Fertility clinics push back

Advisory bodies generally agree that now is not the time for full-on fertility treatment. Some prominent clinics beg to differ.

Several of the fertility world's top advisory bodies have strongly urged fertility clinics to stop or severely scale back services during the COVID-19 pandemic. 

The European Society of Human Reproduction and Embryology (ESHRE) last week reaffirmed that fertility doctors, like other medical professionals, have a "duty" to not make this crisis worse and so should not be providing non-urgent services. Only people facing cancer treatment should be exceptions, they advised. 

They underscored the reasons for their decision: to avoid any coronavirus-related pregnancy complications, to mitigate the unknown risks of parent-to-child transmission, to keep medical resources on the front lines and to follow the rules on physical distancing.

The American Society for Reproductive Medicine (ASRM) first issued guidelines about COVID-19 on March 17 and have since provided two updates. In the most recent, on April 14, they advised that "it is not yet prudent to resume non-emergency infertility procedures." They said that clinics should avoid starting new treatment cycles, cancel all transfers, suspend non-urgent procedures and minimize in-person interactions. The Canadian Fertility and Andrology Society (CFAS) has been advocating a very similar line.

All of those bodies have mere advisory power. But the UK's Human Fertilisation and Embryology Authority (HFEA) is a regulator and can do more than just issue advice. 

On March 23 the HFEA ordered that all non-urgent fertility treatment cease by April 15, last Wednesday. Clinics that don't comply could lose their licence. The HFEA left no uncertainty about what was allowed: "The only patients that can be treated after 15 April 2020 are those that require non-elective fertility preservation as set out in 3(d) of GD0014. For the avoidance of doubt, fertility preservation refers to patients who are about to commence radiotherapy or chemotherapy in the face of cancer or are about to use chemotherapy for a serious systemic disease. The premature infertility test does not apply to women whose fertility is declining due to age or the onset of the menopause."

Advisory and regulatory bodies clearly agree that fertility services, important though they are, should be restricted during this crisis. But some US fertility clinics are pushing back. Some prominent clinics have decided to keep their doors open. Others are petitioning for the ASRM to alter the official advice. Below, some select quotes from their websites.

American Exceptionalism

Reproductive Medical Associates (RMA)

"RMA remains open and operating at full capacity. We are offering IVF, IUI and all major procedures because we know patients may not be able to wait."

Boston IVF 

"We remain open." 

"Boston IVF is open during this unprecedented crisis and our doctors, nurses, and staff will continue to provide care to our patients. We continue to treat existing patients and continue to accept new patients."

"Effective April 6, 2020 – Boston IVF now offers patients the option to start up for the following treatments: frozen embryo transfer; intrauterine inseminations with a natural cycle, clomiphene, or letrozole; donor insemination treatments. In addition, we continue to offer: diagnostic testing: (ultrasound, hysterosalpingogram, saline sonogram, endometrial biopsy, blood testing, semen analysis and sperm freezing)."

"...if you are in an IVF stimulation cycle and you become exposed to COVID-19 or develop symptoms, we may be required to cancel your IVF cycle at that time. This may lead to your body ovulating multiple eggs causing discomfort and significant bloating and nausea. Should this happen you must refrain from intercourse in order to avoid a large order multiple pregnancy."

Shady Grove

"As freestanding, single specialty treatment centers, the resources we utilize to treat our patients do not draw from the same pool as those available to take care of patients suffering from COVID-19 and other serious conditions. This is in dramatic contrast to fertility centers based in hospital settings."

"This is not business as usual. We will limit new treatment cycles to patients for whom a delay could reduce their chances of success in the future. We will continue to offer autologous treatments including ovulation induction (OI)/intrauterine insemination (IUI), in vitro fertilization (IVF) under this limitation."

"While we believe treatments involving a third party fall broadly under the same paradigms as described above, there are important differences, especially in terms of travel and risk; therefore, SGF will not be starting any new donor cycles at this time." 

Colorado Centre for Reproductive Medicine (CCRM)

"CCRM Fertility locations will remain open and will continue to see patients for select appointments. If you are healthy and pass screening criteria, you are welcome to come to the office for an in-person consult. CCRM is taking this very seriously and asking you and or your partner to stay at home if you are ill to protect our patient and staff."

"CCRM facilities will continue to remain open for new patient consultations and fertility testing."

"No, CCRM is not planning to shut down, as there are flu and cold viruses all year long. As a healthcare facility, CCRM is accustomed and proficient at infection control like many hospitals are."

Petition: 'Fight for women's rights to fertility treatment and evaluation.' 
Beverly Reed, MD 

"...we were stunned that the ASRM guidelines called for an essential shut down of all fertility treatment and evaluation."

"First, we take aim with those who refer to fertility treatment as elective. If a person with Type 1 diabetes needs insulin because his or her pancreas is not functioning properly, people would term that as necessary treatment. Yet, a woman that needs medication because her ovaries are not functioning properly is told that this is “elective” treatment. Why? Because an ovary is a female organ?"

"Despite the COVID-19 outbreak, no guidelines or organizations have asked fertile patients to avoid pregnancy or use contraception. Our infertility patients are now asking us: “Why are WE the only ones being asked to make a sacrifice to avoid pregnancy?”

"Throughout history, women have been vulnerable to oppression. In modern times, one would hope that this is no longer an issue that women face. But, here we are again — women are being told they do not currently have the right to make the decision for themselves on whether it is safe to attempt fertility treatment or pregnancy."

More than 20,000 people have signed this online petition. 

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