Michael M. Alper M.D., James A Grifo M.D., Ph.D., Richard T. Scott, Jr., M.D.
On March 17th an ASRM Recommendation was issued to not initiate any new treatment cycles. An ASRM Q&A document on April 7th stated “If you don’t have COVID-19, there is no medical reason to change your plans regarding trying to conceive.” So, the message is that it is OK to get pregnant during the COVID-19 pandemic unless you are infertile! Is this really what the ASRM message should be?
We write this letter in the heat of the COVID-19 pandemic in our states. It is not over and we do not know the ultimate outcome. But we do know one thing – the ASRM’s position during this pandemic has been disappointing to us as REI’s and, more importantly, to the patients we care for. Let us explain.
The ASRM ‘recommendation’, which is not a practice guideline, committee opinion or standard of care, is just that – a non-enforceable recommendation. It is not a regulation or law. However, the ASRM community misconstrued the ASRM statement as something that is mandatory – programs across the country essentially closed directly as a result of the ASRM. There was inadequate clarification of what an ASRM ‘recommendation’ really is. In addition, ASRM did not request any comments or feedback from its membership prior to issuing the recommendations. It left many REIs and members of fertility clinics totally off-guard and many were informed from patients directly, rather than the society they belong to.
The ASRM position of March 17th (and slightly modified since then) was predicated on the social responsibility that medical providers should have during this crisis. Of course, as health care workers we have a profound societal responsibility to not drain resources from a system strained beyond its capacity. But what if we could provide infertility treatments without placing a significant drain on the healthcare system? Does performing an intrauterine insemination or embryo transfer in a 42-year-old place much strain on the healthcare system if performed is an office not associated with a hospital?
The pandemic is not the same in every city or state. Of course, local regulations rule. For example, New York initially placed a ban on elective surgery but on April 8th issued a clarification on the regulation allowing for reproductive services (including IVF) after a discussion between the patient and the doctor. Why do we need a state governor (Cuomo) to bring the patient and doctor together to discuss treatment? Why not ASRM?
And what about safety for our patients and staff. Everyone is scared beyond belief. But, like every action we take, we must weigh risk versus benefit. If you don’t want to take the risk of airline travel - then don’t fly – but we take the risk. The risks of undergoing treatment now can be minimized but will never be zero. Strictly adhering to CDC guidelines and aggressively modifying the way we care for patients during this very difficult time will reduce risks for all. Not zero, but acceptable. So, patients, in consultation with their physicians, need to make the decision – not the ASRM.
If we all knew that the COVID pandemic would be completely done within a couple of months, then this discussion is unnecessary. But experts say that it could be many months before it is eradicated and maybe 18 months until a vaccine is developed. Certainly, a 27-year-old with blocked tubes can wait a bit before initiating treatment. But what about the 40-year-old single women with borderline ovarian reserve who needs IVF? What about the patient in a mandated state who will lose her job and will not be able to afford fertility care? These patients have been abandoned.
The ASRM has done some amazing work for our community and is led by extremely competent and well-intentioned professionals. After this pandemic is over, there should be some soul searching by all levels of government, society and societies. No one element of our society handled this perfectly - we need to learn so that we can all better handle any future catastrophic emergency.
As ASRM members for close to 30 years and having attended virtually every annual meeting, we would only hope that ASRM does some introspection after COVID to learn from what went right and wrong. We are all not perfect.