Covid & Fertility Treatment

Aim of our IVF Centre during COVID Pandemic.

1. The priority of our IVF Centre is to maximize the wellbeing of patients, staff, and society at large with an aim to provide guidance and support based on existing scientific knowledge, to its members and the patients they care for during the coronavirus (COVID-19) pandemic.
2. It is aimed at guarding the health and safety of patients and providers, while also recognizing that it is our social responsibility, as an organization and as a community of providers and experts, to comply with national public health recommendations and apply them to all reproductive settings during this unprecedented time.

2. Fertility consults and stimulations in OPD at IVF Centre 

Current wave of COVID-19 infections in many regions in India is ongoing. Effective and specific countermeasures (e.g. antivirals) are not yet available, and a vaccine is not expected soon.  However, India and we at our centre  appropriately recognize infertility care as essential services in certain circumstances. We recognize the distress this closure is causing any patient awaiting fertility treatment. An assurance is to be given to patients waiting for treatment that we have worked on a safe exit strategy. This program will remain alert to government regulations on the COVID pandemic. Cancer patients for fertility preservation, Low egg reserve are given a preference 

What you need to know before you take up fertility treatment

Before taking up a patient in OPD for stimulation the following counseling/consenting is imperative 

Does the virus carry from an infected patient?

Any risk of viral contamination to gametes and embryos in the IVF laboratory, either from infected patients or professionals, is likely to be minimal because the repeated washing steps of semen and oocytes required for the culture and freezing protocols will result in a high dilution of any possible contaminants. However there is no specific data to back this as currently across the globe fertility treatments are near halted. 

Would COVID 19 Impact Pregnancy ?

To date, there is no clear evidence of any negative effect of SARS-CoV-2 infection on pregnancy, as indicated by the latest updates from the Centers for Disease Control and Prevention (CDC) in the USA and others in Europe.  Even so, we should be mindful that viral infections can be more problematic for pregnant women and acknowledge that some of the medications used in virus-infected patients may not be recommended during pregnancy.

Recent updates on pregnancy outcomes in infected mothers report healthy infants born free of the disease. However, there are small case series reporting adverse outcomes, such as premature rupture of membranes and preterm delivery. Data on pregnancy outcomes, although reassuring, only report small numbers and must be interpreted with caution. Furthermore, as reports mainly refer to infection in the third trimester, there is no information on the possible effect of SARS-CoV-2 infection on pregnancies in their initial stages. 

Why is it important to understand that freezing of eggs or embryo may be required?

We support the safe storage of gametes, embryos and other tissues during this difficult period. Patients need to be counseled about benefits of freezing in these conditions. Freezing may become the only option in case patient contacts COVID 19 during the course of treatment or has been a close contact needing quarantine

Cancellation of cycle where patients develop symptoms of COVID 19 and test positive may be needed

In case a patient tests positive during stimulation the cycle must be cancelled. Following which counseling against unprotected intercourse to avoid multiple pregnancy is done. Embryo transfer or IUI is not to be done in COVID suspects or positives

Emotional and psychological support to patients 

Counseling forms an important aspect.  In order to do so, it is essential that they recognize and understand the impact of the threat of the current pandemic, how it manifests in patients.  The team at the IVF centre will remain available to provide supportive care, psychological support and clinical advice to their patients, preferably via online consultation.

Counseling on safe measures during stimulation

It is imperative that you do not contact infection during your Fertility treatment. To prevent contact of infection it is important that you take precautions to avoid disease

1. Hand sanitization
2. Mask
3. Social distancing
4. Report if any symptoms suggestive of COVID infection

The key principle in restarting activity in an ART centre is that patients, staff and

anyone attending the centre is triage-negative which means that a questionaaire given to patient is showing him to have no risk of COVID. The negative patients can be taken up for treatment. The positive triage patients are sent for a COVID test

How do we ensure your safety?

