FERTILITY TREATMENT AND PREGNANCY DURING THE COVID-19 PANDEMIC
updated December 15, 2020
FERTILITY TREATMENT AND PREGNANCY DURING THE COVID-19 PANDEMIC
December 15, 2020 Update: COVID-19 VACCINE
Carolina Conceptions is closely monitoring COVID-19 Vaccine plans and how they affect our patients. We encourage our healthy patients to get the vaccine when it becomes available. Women who are trying to get pregnant are strongly encouraged by ACOG to get the vaccine now (see below). We also encourage healthy women who are pregnant (any trimester) to get the vaccine. The COVID-19 mRNA vaccine does not use live virus, and so similar to the influenza vaccine, there is no potential for genetic damage to a fetus. Theoretical concerns regarding the safety of vaccinating pregnant or trying-to-conceive individuals do not outweigh the potential benefits of receiving the vaccine. We support women to be free to make their own decisions in conjunction with a discussion about the COVID-19 Vaccine with their clinical care team.
American College of Obstetricians and Gynecologists COVID-19 Guidance Statement
ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there are also no data to indicate that the vaccines should be contraindicated, and no safety signals generated from DART studies for the Pfizer-BioNtech vaccine. Therefore, in the interest of allowing pregnant individuals who would otherwise be considered a priority population for a vaccine approved for use under EUA, make their own decisions regarding their health, ACOG recommends that pregnant individuals should be free to make their own decision in conjunction with their clinical care team.
Vaccination is strongly encouraged for non-pregnant individuals. Further, ACOG recommends vaccination of individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination based on ACIP prioritization recommendations. Additionally, it is not necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.
If an individual becomes pregnant after the first dose of the COVID-19 vaccine series, the second dose should be administered as indicated. If an individual receives a COVID-19 vaccine and becomes pregnant within 30 days of receipt of the vaccine, participation in CDC’s V-SAFE program should be encouraged.
ACOG recommends COVID-19 vaccines be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP. While lactating individuals were not included in most clinical trials, COVID-19 vaccines should not be withheld from lactating individuals who otherwise meet criteria for vaccination. Theoretical concerns regarding the safety of vaccinating lactating individuals do not outweigh the potential benefits of receiving the vaccine. There is no need to avoid initiation or discontinue breastfeeding in patients who receive a COVID-19 vaccine.
Society for Maternal Fetal Medicine (SMFM) Vaccine Statement
“In general, SMFM strongly recommends that pregnant women have access to COVID-19 vaccines in all phases of future vaccine campaigns, and that she and her healthcare professional engage in shared decision-making regarding her receipt of the vaccine. Counseling should balance available data on vaccine safety, risks to pregnant women from SARS-CoV-2 infection, and a woman’s individual risk for infection and severe disease. As data emerge, counseling will likely shift, as some vaccines may be more suitable for pregnant women. mRNA vaccines, which are likely to be the first vaccines available, do not contain a live virus but rather induce humoral and cellular immune response through the use of viral mRNA. Healthcare professionals should also counsel their patients that the theoretical risk of fetal harm from mRNA vaccines is very low.
May 28, 2020 Update: The safety of our patients, employees, and suppliers remain Carolina Conceptions’ priority. As the Coronavirus Disease (COVID-19) outbreak continues to evolve and spreads globally, we are monitoring the situation closely and will periodically update our company policies based on current recommendations from the Centers for Disease Control and Prevention and the World Health Organization. Only patients are permitted in our office at this time.
To prevent the spread of COVID-19 and reduce the potential risk of exposure to our workforce and visitors, we are conducting a simple screening questionnaire:
1. Have you experienced any cold or flu-like symptoms in the last 14 days (to include fever, cough, sore throat, respiratory illness, difficulty breathing, and/or shortness of breath)?
2. Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days?
If you answer YES to either of these questions, you will be required to arrange COVID-19 lab testing and confirm that you are negative before being allowed access into our office.
If you live in the Raleigh area, you can come to our office on the day of your baseline ultrasound to be tested for COVID-19.
If it is more convenient for you to get tested elsewhere, then you may go to a drive-through facility which you can locate here: https://www.doineedacovid19test.com/
Find a testing site in North Carolina and follow the instructions listed on the website. You will need to obtain a COVID-19 testing lab requisition order form from Carolina Conceptions.
April 24 Covid-19 Update: Carolina Conceptions is closely monitoring local and national advisories on COVID-19.
Starting May 4, 2020, we will restart fertility treatments.
