Luciano Nardo, MD MRCOG, Clinical Director at Reproductive Health Group (RHG) is discussing going back to operation in IVF clinics after the lockdown and preparing for the new normal in IVF treatments.
I think this is quite important to make it clear, all patients undergoing treatment would be triaged at some critical points during the treatment. At the time of a collection as well as at the time of embryo transfer or on the day before performing the procedure, patients will be presented with a triage questionnaire. If the patient develops symptoms since the last clinic appointment, we will advise to freeze the embryos. We are still uncertain about the effect of coronavirus in pregnancy, all the pregnancy and the fetus although initial reports are quite reassuring I think it’s fair that we will provide the freeze-all policy in order to mitigate any potential and unknown risks.
These very much depend on the clinic. In our clinic we have come up with a solution to ensure that patients and staff are protected from the risk of COVID- 19 infection before they attend the appointments and what we have done, we’ve created some patients PPE packs, so the patient’s will collect their own personal protective equipment pack and they will be invited to wear masks, gloves when they attend the clinic so we’re not taking the chance of patients coming to the appointment as we would be providing them with everything they need before they attend the clinic.
Absolutely, before patients enter our clinic and I suspect most clinics, they would be triaged, there be temperature will be screened. In our clinic, we are about to install a temperature screening pod which is similar to a screening that we are used to seeing at security sites within airports. The visitor will step from outside into the pod and his temperature will be screened by a member of our team before the person is allowed in. Once the person is within the clinic we are fortunate because of space within our clinic, but we will be limiting the number of patients within waiting areas, and we will maintain safety, the physical distance between patients and clinic staff. All the patients and the staff will adopt a mask policy, and depending on the circumstances, the clinic staff will also be wearing face protection devices.
There are no guidelines about being infected after the embryo transfer. That’s what infection has to be confirmed and what we use in our clinic and is the easier method which is 90 % sensitive and 100% specific to confirm ongoing all past infection. We recommend that patients have conceived after the embryo transfer, and they do get infected, then they will follow the national guidelines in terms of managing the pregnancy. The Royal College of Obstetricians and Gynaecologists in the UK, in their most recent guidance to patients, don’t say that pregnancies will be affected by the coronavirus. Clearly, we are just at the early stages of this pandemic, and we are waiting for more meaningful and robust information. What I would say is that 81% of healthy individuals may be asymptomatic or may have only mild symptoms. In time there will be a large proportion of pregnant women that would become infected, and as time goes by, we will acquire more information to provide robust advice but also add good guidelines.
The quick answer to that question is no. It is not because of the COVID-19 that we’ll be using a freeze-all policy. Within our clinic and many other clinics in the UK and worldwide, there’s been a move towards frozen transfer cycles anyway, and there is growing evidence, and there is published literature to indicate that the chances of a successful IVF cycle ending with a live birth are not significantly affected by the freezing, thawing and transfer of blastocyst. In our centre, the live birth rate of cycles, with the transfer of frozen versus fresh blastocysts is very much the same. This will certainly depend on the patient population, on the quality of the embryos, but more importantly on the freezing and thawing expertise policies and procedures available within each lab. Within our laboratory, we have 98% of our cryopreserved blastocysts that survive the thawing process, so 98% of blastocysts survive and are suitable for transfer.
Well, this is not possible. In the UK the government regulator advised all the clinics to complete the fertility cycles by the 15th of April. That means the advice was given when the lockdown started on the 23rd of March, so we had about three weeks to complete all the treatment cycles. There is no patient, that I’m aware of, at the moment in any IVF clinics in the UK that is in treatment unless it is a cancer patient as the government has allowed the provision of fertility services for fertility preservation in cases of cancer. Before the lockdown, treatment was in place, and treatment had to be completed after they lockdown by the 15th of April if not clinics had to cancel the treatment cycles. Now that we plan to reopen as soon as the HFEA permits IVF clinics to reopen. The measures put in place and also the strategies that each clinic will employ should limit the risk of cycle cancellation, but inevitably cycles may be cancelled if patients become symptomatic, test positive or decide themselves to cancel because they may be aware of becoming in contact with somebody that could potentially be infected.
It very much depends on what protocol and for controlled ovarian stimulation you will be needing for your treatment. There are some protocols where you can go straight from the pill straight into the stimulation. You don’t have to wait for any length of time, there are some protocols when you need to stop the contraceptive pill, but in that case, the period should return within 5 to 7 days, and that is when you can resume or start the fertility treatment.