDC current recommendations, such as hand washing with soap, not touching her face, and practicing social (physical) distancing.
Can’t my practice avoid the risk by screening patients and staff?
Unfortunately not. COVID-19 has become a community-acquired condition which is highly infectious, and people may be infectious before they have any symptoms. It is not possible to eliminate risk to patients and to staff by screening individuals for symptoms, known exposure, or travel history. If fertility clinics continue to start new cycles and perform diagnostic in-office testing, the virus will spread to other fertility patients and fertility clinic staff.
What can my practice do to cope with the challenges now?1. Offer telemedicine visits.
- Schedule consultations and begin to prepare your patients for further testing and treatment. Seek insurance authorizations for treatment. If you prepare patients now, you’ll be ready to begin treatment as soon as it is safe to do so.
- Telemedicine visits can be billed and may be reimbursed by insurance.
2. Provide nurses, managers, and embryologists with an opportunity to do on-line training for continuing education.3. Some practices are taking this time to improve practice operations. Maybe this is right for you, maybe not.
4. Patients may be concerned about the safety of their frozen embryos, eggs, and sperm. Some practices have implemented plans, such as staggering staff so that a minimum of embryologists is available and ensuring a constant supply of liquid nitrogen. Please also consult the ASRM recommendations. Additional recommendations will be forthcoming from SART.
5. Practices can consider sharing ideas about how to deal with this crisis from a business perspective.
6. Refer patients to RESOLVE and counselors for emotional support through this difficult time.
A special letter from the trenches of the Covid-19 pandemic from one of our own SART members, Dr. Harry J. Lieman. Go to https://www.sart.org/professionals-and-providers/covid-19-from-the-trenches/ to find out more about how this REI became part of a community of physicians treating COVID-19 patients and solving problems amidst the chaos.