Preparing for the new normal in IVF

Luciano Nardo, MD MRCOG
, Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery, UK

From this video you will find out:

resuming of the fertility services in a manner that minimizes the infection
safety, transformation and adaptation in IVF treatment
risk assessment – identifying the risks of infection
risk mitigation – taking measures to reduce the risk of infection
practical and logistical measures
clinical safety measures

Preparing for the new normal in IVF

What the IVF treatment will look like after the lockdown?

Prof. Luciano Nardo, MD MRCOG, Consultant Gynaecologist & Specialist in Reproductive Medicine is discussing going back to operation in IVF clinics after the lockdown and preparing for the new normal in IVF treatments.

What the IVF treatment will look like after the lockdown? - Questions and Answers

1.Logistically, how to handle the situation if just before embryo transfer a patient develops symptoms?

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.

What precautions can we take when attending a clinic appointment?

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.

Will the situation change the way ‘person 2 person’ meetings are held in 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.

Are there any guidelines for patients who got infected after an embryo transfer?

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.

If embryos had to be frozen because a patient/partner contracted COVID, is there a difference between live birth success rates from frozen vs. fresh embryos?

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.

How did you deal with the patients that had already started treatment before the lockdown?

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.

If a patient started to use contraception pill to regulate period before the lockdown, how long can I use these pills before I can go for the treatment?

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.

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Authors

Luciano Nardo, MD MRCOG

Prof. Luciano Nardo, MD MRCOG, is a Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery, UK. He trained in Italy, London and Manchester before being appointed as a consultant in gynaecology and reproductive medicine at St Mary’s Hospital, Manchester, where he worked full time until 2011. His clinical and academic interests are in infertility, assisted conception, gynaecological endocrinology, pelvic pain, menstrual disorders and hysteroscopic management of uterine abnormalities. He has expertise in gynaecological ultrasound scan and management of early pregnancy problems including recurrent miscarriage. He has vast experience in advanced laparoscopic surgery for the treatment of endometriosis, adhesions, fibroids, ovarian cysts, tubal surgery and other benign gynaecological conditions regularly performing complex laparoscopic procedures such as hysterectomy, myomectomy and reversal of sterilisation as day case procedures. Luciano is a Member of the Royal College of Obstetricians and Gynaecologists and an associate member of many other learned societies. In July 2017 he was appointed as Visiting Professor to both Manchester Metropolitan University and Catania University, in recognition of his long term commitment to research and teaching alongside his clinical career. He has published in excess of 100 papers on many aspects of gynaecology, reproductive medicine and surgery and is regularly an invited speaker at national and international conferences.

Event Moderator

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.

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