COVID-19: The Impact on Fertility Patients

In managing the impact that COVID-19 is having on fertility patients here in South Africa, local fertility clinics are guided in by SASREG – the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy. The society represents specialists – ranging from gynaecologists, embryologists and scientists to fertility and theatre nursing sisters, allied practitioners, psychologists and social workers in the field of Gynaecological Endoscopy and reproductive medicine – and serves to protect the interests of patients undergoing fertility treatment.

Cape Fertility is very proud to be a SASREG-accredited fertility clinic. In addition, one of our fertility specialists, Dr Sulaiman Heylen is currently the President of SASREG. Along with Dr Nomathamsaqa Matebese, also a fertility specialist at Cape Fertility, Dr Heylen was part of the team that created the COVID-19 best practice guidelines for fertility clinics in South Africa.

Health Risks

Fertility patients were particularly concerned about the health risks that COVID-19 could pose to themselves and their partners, how it could affect their ability to conceive and to what risks it would expose a fetus – and later a baby.

Cape Fertility’s fertility specialists believe that most fertility patients can safely proceed with fertility treatments, provided that the right safety procedures are in place, as they are at Cape Fertility.

This opinion is based on the current scientific knowledge. Firstly, young and healthy women are one of the lowest risks groups for severe COVID-19 infection. Secondly, very few pregnant women have experienced severe COVID-19 disease. Thirdly, even in case of an infection with the COVID-19 virus the risks for a pregnant woman and a young child are very low.

Based on recent publications by the Lancet medical journal, Translational Pediatrics and statements from the CDC, SASREG provided the following guidance with regard to COVID-19 and fertility.

• Young healthy women (typical of women undergoing fertility treatment) are at lower risk of developing the severe disease if affected by COVID-19.
• Undergoing fertility treatment does not increase the risk of contracting COVID-19 (beyond the risk that any individual takes by venturing into public space).
• For women who are trying to conceive, or who are in early pregnancy, there is no evidence to suggest an increased risk of miscarriage with COVID-19.
• At the moment, pregnant women do not appear to be more severely unwell if they develop COVID-19 infection than the general population. It is expected that the large majority of pregnant women will experience only mild or moderate cold/flu-like symptoms.
• Women who have severe COVID-19 infection during pregnancy could be at increased risk of miscarriage or early labour.
• There is no evidence that the virus can pass to the developing fetus (vertical transmission).
• Newborn babies and infants do not appear to be at increased risk of complications from the infection.

Knowing that COVID-19 poses no special risk to women undergoing fertility treatment, to the developing fetus or to newborn babies will certainly provide peace of mind.

However, it is important to prevent the spread of the disease and protect yourself from contracting it. This is because fertility treatments cannot be provided to women who test positive for COVID-19 until all symptoms have cleared.

Time Lost

Many fertility patients are already under significant emotional stress, and the cancellation of their fertility treatments for an unknown time period was an intensely emotional experience.

Fertility treatments are emotionally and physically intense at the best of times, but to hear that their highly anticipated treatments were disrupted by the coronavirus pandemic seemed devastating to many couples. It is not surprising – fertility treatments are often time sensitive and the expensive procedures can have tight timelines. Fearing that they have lost time and opportunities to conceive, many fertility patients and their partners were shaken by the news of cancelled treatments due to COVID-19.

During lockdowns across the globe, fertility clinics were forced to close their doors. In Australia, IVF clinics only resumed fertility services from 27 April, after the ban on non-urgent elective surgeries was lifted by the government. In the UK, fertility services were temporarily suspended on 23 March in response to the coronavirus lockdown and could only apply to reopen from 11 May if the safety and protection of staff and patients were ensured.

Here in South Africa, the initial hard and extended lockdown in South Africa between 27 March and 30 April was reduced to Lockdown Level 4 on 1 May.

During the initial lockdown locally, SASREG’s guidance, based on senior legal opinion, was that fertility clinics were entitled to continue with essential services for patients of advanced age; patients with a diminished ovarian reserve; patients with poor prognosis for whom time is essential and for oncofertility patients.

Since the beginning of May, when South Africa went into Lockdown Level 4, all fertility treatments are now allowed under strict safety regulations.

Around the world fertility patients expressed concern that time was already not on their side and that every month that passed diminished their chances of conceiving. This created a great deal of stress. Women on fertility forums and social media said they felt “crushed” and “devastated”.

Sally Cheshire, chair of the Human Fertilisation and Embryology Authority in the UK, acknowledged the plight of fertility patients during the announcement that UK clinics may apply to reopen, and was quoted in the media as saying “I know that the closure of clinics has been extremely distressing for patients and this will be good news for those wanting to resume treatment and have the opportunity to try for their much longed for family.”

Eve Feinberg, an associate professor of obstetrics and gynecology at Northwestern University, and a member of the ASRM’s COVID task force was also quoted in the media pointing to studies demonstrating that delays of six, eight, or even 12 weeks in starting IVF cycles do not make pregnancy any less likely. This did not seem to allay fears, judging from the reaction from fertility patients in the US. The American Society for Reproductive Medicine (ASRM) initial cautious approach prompted an outcry from patients and 20,000 fertility patients signed a Change.org petition asking ASRM to reconsider its recommendations. At the same time, the Fertility Providers Alliance (FPA) was formed to lobby against the suspension of fertility treatments and within a week 400 fertility specialists joined.

Among SASREG’s COVID-19 guidelines for local fertility clinics is patient counselling. It says, “All patients must be carefully counselled of the risks and benefits of proceeding with fertility treatment. This counselling must include the potential pregnancy-related risks, the transmission of SARS-CoV-2 virus, cancellation of treatment and all other concerns.”

At Cape Fertility clinic, you can rest assured that counselling is among the many services we provide to ensure you enjoy the best quality, individualized, compassionate fertility care.

The effect of COVID-19 on fertility treatments

To limit the impact on fertility patients in South Africa, SASREG closely monitored the situation and provided best practice advice to local fertility clinics. The Cape Fertility team not only strictly adheres to these guidelines for the safety of our patients and staff, we are also proud to have contributed to their creation.

While all fertility treatments are now allowed under strict safety regulations since South Africa went into Lockdown Level 4 the beginning of May, there are many changes to the way fertility treatments are now delivered.

You can read more about how SASREG’s guidelines will affect the delivery of fertility treatments in our article: Fertility treatments during COVID-19…

Or simply contact us by clicking here  and we will answer all your questions.

We look forward to helping you commence or continue your fertility journey in the safest way possible!