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March 19: COVID-19 and The New Reality of Fertility Care

By Dr. Tom Hannam MD FRCSC REI

Wednesday evening, the Canadian Fertility and Andrology Society (CFAS) put out their well-considered opinion that it is time to shut down active fertility treatments in Ontario and across Canada.

As you know, I’ve been encouraging patients to consider quickly freezing eggs or embryos while healthy. A lot of patients have taken us up on this opportunity and we look forward to seeing through the cycles we can.

But the moment of running cycles exactly as you need is on hold.

What changed? Not the apparent risks of pregnancy.

For patients reading this blog who are already pregnant, please know I believe your pregnancy and our healthcare system are safe today.

I keep promising to write about this subject, apologies for the delay. Other factors keep pressing in, as you know. More on that in another post.

But suffice to say here: the change wasn’t because health risks for pregnancy have changed in the past few days.

Who is the CFAS and why do they influence our treatments?

From their website:

The CFAS is a multidisciplinary national non-profit Society that serves as the voice of reproductive specialists, scientists, and allied health professionals working in the field of Assisted Reproduction in Canada. The mission of the CFAS is to responsibly advance reproductive science and medicine in Canada through leadership, research and guidance.

I respect the CFAS as a group of dedicated, compassionate, and mindful individuals doing their best with limited data and exceptional times. Such groups make me proud to live in Canada.

I have previously served on the board and understand the dedication involved. The CFAS doesn’t get to control our treatments so much as dedicated clinicians like us choose to follow their expert recommendations.

That doesn’t make the decisions today easy to work with. Today the CFAS decided we, the fertility community, need to interpret public health policy with the following specific recommendations for the next two weeks:

  1. Consultations by telemedicine or phone
  2. Complete current IVF cycles with freeze-all of eggs or embryos
  3. Suspend all diagnostic and elective procedures
  4. Postpone all new cycle starts (IUI, IVF) aside from urgent cryopreservation of oncology

I wasn’t present but heard it was a difficult discussion today. Of course it was: there isn’t a good decision to be made here.

On the one hand,  all of us need to be actively making choices now, including enhanced social distancing, to flatten the curve to help the vulnerable, and maybe healthy patients of reproductive age as well. It is important for fertility clinics, and all of us, to do our part and respect the advice of our public health leaders.

And also: fertility patients have a unique and overwhelming time element built into the condition. The coronavirus experience could be with us for a very long time indeed.

Two weeks paid social isolation away from work as many companies are touting today is good, of course. But we aren’t going to be past coronavirus in two weeks. My preferred read predicting timelines is this MIT Technology Review paper.

Tonight I have a 38 year-old patient desperate to freeze eggs. She has done everything right to get set up. In the months ahead she worries her opportunity to freeze eggs could pass, and is emailing me to try to keep our clinics and the lab open.

There is no perfect decision here.

What We Are Doing at Hannam Fertility Centre

We are going to accept the CFAS recommendations. As I said, there is no perfect decision here, and this one is being made by experts to the best of their ability in deference to our public health colleagues.

I trust this decision. I also agree that it needs to be revisited in two weeks.

Specifically at HFC, for the next two weeks:

  • As of yesterday, no active treatments that can result in pregnancy
    • No cycle monitoring or IUIs
    • No FETs
  • As of today, remote support for patients only
    • No new stimulation starts
    • No in-person diagnostic tests
  • …except as necessary
    • Ongoing support for anyone who has started medications
    • Medically necessary monitoring in the first trimester
  • Aggressive social distancing
    • Consolidation to one site in Toronto
    • ‘Thin’ staffing only
      • We don’t support work-from-home except in exceptional circumstances
      • But we can limit staff physically present commensurate to our limited services and patient volume

I know these bullet points bring up specific questions and you need answers. Please email your clinical team, or send a note to me tom.hannam@hannamfertility.com and we will forward it to the appropriate person.

I’m so saddened everyone for what is transpiring. I had really hoped we could freeze eggs and embryos without delay for everyone. I hope that we will be doing so again soon.

Ideally we can all support our broader at-risk communities and our healthy fertility patients at the same time. I have some ideas about how we can do just that, and look forward to sharing them with the community.

It won’t be fertility as usual, but hopefully we can find a way to do our part and safely take care of our specific patient population too.

More to come.


 

About the Author

Dr. Tom Hannam
The founder of the Hannam Fertility Centre, Dr. Hannam has sat on the board of the Canadian Fertility and Andrology Society, and is a member of the American Society for Reproductive Medicine, the Society of Obstetrics and Gynaecology of Canada, and the European Society for Human Reproduction and Endocrinology.

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