By fertility experts from Spain.
Watch the recording of live Online Patient Meeting with Dr. Hana Visnova, Medical Director at IVF CUBE in Prague, Czech Republic, who answered patients’ questions about their frozen eggs or embryos that are stored at her clinic during the Coronavirus times.
IVF clinics store frozen, that means vitrified, embryos and all sides in containers with nitric oxide. We do it with liquid nitrogen at the temperature of minus 196 degrees. Those containers could be small or larger ones. We usually keep embryos separate from oocytes and separate from sperms, and it depends on the capacity of the clinic how large those containers are, how frequently we need to add some nitric oxide to be sure that embryos are safe. But any clinic like our clinic, as a responsible person, who is taking care of those stored embryos, we usually do it the same way as during Christmas time or holidays time or any normal break breaks in our practice.
The normal monitoring process depends on the local practice of each clinic, but the usually visual assessment of the quality of storage containers is done daily. There are then some monitoring options to measure the level of nitric oxide. Then you have also options of electronic semi-automatic monitoring systems with sensors to measure the concentration. In our clinic, we need to replace or to add some liquid nitrogen twice a week. Each clinic has a definition of persons who are responsible to check the quality of storage regularly. In our country we share duties, and there is a list of persons who have access to the laboratory and who have skills and experience to take care of embryos.
As far as I’m informed, the recommendation of the International Society of the ESHRE society in Europe issued in the middle of March to stop any IVF treatments and to keep embryos and sperm frozen. And the healthcare system is safe despite the current dramatic situation. It comes down to not strain the healthcare system due to the additional risk of patients seeking any kind of treatment like complications in early pregnancies. So most clinics, I believe, have stopped embryo transfers, and those clinics do now not provide any fresh treatments. It is more related to the quality of the healthcare system in each country. Once the situation with coronavirus is under control, and there is no risk that the system will not be able to accept pregnant women with some possible complications then I believe, we will very slowly begin to do embryo transfers.
COVID virus cannot affect the embryo. It also has no receptors in the endometrium, so the virus cannot bind itself to the human lining or the embryo or the sperm or the egg, so this is answered, and there is enough scientific knowledge that the virus is not inside the embryo. It cannot survive there.
This is a very difficult question because no one can assure you how soon will the borders open or which countries will allow travel and which countries will remain closed. As far as I am informed, there are some transport companies offering transport of embryos in the European Union so once you are very close to the legal age limit of treatment in The Czech Republic and, if during the next weeks there will not be any signs of travel options and the travel ban where we’ll ask for a longer time, you can consider contacting some of those companies and arrange transfer of your embryos to a different country with a higher age limit.
If COVID infection affects the donor in the middle of her simulation then we will need to cancel the simulation immediately. She will be at health risk of pneumonia so she will not be able to attend for a connection collection and, even the donor will present at risk for any medical personnel so for our nurses or doctors or anaesthetist during the procedure. But the most important is that the donor herself if she gets sick with COVID she cannot proceed with the treatment she needs to stop immediately, because there is no point in continuing so if there is a really high degree of infected people then there might be a shortage of available donors or longer waiting times. I believe we should test them before starting the simulation to be sure that we would not face any unexpected events or to minimize the risk that she will get infected later, or that we will recognize her infection late during the stimulation period.
I’m afraid this is a question which I am unable to answer. As I am not a politician and I can’t predict right now how long will the pandemic situation last. In our country, there are now short trips allowed to the Czech Republic for 24 hours stay in the Czech Republic. It will probably be possible soon but only for people who travel for only 24 hours and probably the airports will remain closed for a longer time. So it depends on which country you live in. If you need to fly over, then you need to wait until the airports and airlines can open their normal flight schedules from neighbouring countries once the borders are open. If we speak about Germany or Austria. Maybe there will be an option to travel across the border if you don’t stay in the Czech Republic for longer than 24 hours. That is just preliminary information from our politicians, and I’m not sure how soon such options will be possible, but only for those who travel by car. If you live in the UK or some other country a longer distance from the Czech Republic and this is more related to the airlines and airports, the official information when the airlines start working is very dynamic. It is constantly changing, at times you receive different information twice a day. We can get some information from our country, and different information could be available in your country, so really you need to be very flexible and check all available information almost on a daily or weekly basis. Hopefully, fingers crossed, it will be possible in October. It seems far away, so hopefully, it is going to be possible to fly over to some other European country and then to rent the car and travel by a rental car to the Czech Republic.
No, definitely not. Duration of the storage has no impact on quality. There is no difference if your embryos are stored for two months or two years, or four years, so this is nothing to be worried about. They will be the exact same quality as they were.
I’m afraid this is not the case, because the legal age limit is a legal definition of 49 years of age. We cannot break the law, and I’m afraid that to expect any changes in the legal situation is not real. There will be so many legal requirements due to the pandemic situation, so many legal troubles, I expect that no one will be keen to prolong or change the law of IVF limits. This is my opinion, this is not a topic number one for politicians or lawyers to request a change or prolongation, because there are many health, legal and economic problems which we will face in the near future. I’m afraid no one will be interested in spending time changing the law of IVF legal limitation.
This is probably a question from some of my colleagues from a different clinic. There are now scientific discussions about how safe liquid nitrogen is. Whether we need to sterilize the liquid nitrogen during the procedure. It depends on how you separate the embryos. If you have a frozen tank now, you can use sterilized nitrogen for this container and, because you don’t probably store any new embryos, I believe those embryos frozen before corona time are safe. The problems may arise if the pandemic situation lasts for a very long time. Then, we will need to regularly sterilize those containers and sterilize the nitrogen.
