Although preventive measures (universal masking, physical distancing, hand hygiene, and prompt testing with isolation and contact tracing) can significantly decrease the transmission of the virus that causes COVID-19 illness, the consensus among experts is that only an effective COVID-19 vaccine will end the pandemic. Despite the categorization of pregnancy as a high-risk condition for severe COVID-19 illness, hospitalization, and mortality, pregnancy remains an exclusion for participation in vaccine trials. There was no biological reason for exclusion of pregnant or lactating patients from these trials.
At UCSF, in alignment with the American College of Obstetrics and Gynecology, the Society for Maternal Fetal Medicine and the American Society for Reproductive Medicine, we recommend that pregnant patients and patients who are actively trying to conceive have access to COVID-19 vaccines, and that they and their healthcare professional engage in shared decision-making regarding receipt of the vaccine. Counseling should balance available data on vaccine safety, risks to pregnant patients from SARS-CoV-2 infection, and an individual's risk for infection and severe disease. mRNA vaccines, which are the first vaccines available, do not contain a live virus but rather induce humoral and cellular immune response through the use of viral mRNA. The theoretical risk of fetal harm from mRNA vaccines is very low.
If you are actively trying to conceive and are eligible for the vaccine, there is no reason to delay pregnancy attempts or fertility treatment because of vaccine administration or to defer treatment until the second dose has been administered. Patients who conceive in the window between the first and second dose of the vaccine should be offered the second dose of the vaccine at the appropriate interval.
May 7, 2020
We understand how hard it has been for patients working to build their families and achieve other reproductive goals to delay their care. In balancing the safety of patients and staff, the health of our community, the reallocation of critical healthcare resources, and the time-sensitive fertility needs of our patients, CRH has decided to resume fertility treatment. All patients whose fertility treatments were delayed or cancelled can expect to resume their care before the end of June 2020.
We are taking the utmost care to avoid coronavirus transmission within our clinic. However, there is still risk of exposure to and infection with coronavirus through the clinic by contact with other patients or providers.
If you are exposed to or infected with coronavirus, or if you develop fever, cough or flu-like symptoms, your treatment cycle will be halted immediately, without reimbursement of rendered services.
At any time, changes in local, state or federal regulation may restrict business and non-emergent medical activities, including fertility treatment. If this occurs, your treatment cycle may be halted.
Please note that you have the option to postpone your treatment if you wish to do so.
Screening: UCSF has implemented rigorous screening procedures at the institutional level. All patients will undergo a two-step process including symptom screening by phone the day prior to their appointment, and in-person screening the day of the appointment before being admitted into clinic. Staff will be screened on a daily basis by UCSF-wide protocols prior to entering clinic. Please arrive early for your appointment to ensure adequate time to be screened.
Testing: Because of their frequent appointments, patients undergoing IVF cycles will be tested for SARS-CoV-2 twice per cycle. Tests will occur prior to starting stimulation and again prior to retrieval. Testing will occur at the UCSF Mobile Testing Unit in Laurel Heights, which allows patients to be swabbed while in their cars. This protocol has been devised with our anesthesia colleagues who are a critical part of patient safety.
Personal protective equipment (PPE): Masks are an essential part of mitigating the transmission of this virus. All patients and staff will be provided surgical masks and required to wear them in clinic.
Social distancing: We are taking numerous measures to promote social distancing as we resume clinical operations. Appointment slots will be extended to minimize the number of individuals interacting in clinic at any given time. In accordance with University policy, only patients with appointments will be allowed into clinic. No visitors will be allowed, irrespective of appointment type. We have rearranged our clinic flow to space out appointments over the extended clinic space. Other measures have also been implemented to minimize the number of interpersonal interactions.
Providers and staffing: To keep everyone safe, we have restructured our staffing. The minimal required number of individuals will be present in-person in clinic at any time. We are utilizing extensive telehealth to promote this goal. All staff able to work from home are supported in doing so. Please note that regardless of the physical location of your physician and team on any given day, they are available to you for all of your concerns and needs.
Other environmental measures: Extended appointment times also allow for comprehensive disinfecting of all patient spaces between each appointment. In addition, only one person will be allowed in an elevator at a time.
Importantly, you will notice some changes if you have previously undergone IVF treatment at CRH. In addition to the measures noted above, we want to underscore that, in accordance with university policy, we are unable to accommodate any visitors to come with you to in-person clinic appointments. This includes procedures such as egg retrievals and embryo transfers. While we know this is certainly not ideal, it is a current requirement to safely resume our clinical operations. For longer non-procedural appointments, you may opt for telehealth visits so you and your partner/visitor may be able to see your doctor together.
