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IVF in the Time of COVID19

I know my patients fears and frustrations. You’ve waited years for this moment. You’ve dieted. You’ve cut out wine, treats, nicotine, THC…. you have agonized, scrimped and saved. Borrowed from parents, 401Ks, against mortgages- to scrape together enough for treatment. This is YOUR chance for a rainbow. Every day we delay is a day too long for our patients. And now the world feels like it’s crashing down around us.

The US already has a horrific maternal fetal death rates, for a myriad of reasons. We are reporting infant deaths from the coronavirus in the US, simply because more infants die here than in other first-world countries. We know that some women have no apparent symptoms of coronavirus when they arrive at the hospital, only to deteriorate soon after giving birth; requiring admission to the intensive care unit, and extraordinary life-saving measures. We now know individuals infected with asymptomatic COVID19 who have elective surgery, in general, have a 20% higher likelihood of death.

Infertility patients are a PARTICULARLY vulnerable patient population, because they have a unique desperation and sorrow. There are not many things that can be compared to the pain, sorrow, pressure and emotional distress that infertility causes. As scientists and fertility doctors our first priority is to the health of our patients. Like you, we don’t know enough.

Why does ASRM recommend 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?

Some explanations are:

Moderate forms of OHSS (ovarian hyperstimulation syndrome) occur in 5% of patients undergoing ART; 2% of patients require hospitalization. Death occurs with an incidence of approximately 3 per 100,000 ART cycles. During the egg retrieval, your doctor uses a vaginal ultrasound to guide the insertion of a long, thin needle through your vagina into the ovary and then into each follicle to retrieve eggs. There are possible severe risks for this procedure, including injury to organs near the ovaries (bladder, bowel, or blood vessels). Very rarely, bowel or blood vessel injury can require emergency surgery and, occasionally, blood transfusions. Also, pelvic infections can occur, which can be severe. A certain small percentage of patients will also experience complications from undergoing anesthesia. Complications from IVF treatment use hospital resources that need to be directed towards others at this time. Consider that your partner will not be able to be with if you require treatment- like Giuliana Rancic did after her infertility procedures.

“Blood curdling screams, just plain agony. And it kept getting worse and worse and worse. I knew I had to get her out of there and get her to a hospital.” He took her to Northwestern Memorial Hospital in Chicago, where the doctors determined that she was bleeding internally.” Bill Rancic

I’m being asked to re-use personal protective equipment or use it sparingly for our patients that are most in need. PPE supplies are running dangerously low everywhere in the country. I’m putting myself and my family in calculated danger every day. There is no way for me to socially distance myself from your husband as he hands me his sperm sample, or when i have to centrifuge it in the lab. IVF practices are still treating those undergoing chemotherapy (future fertility will be destroyed, those in mid-cycle, and those whose mental health would be severely compromised by stopping treatment.

We don’t know how safe #TTC and COVID19 is yet for newly pregnant women- but we do know that fevers ARE dangerous. Women who are planning a pregnancy should protect themselves from fever and infection during early pregnancy to help prevent severe birth defects, like AnencephalySpina bifidaEncephalocele, and Cleft lip with or without cleft palate. Your lung and heart function will be lowered. Complications of early pregnancy are high (ectopics, miscarriage), especially for our patients where those are the precise reasons for their infertility!

At ART Compass, we are giving away free subscriptions to our platform to IVF clinics. We are trying to keep small clinics in business and IVF staff / embryologists working during the shutdowns. We’re giving away everything for free. Because what else is there? What is left to do when so much is at stake?

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