In our clinic, we always freeze a single embryo in each straw because we don’t know what will be the plan. If there will be single or double transfer scheduled later, so definitely we freeze only a single embryo to eliminate the need of second vitrification.
Transport companies need a license, so they undergo a strict licensing process to receive the permit to transport human tissues and human cells. Each country has the authority to control the safety and quality of transport, and only a transport company with a license is allowed to transfer your embryo. This is a very safe process. The duration of transport depends on the distance, depending on how far the clinic or the country is. You can imagine, if they take your embryos in a transport container by car, then how long this will take depends on the distance between your city and the city of storage of embryos. If they need to fly over, then again, there is a problem with the airlines and airports. How soon they will be able to transfer to arrange transport.
Yes, we do run an egg donation program. Especially, we offer fresh egg donation treatments. We don’t arrange any egg sharing. We have a quite large database of 800 donors, and we hope to return to a regular egg donation program shortly after the crisis is over. We have only Caucasian donors coming from the Czech Republic. The database is quite extensive, so we can match phenotype requirements, but only in terms of Caucasian type. We don’t have any African American donors or Asian donors, unfortunately. We don’t have a large community of foreigners living in the Czech Republic who would be available for donation. Donors from abroad are simply not available because egg donation is a time-consuming process and there are repeated appointments necessary and plenty of blood tests and genetic testing is mandatory in our country, so it is impossible to recruit the donors from abroad.
There is very limited data addressing this topic but, I believe if you don’t develop severe COVID complications like pneumonia, then the infection just affects your lungs or nasopharynx, and it is not transferred to the womb. It will not have any impact on the embryo quality, and it has no possible impact on the success rate.
No, we don’t. Surrogacy is not allowed in the Czech Republic. I believe there are some clinics, but it’s not all of them are actually offering surrogacy. In our country, there is very limited access to surrogacy but only for women of Czech origin, who have their close friend or relative willing to be their surrogate. They need to to find the surrogate themselves, and all participants need to be of Czech origin, and the delivery must be expected in the Czech Republic.
Right now it is impossible to do an IVF, but we are waiting for the development of the infection the Corona situation is very quiet. In the Czech Republic, there are currently very few affected persons and very few in hospitals or intensive care units, so maybe we will reconsider and start treatments very soon but, it depends really on the local development of the infection. Each country has a different scenario, but right now, in our country, the infection is under control, so even normal hospitals plan to start normal operations during the next weeks. Since March there was only some care available all around the Czech Republic in any hospital like serious injuries or severe, urgent operations were performed. Any elective treatments have been cancelled, but because the situation has calmed down, there is a plan to start elective operations as well. So along with this decision, I believe we will change plans, and we will start to run the treatment for women living in the Czech Republic. Right now we do just some ultrasound checkups, we do we run a lot of Skype consultations and, of course, those women who live nearby, if they have any gynaecological trouble or any pain or any bleeding or are pregnant women seeking advice they can visit us personally and we try to help them even if they are not patients of our own clinic. We just offer now normal pregnancy care to anyone who has no access to a normal gynaecologist or obstetrician.
It depends on the legal situation in each particular country. For example in the Czech Republic, if I understand the question correctly, if this treatment happens in the Czech Republic, then after the delivery the legal parent who is written in the birth certificate is the surrogate mother and the genetic father of the child. So the partner who gave the sperm for the fertilization. At six months of age of the newborn child, they need to go to court, and they need the help of an attorney to conduct a legal change of birth certificate. If the surrogate mother and both intended and genetic parents attend the court and say that this was their free decision to use a surrogate mother, that there was not any commercial surrogacy done and then the judge will change the birth certificate. There will be a new certificate with the names of the genetic parents. Usually, at the age of one year of the child, they become legal parents of the child.
It depends on a lot of details if we speak about fresh simulation using our eggs then there is no risk of hyperstimulation, there is sufficient data that the fresh transfer is better. In some medical circumstances, it is better to freeze. With donor eggs and fresh transfer, there is a decline of 5% probably all around the globe. If you use frozen embryos with recitation there is maybe 5% decline because of vitrification of embryos. If there is a good option to arrange a fresh transfer then I will recommend doing a fresh egg donation. Of course, this is much more difficult for travel arrangements and treatment arrangements because we need to synchronize treatment of the donor and treatment of the recipient. So there might be more issues to address, and recipients need to be more flexible to arrange to treatment. But because there is statistical evidence of better success rate, we prefer to do so despite the workload needed for a fresh transfer.
We do have a lot of patients coming from abroad, especially from European countries. We also have some patients from Australia from the U.S., Canada, so as long as they can just simply travel to the Czech Republic we would be able to treat them. Right now it is impossible because of the travel ban, but we hope the situation will get back to normal soon and then we will be really happy to see patients from abroad visiting our clinic again. I hope we have a good reputation abroad, and we have a multilingual team speaking German, English, Italian, so we .can invite patients from other countries to be treated.
We try to maintain the best hygienic conditions of the clinic as possible. We have an intensive system of disinfection. We have some protective tools for the medical personnel, and we also request patients to adhere to those criteria that we want them to follow. We try not to have too many people in the waiting room. We want them to disinfect their hands once they arrive at the clinic. They need to wear face masks during the stay in our clinic. Actually, in the Czech Republic, it is now mandatory to wear a face mask. We request patients to be tested for COVID before they attend the clinic. Once we decide to start the treatment, we will request the test for COVID but now as I told you we don’t run any fresh treatments yet. Safety The safety of patients and also the safety of our staff is now the most important topic. We try to control all the conditions to be able to provide a safe environment in the clinic for the patients who need to visit us. We also request the patients to come to the clinic only if they are really healthy, if they don’t have a temperature, they have not met any person suspected to be COVID positive and, we ask them to disinfect their hands and to have the facemask etc.