In April 2020, the coronavirus (Covid-19) pandemic caused a temporary closure of all UK fertility clinics. As from 11th May 2020 clinics had to apply to the HFEA to recommence treatments but must ensure that they provide a safe service for patients, and a safe working environment for clinic staff.
Before commencing treatment, you should be fully informed of the risks related to Covid-19, including the increased risks when attending clinic, and in pregnancy. You should then be offered a choice of whether to proceed with, or postpone your treatment.
Please be aware that as this is still an evolving situation, further disruptions are still possible.
We hope that the information in this leaflet will answer some of your queries before starting treatment.
Is it safe to have fertility treatment now?
If you or someone in your household is clinically vulnerable and are ‘shielding’ then you should proceed with treatment during the pandemic. If you are not ‘shielding’ but you would prefer to defer your treatment until after the pandemic, this option should be open to you and we would advise you discuss with your clinic at the earliest opportunity.
Your clinic should recognise that patients are likely to be anxious about the coronavirus infection and its potential effects on pregnancy. Pregnant women do not appear more likely to contract the infection than the general population, or to be at higher risk than non-pregnant individuals of severe Covid-19 infection, requiring hospital admission. However, pregnancy itself does alter the body’s immune system and response to viral infections in general, which can occasionally cause more severe symptoms. This is particularly true towards the end of pregnancy.
There is currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to Covid-19, and no evidence that the virus causes birth defects. Some women with Covid-19 have experienced pregnancy complications, including preterm birth and preterm prelabour rupture of membranes. Transmission of the virus from a woman to her baby during pregnancy, or during labour and delivery, is thought to be probable, although the proportion of pregnancies affected, and the significance to the baby, has yet to be determined.
Nonetheless, you should receive guidance and information, taking into account your individual clinical situation, your risk profile, and the likely persistence of the virus in the local community in the medium term. This information and guidance, and your decision whether or not to proceed with fertility treatment, should be documented in your medical record.
The risks about the impact of Covid-19 on pregnancy have been considered by the Royal College of Obstetricians and Gynaecologists (RCOG) who are regularly updating their guidance (www.rcog.org.uk). You will need to take this into consideration and actively consent to having treatment whilst there is a risk that you could contract Covid-19, either during the treatment, or if successful, during pregnancy.
What should the clinic be doing to protect me and others from Covid-19?
· Assessing the Clinic layout
· Social distancing- ensuring 2 metres distance where possible
· Screening patients prior to arrival at clinic by telephone questionnaire
· Screening (by questionnaire and/or temperature) on arrival at clinic
· Use of alcohol gel /hand washing on arrival and before leaving the clinic
· Reducing the number of patients in clinic at any one time
· Providing personal protective equipment for staff members and ensuring appropriate use
· Additional cleaning of surfaces within the unit
· Your clinic should use electronic platforms for consent-taking, where available
· Cancelling treatment cycles where there is suspicion of Covid-19 infection
· All staff members should be instructed to avoid unnecessary exposure (both at work and in private) as per current government policies for social distancing.
· If any staff member is at risk of Covid-19 they will be advised isolation/ testing as per policy and government guidelines.
· Particular caution should apply to patients with underlying medical problems whose co-morbidity places them at a higher risk of complications in the event of contracting coronavirus infection. This includes patients with obesity, hypertension, diabetes, and those receiving immunosuppressive medication. It may be appropriate for such patients to delay treatment until epidemiological evidence shows a sustained reduction in the community spread of the infection.
What can I do to protect myself and others from Covid-19?
It is very important that you minimise your chance of getting Covid-19 infection prior to and during your treatment.
· Please follow the advice of the government – see https://www.gov.uk/coronavirus https://www.gov.scot/collections/coronavirus-covid-19-guidance/ https://www.nidirect.gov.uk/articles/coronavirus-covid-19-overview-and-advice https://gov.wales/protect-yourself-others-coronavirus
· Wash your hands regularly with soap and water for 20 seconds.
· Carry a tissue – Need to cough or sneeze? – Use the tissue, discard in a bin and wash your hands as soon as possible. ‘CATCH IT, BIN IT, KILL IT’.
· Avoid contact with anyone who has symptoms of coronavirus.
· Avoid non-essential use of public transport when possible.
· Work from home, where possible.
· Avoid large and small gatherings in public spaces as infections spread easily in closed spaces where people gather together.
· Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
· Use telephone or online services to contact the unit, your GP or other essential services.
· You may wish to consider wearing a face covering
It is important that you attend your appointments with your clinic only at the time that you have been allocated. Please build-in time for travel and parking so that you are not late. If you miss your appointment slot the clinic may have to ask you to re-attend later in the day.
What are the symptoms of Covid-19?
The main symptoms of coronavirus are:
· a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
· a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
· Loss of taste or smell
Other symptoms include – hoarseness, nasal discharge/ congestion, shortness of breath, sore throat, wheezing or sneezing, tiredness, and muscle aches and pains.