We will resume Letrozole, COH, TIC, IUI, and TDI cycles. If your period starts May 4 or after, please call our office to schedule a baseline ultrasound.
We will also restart IVF treatment cycles and Frozen Embryo Transfer (FET) cycles. Our nurses are in the process of contacting patients in the order that their IVF/FET cycle was cancelled so we can help you map out new dates. For patients who have completed a class only, you will be contacted in the order you had your class to establish new dates of treatment. If you are not already on birth control, please start birth control on cycle day 2 of your upcoming period.
Please understand that we are very sensitive to everyone’s sense of urgency, and our plan to maintain fairness in restarting treatment is to go by our list. It will take us some time to go through our list of patients and give all of you new dates, but know we are in the process of reaching out to everyone in the order that you were originally seen.
If you do not feel comfortable restarting your treatment at this time, we understand. Please reach back out to us when you are ready and we will work on dates for you.
The health and safety of our patients and our staff is of utmost importance. We will continue to limit the number of staff and patients in the office at any one time. Therefore, all consultations, new patient visits, and nurse classes will continue to be offered via telemedicine until further notice.
Please note that all semen analyses should be completed as drop-off appointments and not in-office collection. Sperm collection for IVF and IUI should be done at home unless you live over 60 minutes from our office in Raleigh. We can provide you with an at-home collection kit, just ask!
While we will be opening our doors to these appointments, we will continue to socially distance, and ask our patients to do the same.
– We will require patients to WEAR THEIR OWN FACE MASKS in order to walk into our office. If you don’t have one, there are lots of online ideas to make one yourself from old t-shirts.
– Patients and Staff will be screened by one of our staff at the first floor elevator lobby for COVID-19 symptoms and will have their temperature taken. Only patients who pass the screening will be allowed into the elevator and into our 3rd floor waiting room. Only 1 person should ride in the elevator at a time. Please do not risk infecting others and stay home if you have any thoughts that you may have been exposed to COVID-19.
– Patients will be required to sign a waiver of consent to treatment during the COVID-19 pandemic.
– We will space our patient appointments in order to help keep the minimum number of patients in our office at a time. No walk-in appointments are permitted until further notice. You must call to make an appointment if you wish to be seen. In addition, arrive no earlier than 10 minutes early to your appointment. If you are late, you will need to reschedule your appointment.
– We continue to require that only patients come to these appointments, which means children, spouses, and friends/family members CANNOT accompany you to your appointment. This includes embryo transfers and OB ultrasounds.
– Avoid traveling to areas with active outbreaks of COVID-19 and remain away from others that may have traveled to at risk areas for a minimum of 14 days.
– If you have traveled to a country where COVID-19 has been reported, we recommend that you postpone treatments and all office appointments until two weeks after returning home.
– Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
– Adhere to social distancing (i.e. avoid large gatherings or unnecessary close exposure to people outside of your family) for the immediate future.
April 21, 2020 COVID-19 Update: We have exciting news! Carolina Conceptions will re-open our doors on Monday, May 4th to patients who need to schedule Hysterosalpingograms (HSGs), saline sonograms, and semen analyses. Call our office at 919-782-5911 to make an appointment. As our front-desk staff are currently working shortened hours, just leave a message and we will return your call to schedule these appts. Please note that semen analyses should be completed as drop-off appointments and not in-office collection. We can provide you with an at-home collection kit, just ask!
The health of our patients and our staff is of the utmost importance. While we will be opening our doors to these appointments, we will continue to socially distance. We will require patients to BRING THEIR OWN FACE MASKS in order to walk into our office. If you don’t have one, there are lots of online ideas to make one yourself from old t-shirts. In addition, patients will be screened by one of our staff at the first floor elevator lobby for COVID symptoms and will have there temperature taken. Only patients who pass the screening will be allowed into the elevator and into our 3rd floor waiting room. Please do not risk infecting others and stay home if you have any thoughts that you may have been exposed to COVID-19. Finally, we will space our patient appointments in order to help keep the minimum number of patients in our office at a time. We continue to require that only patients come to these appointments, which means children, spouses, and friends/family members CANNOT accompany you to your appointment.
We are awaiting further updates from ASRM on April 27 as to making decisions about restarting fertility treatments such as IVF, FETs, and IUIs. Please continue to monitor our website and social media for updates. We can’t wait to help make your family a reality again!