We suggest that all patients follow regional and local policy regarding sheltering in place. Given the risks of cancellation interrupting IVF cycles as outlined above, patients undergoing IVF cycles may wish to be additionally cautious with regards to social distancing measures while undergoing treatment.
We do not currently have the capability to test all patients for active viral infection or prior exposure to the virus. For now, given the intensity of treatment and number of in-person appointments required, only IVF patients will be tested during their cycles, as detailed above.
There is currently no evidence that coronavirus is transmitted to or carried by oocytes (eggs) or sperm. There is no immediate threat to the safety of frozen eggs, sperm or embryos. CRH has rigorous policies and procedures to maintain our liquid nitrogen tanks with several layers of safeguards. Embryology staff will be subject to the same screening and distancing policies as all CRH staff, and continue to use rigorous PPE protocols.
At this time, there are no definitive data on the impact of COVID-19 on fertility, pregnancy, childbirth or transmission of disease to newborns.
• The risks of COVID-19 in pregnancy are unknown, and could include, but are not limited to, birth defects, miscarriage, stillbirth or preterm birth. High fever in the first trimester of pregnancy, from any source, increases the risk for miscarriage and birth defects. If you have a fever during pregnancy, please contact your provider to pursue mitigating measures such as taking Tylenol and to ensure appropriate evaluation and supportive care.
• It is unknown if pregnancy increases the risk for acquiring COVID-19 or worsens the severity of the disease.
Researchers at UCSF are leading a nationwide study to understand the implications of COVID-19 in pregnancy, focusing in on the first trimester. The study is called ASPIRE (Assessing the Safety of Pregnancy in the Coronavirus Pandemic). This information will help us address urgent questions needed to keep pregnant women and their babies safe. Learn more about ASPIRE at http://aspire.ucsf.edu. Currently of the several billion dollars in research support from the government for COVID projects, unfortunately no funding has been allocated to pregnancy and child development research; development and sponsorship opportunities are actively being pursued. We encourage you to partner with this effort as a participant or other supporter.
Note: The COVID-19 pandemic is rapidly evolving, with new information every day. The above information is subject to change on this basis. Please check back and speak with your provider for the most up-to-date information.
Please contact us via CRH-Managers@ucsf.edu with additional questions you would like to appear on this page. We are here and we are listening.
If you wish to speak to your primary doctor further about any of the above, please don’t hesitate to reach out to your Care Team directly.
April 16, 2020
FAQs for Patients Related to COVID-19
Presented by ASRM and SART
We understand that it can be devastating for those who have been trying to build their families to now have to delay treatment due to COVID-19. The goal of this communication is to help give patients a clearer understanding of the ASRM COVID-19 Task Force recommendations, and to help answer questions they may have.
A: It is extremely difficult to consider postponing your treatment. Most people have gone through tremendous loss and grief by the time they get to the place where they are doing an IVF cycle. In addition, navigating the cost and insurance coverage aspects is daunting. Now that you are at this point in your family building, you are dealt a huge unknown with the COVID-19 pandemic, and how you should proceed, or start, this medical treatment. It should be somewhat helpful to hear that there is no evidence that delaying treatment for a month or two will ultimately affect your ability to have a child, even if you have concerns about advanced age and / or diminished ovarian reserve (low egg supply). The ASRM recommendations will be continuously reviewed and updated, as we know that many people do have concerns about waiting longer than two months.
A: No one providing your care believes that any fertility treatment is elective. Infertility is a disease, and treatment of infertility is medically necessary. There is a distinction between a treatment that cannot be postponed even for a few days (such as surgery for a ruptured appendix), and treatment that is time sensitive and extremely important (such as IVF) but not a medical emergency. Unfortunately, there is not a universal definition, and we have seen many misleading terms used, even by state public health agencies.
We know that other important non-emergency treatments also are being postponed during this pandemic. Fertility treatment is not being singled out. Orthopedic surgery, eye surgery, kidney stone procedures, dental procedures, and many other treatments also are being postponed due to the COVID-19 pandemic.
A: As anyone who has been through fertility treatment or has prepared to begin fertility treatment knows, multiple clinic visits and procedures are required. Unfortunately, even if a clinic tries to screen patients and staff to lower the risk of novel coronavirus exposure in the fertility clinic, there is no way to guarantee prevention of exposure. COVID-19 is now spreading through communities and is not limited to those who have traveled to certain countries. People who have the novel coronavirus are contagious days before they develop any symptoms. The virus can be in the air that they breathe out and the air you breathe in. This risk is reduced by wearing masks and by increasing physical distance between people. However, even these precautions aren’t foolproof and do not guarantee your safety. We wish we could screen in a way that could eliminate risk, but we honestly cannot.