What should I do if I or anyone in my household has symptoms of Covid-19?
· Do not attend your clinic in person if you have symptoms of Covid-19, or have been in contact with anyone with symptoms of Covid-19, or who has been diagnosed with Covid-19.
· Do contact the clinic by telephone for advice
· If you need advice regarding coronavirus symptoms please use the 111 online coronavirus service (https://111.nhs.uk/covid-19/)
Should the clinic be screening patients for Covid-19?
All patients should be contacted by telephone in advance of their appointment and requested to answer standard questions but are not necessarily routinely tested. To protect you and staff, the clinic will not be treating patients with Covid symptoms. It is important that all patients answer the questions honestly so that the clinic can reduce the risk of transmission of the virus to other patients and staff members.
You must notify your clinic before attending your next appointment If the answer to any of the questions in the screening questionnaire changes.
If my partner, a member of our household or myself, develops symptoms of Covid-19 during treatment, what will happen?
· Contact the unit by telephone for advice before attending any appointments.
· If the clinic is unable to proceed with your treatment in a manner that is safe for staff and other patients, it would be necessary to cancel your cycle at that time.
What happens if my cycle is cancelled because of risk of infection with Covid-19?
· The cancelled cycle should not count as an NHS funded cycle.
· If self-funding, a further cycle with no additional charge or a full refund should be offered.
· Your treatment cycle should be rescheduled for the earliest available slot.
Which appointments should my partner attend with me?
To minimise the risk of spreading the virus, it is important to reduce the number of people attending the unit. Therefore, your clinic may have to ask that you attend most of your appointments by yourself. There may be certain circumstances where your partner will be required to attend the clinic. Your clinic will notify you in advance which appointments these apply to.
What support is available to me?
This has been an extremely challenging and distressing time for patients and some may experience anxiety during the current situation. It is important your clinic is offering support:
· Your clinic as a minimum should offer telephone counselling appointments.
· Fertility Network UK provides free and impartial support, advice, information and understanding for anyone affected by fertility issues. https://www.fertilitynetworkuk.org
· If you are feeling low or anxious, information and support is available from: https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing/guidance-for-the-public-on-the-mental-health-and-wellbeing-aspects-of-coronavirus-covid-19 https://www.mind.org.uk/information-support/coronavirus/ https://www.breathingspace.org.uk/
Where can I get further information?
Fertility Clinics Reopening Safely, with Rachel Cutting, HFEA.
Covid-19 Your FET Questions Answered
1. Will a frozen embryo transfer be as successful as a fresh cycle and does this depend on your age?
The chances of success with frozen embryos are very similar to fresh embryos and that is related to the woman’s age at the time of collecting the eggs. Therefore, with frozen embryos, the chances of success will be very similar to the chances of success at the time of the freezing of the embryos, no matter how long before this was done.
2. Are the embryos likely to defrost ok?
Yes. Embryos are commonly frozen on day 2, 3, 5 or 6 after egg collection, with the day of freezing dependent upon a number of clinical factors. Embryos are now frozen using a technique called vitrification and their chances of survival after thawing are over 90%. If they survive they give you very similar chances of success to fresh embryos.
3. Will my embryo be affected once inside me if I catch the virus?
So far there is no evidence that COVID-19 can be transmitted from the woman to the embryo or the fetus, so even if you become ill with COVID-19 once you have had a positive pregnancy test, it is very unlikely that this will affect the baby.
4. How safe are my frozen embryos from the virus?
From what we know they are safe. So far no one has identified transmission of any virus in liquid nitrogen. There is also no evidence for the presence of COVID-19 in the embryos and therefore even if you were positive for the virus at the time of egg collection the frozen embryos should have no COVID-19 in them.
5. Is there a chance any of the clinic staff could have had the virus when I had my egg collection yesterday?
It is very unlikely that any clinic staff were suffering from COVID-19 when you were treated. Clinics and health care professionals have been aware of the advice from the government to self-isolate if there are any symptoms of infection. However, we know that all infections have a phase where the person may harbour the virus but does not show signs of infection. This is known as the ‘Incubation period’ and for novel coronavirus this is on average around 5 days. People are more likely to be infectious when they are sick, but some spread may occur from people without symptoms.
6. I’ve been stopped mid-cycle. Will my body be able to get back to normal after only some of the meds?
Yes. The fertility medications – both the injections used to stimulate the ovaries and the hormones used to prepare you for a frozen embryo replacement – are cleared from the body in a matter of days. You are likely to have a menstrual period within 2 weeks of stopping all medications. We would recommend to use barrier contraception or abstain from sex until you get your menstrual period.
Covid-19 Coping Strategies with Angela Pericleous-Smith, BICA Specialist fertility counsellor.
Click here to read stories from other patients experiencing treatment delays and cancellations.