April 14, 2020 COVID-19 Update: Today, ASRM announced another COVID-19 update for infertility patients. For now, ASRM continues their recommendation to halt infertility treatment. However, there is more discussion being raised about recognizeing infertility care as an essential service. There is also discussion about the potential to allow patients with time-sensitive diagnoses (such as advanced reproductive age and diminished ovarian reserve) access to treatment. We will await the next ASRM recommendation that will come out April 27. Until then, please know that the Carolina Conceptions team is here for you. Please call us at 929-782-5911 to schedule either a physician consult or a nurse class to make a play for when these treatment restrictions are finally lifted.
March 30, 2020 COVID-19 Update: Starting April 17, Carolina Conceptions will be temporarily halting routine care of patients in the office. Each physician will be continuing to answer questions by email. Please find your physicians’ emails on our website under each of our bio pages. Our doctors will continue to do teleconsultations now and after April 17. Our nurses will continue to do superovulation, IVF, and FET classes via teleconferencing during this time as well. Consultations and nurse class appointments can be made by calling our office at 919-782-5911 and speaking with our receptionist M-F 7:30 AM -12:00 PM. Please remember that patients should not use social media as a way to contact us or ask questions due to health care privacy laws. We will continue to provide updates on our website, Facebook, and Instagram. Please stay safe, everyone.
We have decided to suspend new cycles of ovarian stimulation for timed intercourse, intrauterine insemination (IUI), and donor insemination. Patients in the midst of a treatment cycle can continue, and if successful, will be able to continue receiving care through our office until they are ready to meet with their OB GYN. Otherwise, we suggest patients reach out to their physician at Carolina Conceptions or schedule a phone consultation to discuss plans for the future. We also suggest patients check back periodically on our website or social media platforms for updates.
ASRM has developed an expert task force regarding COVID-19, and on March 17, 2020 they issued a statement recommending “suspension of new, non-urgent treatments. Specifically, the recommendations include:
- Suspension of 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.
- Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
- Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
- Suspend elective surgeries and non-urgent diagnostic procedures.
- Minimize in-person interactions and increase utilization of telehealth…
Data on its impact on pregnancy and reproduction remains limited. However, the task forced used 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 in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients.”
We wish to inform patients of these recommendations as soon as possible, which is why we are disseminating this information on social media and on our website. We will be reaching out to patients who are in treatment or plan to begin treatment soon, so that we can discuss the situation and come up with a plan. We realize that some patients will not be able to stop treatment and will want to continue despite the latest recommendations. We will allow patients to proceed if they are in the midst of a treatment cycle. Please check back on our website for the latest developments as there may be an interval when we will not be able to offer services due to the risk of the virus.
PREGNANCY AND COVID-19
According to the CDC, we do not currently know if pregnant women have a greater chance than the general public of getting sick from COVID-19 nor whether they are more likely to have serious illness as a result. We also do not know at this time if COVID-19 would cause problems during pregnancy or affect the health of the baby after birth.
We still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery. No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus. In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.
According to the CDC, we do not know if there is any risk to infants of a pregnant woman who has COVID-19. There have been a small number of complications with pregnancy or delivery (e.g. preterm birth) in babies born to mothers who tested positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection or other causes.
For the safety of our staff and patients, we ask that you notify us immediately if you have any cold or flu symptoms, have a fever, have been in contact with someone who tested positive for COVID-19, or have recently traveled to China, Japan, South Korea, Iran, or Europe. In an effort to help us do our part to limit the spread of disease, we ask that you not enter our waiting room if you meet these criteria to avoid potential exposure to our staff and other patients. Also, friends and family members are not permitted in the waiting room unless they are directly needed for the appointment (for example, male patients providing sperm for IUI or IVF). All patients will be asked to check in, then wait in their car and we will call when you are ready to be seen for their appointment.
If you have symptoms such as mild to severe respiratory illness with fever, cough, and difficulty breathing, please call your primary healthcare provider, especially if you have any of these symptoms and have been in close contact with someone who has COVID-19 or if you have recently traveled to an area with ongoing spread of COVID-19.
For new patient and follow-up consultations we ask that we have a phone consult rather than meeting in person. Partners and spouses of patients will not be allowed to attend an in-person appointment, but are welcome to call in via speakerphone.
We know that infertility treatment can be a very stressful time and the concerns of COVID-19 in treatment and pregnancy only add to the situation. Carolina Conceptions is closely monitoring real-time developments and continually looking to experts such as the Centers for Disease Control (CDC), World Health Organization (WHO) and American Society for Reproductive Medicine (ASRM) for guidance.