International experts commentary for assisted fertility treatment facilities amidst COVID-19

"Time sensitive" patient groups need to be carefully assessed for ART treatment in COVID-19 era

Key Points

Highlights:

• Many authorities recommend prolongation of lockdown in health services providing complex fertility treatments.
• This precaution may be hazardous not only to infertility patients. 
• The problem of how assisted reproductive services may start after the current lockdown should be unique for each country. 

Importance:

• Women affected by serious conditions like malignancy, autoimmune disorders, hematologic disorders, etc., who may receive gonadotoxic treatments, require urgent procedures for fertility preservations. 
• Besides, there are young patients with diminished ovarian reserve, and having the risk of premature ovarian insufficiency represent the “time-sensitive” category. 

Background

• Conceiving by assisted reproductive technology facilities to get pregnant constitutes 0.3% part of all infants born yearly and the total number of deaths from COVI-19 worldwide is reported 0.1% of all human deaths. 

What's done here:

• Authors aimed to emphasize the continuation of fertility care in a safe environment and restarting assisted reproductive technology facilities during COVİD-19 pandemic restrictions to competent authorities and health care providers.
• The authors recommend suggestions that may result in prognostic-stratification of more vulnerable infertility cases, such that worldwide fertility treatments may restart.
• At a time span focusing on preventing complications and limiting burdens for health systems in all countries worldwide, the viewpoints of the authors could help authorities and health care providers. 
• Finally, these suggestions may help in identifying patients that should be prioritized for the safe continuation of fertility care.

Key results:

• Beyond offering assisted reproductive technology treatment to the vulnerable patients also the impact on the resulting pregnancy need to be taken into consideration.
• Male patients undergoing medical treatment aiming at improving their fertility should not be forgotten, like men at reproductive age who are recommended to freeze sperm urgently. The andrological services must be are available after lockdown.
• There would be a considerable time span before the broader implications of the current restrictive measures for patients as well as a society be assessed properly.
• Various lockdowns have slowed the spread of infection but new cases will appear inadvertently, as soon as measures are loosened.

Lay Summary

A multinational and multi-institutional commentary led by Dr. Alviggi from Italy and Dr.Esteves from Brazil has addressed important issues on assisted reproductive technology treatment amid COVID-19 lockdown suggesting remedies in the journal of "Reproductive Biology and Endocrinology" May 2020 issue.

Prolongation of lockdown in health services providing high tech fertility treatments has been advocated by most of the authorities, however, this situation is affecting adversely both the infertility patients and the whole society together. Restarting these services after the lockdown is a unique issue for each country due to the different recovery curves.

Women with important health issues like cancer, immune disorders, hematologic diseases among others, having gonadotoxic applications that need quick interventions for the preservation of fertility. Additionally, among vulnerable groups of fertility preservation, younger women with lesser ovarian capacity that have a risk of ovarian insufficiency are in need of abrupt intervention.

The collaborative international multi-institutional commentary suggests solutions for prognostic-stratification in these vulnerable infertility cases so fertility treatments may restart all over the world. These may help authorities and health care providers in reaching effective assisted reproductive treatments without risking the patients. The start of assisted reproductive technology treatments has to take into consideration the resulting pregnancies also.

Male patients having medical treatments to improve fertility should not be omitted thus andrological services must also be available. The exact assessment of the consequences of COVID-19 restrictive measures for patients as well as society needs a considerable time span. It should not be forgotten that various lockdowns have slowed the spread of infection but new cases will appear as soon as measures are loosened. 

This international commentary provides a viewpoint to help both authorities and health care providers to better identify the priorities and the management for infertile patients affected by the COVID-19 pandemic restrictions. The precise prognostic determination of patients and the selection and establishment of the weight for “time-sensitive” patients is imperative for governing the step-by-step restart of assisted reproductive treatment services worldwide.

Research Source: https://pubmed.ncbi.nlm.nih.gov/32404170