By Dr Kshitiz Murdia
The COVID-19 pandemic has brought about a new normal that the world had neither anticipated nor prepared for. With a distinct demarcation of what is essential and what isn’t, it is only natural for people to be uncertain about their present and future alike. Couples who aspire to become parents through assisted reproductive techniques face a similar predicament with the burgeoning cases in the country that have led to lockdowns in many parts.
If you and your partner are looking to start fertility treatment or are in the middle of one, these guidelines are what you need to know to ensure you and your future baby’s safety.
Can patients with comorbidities such as diabetes, hypertension, etc, seek treatment during the pandemic?
It has been found that the severity of COVID-19 is a reflection of the co-morbidities a person has. Anyone with diabetes, hypertension or other high-risk conditions such as chronic pulmonary-renal/hepatic diseases or persons who are taking immunosuppressants related to organ transplants or receiving multiple medical therapies must consult their specialists. This is not limited to treatment during the pandemic but also under normal circumstances as they may pose as challenges. Only after getting a go-ahead from their doctors should patients make an informed decision; consent for the same will be documented and will be provided proper counsel.
Do I have to take the RT-PCR test before every visit to the clinic?
Patients and their partners are strongly advised to get a negative RT-PCR test report before commencing treatment. This must be repeated before any assisted reproductive technology (ART) procedure that is considered invasive and requires regional or general anaesthesia such as egg retrieval, hCG trigger or embryo transfer. It is advised that the test is done less than three days prior to the procedure. To avoid getting infected, we strongly recommend patients, partners and potential donors (where applicable) to self-isolate from the beginning of ovarian stimulation until the procedure is finished.
Is a negative RT-PCR enough to begin treatment?
No, additional steps have been taken to ensure patient safety as mandated by the ICMR’s guidelines for commencing ART services during the pandemic. Two weeks before starting treatment, patients are required to fill an ART risk assessment triage questionnaire; the same must be filled before every OPD clinic visit as well as before starting ovarian stimulation medication.
What if a patient tests positive in the middle of treatment?
In case patients undergoing ART procedure test positive mid-treatment, they are advised to wait till they have recovered and are not able to spread the infection to others. National and/or State guidelines regarding a negative test must be adhered to before resuming treatment. The same is also applicable for donors.
In case a patient or her partner is symptomatic or tests positive after egg retrieval, it is advisable to postpone transfer of the embryo. In such a scenario, eggs, sperms or embryos must be frozen, as the case may be, for future use.
Tested negative – what should a patient do?
In cases of asymptomatic or symptomatic cases treated at home, recovered patients should provide a medical certificate to begin treatment. In severe instances where the patient required respiratory support, they have to provide a clearance report from the treating physician or local Registered Medical officer (RMO).
Will there be a mandatory appointment system in place?
Taking an appointment before visiting a clinic is appreciated and also mandatory in certain cases. Social distancing is of paramount importance at patient reception, arrival and checking in process, consultation, ultrasonography, counselling, sample collection, and all other communal areas. Thermal screening is imperative prior to entering a clinic and physical barriers between staff and patients, including the appropriate use of PPE is required inside the clinic.
A number of ART clinics may also provide teleconsultation and semen consultation services to minimise the number of trips taken to the clinic, depending on the patient profile.
When should a patient cryopreserve their gametes or embryos?
In the COVID-19 context, cryopreservation of gametes and embryos is required if either or both partners test positive for the infection. There can be two broad scenarios: (a) If the male partner tests positive after egg retrieval, the eggs are frozen. (b) If either the male or female partner or both test positive after retrieval of eggs and sperms, the resultant embryo is frozen till they get a medical clearance.
As a precautionary measure for known COVID-19 positive patients, cryopreservation practices similar to those observed in case infectious diseases such as HIV are implemented for their safety. This includes high security straws or vials, vapour phase or separate liquid phase storage, separate cryo-containers and closed system vitrification process.
What about donors?
For donors, a triage questionnaire to check for high-risk individuals is filled; if the donor has a positive RT-PCR result for COVID-19 during the cycle, a cancellation may be considered. Since certain research has found the presence of the novel coronavirus in semen, albeit non-conclusively, all anonymous samples are mandated by the FDA to be quarantined for six months. Similar quarantine may be performed with a known donor’s specimen depending on the will of the patient and physician.
(The writer is CEO & Co-Founder, Indira IVF.)