Safety measures in OPD

1. Providing sufficient minimal staffing so that there is no overcrowding 
2. Spacing urgent in-clinic appointments throughout the workday, – 15 minute gap during which whole area is sanitized
3. Enabling staff to work from home in areas such as data entry so that area is not crowded
4. Implementation of mandatory health screenings at entry to the facility of patients who must be seen in person. Health screening should include 

• Temperature checks
• Provision of face masks: Triple layer mask to be worn by all persons in hospital (Patients, Staff and Visitors) 
• Compulsory hand hygiene :Patients should wash hands with soap and water for at least 20 seconds or hand sanitizer containing at least 60% alcohol can be used.
• 3-foot social distancing policies in shared spaces. 

• Filling of self declaration form at registration which has the triage quetsionaire. Screened for H/O travel and contact and what zone they come from in relation to pandemic. Febrile or symptomatic patients should be isolated as necessary to provide essential care and referral to flu clinic. They are not allowed to enter IVF area
• All staff complies with rigorous sanitization practices and utilization of personal protective equipment so that they do not carry the disease. .

• Attendant (only if required) – Should have mask and sits outside maintaining 3 feet distance
• All patients with a previous confirmed COVID-19 infection should present medical evidence of clearance in order to be eligible for treatment. If patients have been on respiratory support during the COVID-19 infection episode, they should additionally provide evidence of assessment and a medical specialist report.

Precautions taken

• Provision of protective screens for administrative staff 
• Provision of personal protective equipment and sanitation devices for patients and staff • 
• Restriction of access for partners and accompanying persons 
• Redesign of waiting rooms and working spaces to guarantee appropriate distancing 
• Management of appointments according to specific timetables, also for scans and blood tests • 
• Subdivision of staff into mini-teams to reduce unnecessary exposure of patients and staff members

Front Desk Protocol

1. Only appointment patients with strict adherence to time
2. Billing  to be done online or maintain 3 feet distance
3. 15 minute gap between consults
4. Room cleaning between two consults to be ensured before calling next patient
5. Only husband to be allowed with the patient.  
6. We minimize movement and contact of patient to keep them safe – Encourage online transfer of money for procedures. Billing for lab/pharmacy to be done at IVF Front desk to minimize patient movement. Prescription to be sent to pharmacy by whattap  – Packet of drugs ready when you reach. Similarly for blood tests. Information to lab given. Labels ready in lab – No wait time for patients
7. Use of Telehealth for consults: It is strongly recommended that clinical practices maximally leverage telehealth (or telemedicine). The use of telehealth may be used to begin or continue the evaluation and education of patients to including sharing of reports, developing treatment plans and discussions. It may also be utilized for post procedure queries and followup.

We give telemedicine consult appointments wherever possible and for followup. This is to keep the pa atient safe. You should ask for next consult to be telemedicine consult

8. Triage Form: This form is filled by all coming to the IVF centre and in case there is any history suggestive of infection they are first screened. This keeps everyone safe
9. Minimizing the number of in-cycle monitoring visits to the fewest necessary, as determined by medical feasibility. 
10. Counseling and consenting patients electronically. 

Protocol for OPD Staff

1. Minimum staff to be called – Mini shift
2. Screen all staff at the beginning of their shift for fever and respiratory symptoms. If they are ill, they are to leave the workplace.  
3. Transmission is reduced through

• Hand hygiene – Clean hands often with soap & water/ alcohol-based products (gels, rinses, foams) & after coughing or sneezing and when caring for the sick
• Cover mouth & nose with tissue, sleeve or elbow when coughing or sneezing 
• Avoiding touching eyes, nose, or mouth with unwashed hands
• Since IVF staff is dedicated to IVF and not rotated in the hospital they are not in contact with sick patients

OPD/lab AREA – Cleaning done after each patient including all surfaces and walls

• Lab Protocol
• One hour gap in cases – Oosafe cleaning after each case
• Divide teams and work
• Have backup facilities in case of lab contamination
• Extra care should be taken to reduce exposure to native follicular fluid and sperm by dilution and safe disposal of fluids in individual closed containers, as quickly as possible
• Closed system to be used for freezing