A: It is very hard to deal with uncertainty, especially when you are pursuing the dream of family and unexpected challenges are in the way. Currently, the U.S. is a patchwork of different federal, state and local regulations and recommendations that may make starting or continuing your medical treatment difficult. In many states, the governor or state legislature has restricted fertility clinics from performing medical procedures such as IVF during the pandemic, and have even imposed fines and penalties for healthcare providers who violate the laws.
While ASRM vigorously advocates for fertility care and reproduction as an essential right, there are considerable risks to your health should you become exposed to COVID-19. Fertility care requires interaction with many individuals and any person-to-person interactions increase the likelihood that you may become infected. In most cases, ASRM recommends postponing infertility care until after the crisis passes to reduce your risk of getting COVID-19 because the virus can cause you to become very sick, requiring prolonged hospitalization or even death. Until the peak of the crisis is past, the ASRM COVID-19 Task Force recommends:
Postponing oocyte retrievals
Postponing embryo transfers
Postponing diagnostic tests
A: Some states and local governments are implementing mandatory “shelter in place” requirements, and it is likely that more restrictions are to come. A clinic that begins a treatment cycle could be forced to cancel it by the clinic's city or state regulations. Furthermore, healthcare workers who are exposed to the coronavirus may not be able to come to work. It is possible that even if you begin to invest time and money into fertility treatment now, it could be cancelled due to governmental restrictions or lack of available staff.
A: Yes. There is no immediate threat to the safety of cryopreserved eggs, sperm or embryos. Clinics have policies and procedures to maintain the liquid nitrogen tanks containing frozen embryos, eggs, and sperm. Please ask your doctor if you have any questions about the systems in place at your provider’s clinic.
A: We are NOT saying that women should not get pregnant during this pandemic. We are also not saying that there is no risk. The risks of acquiring the coronavirus in the first trimester are not known and will not be known for some time. We do know that severe illness can lead to pregnancy complications. If you are already pregnant, it is important to take all precautions possible to reduce your risk of exposure to the coronavirus by following CDC current recommendations, such as hand washing with soap, not touching your face, and practicing social (physical) distancing.
A: If your practice offers a telehealth option, consider scheduling a consultation and begin to prepare for your treatment cycle. Seek insurance authorization for your treatment if possible. Some people may want to use this time to focus on improving their general health through efforts such as smoking cessation or weight loss that may improve fertility treatment success. It’s a good opportunity to focus on nutrition and reduce or eliminate habits that are detrimental to overall health. If you prepare now, you’ll be ready to begin treatment as soon as it is safe to do so.
A: Fertility clinics will need to adhere to local, state and federal guidance as to when it is safe for medical practices to resume providing care to patients. As soon as it is deemed medically safe and the likelihood of transmission of COVID-19 is greatly reduced, most restrictions will be lifted. The fertility clinic personnel want to be helping their patients right now and will resume as soon as they possibly can.
A: The ASRM, American College of Surgeons, and many other organizations have recommended that surgical procedures that are not deemed urgent (urgent meaning that someone needs the surgery to avoid serious illness or death) be delayed to reduce the spread of COVID-19. Also, some fertility practices have diverted their medical equipment or supplies to help hospitals and their critical care units fight COVID-19.
A: Yes! The ultrasound and lab testing are recommended at this time, since this is necessary and is considered an urgent matter. Use of face masks, hand washing, and physical spacing are recommended.
A: Yes! People facing an urgent need for fertility preservation can proceed during the pandemic, if this is deemed to be reasonable after consultation with their doctor.
A: COVID-19 infection can last for weeks. Since pregnant women are known to be at increased risk of severe complications from other respiratory infections such as influenza and the novel coronavirus, it may be prudent to wait until you no longer have symptoms to attempt to get pregnant.
A: Based on currently available information, pregnant women who become infected with COVID-19 do not appear to be at increased risk. However, pregnant women are known to be at greater risk of severe complications from other respiratory viral infections such as influenza and SARS. For that reason, pregnant women are considered an at-risk population for COVID-19. Notably, in many reports, cesarean delivery has been used for women who presented in labor and needed delivery. Though evidence is limited, there are anecdotal cases where pregnant women infected with COVID-19 have encountered an exacerbation of breathing difficulties after delivery.
A: Some pregnancy complications have been reported among infants born to mothers positive for COVID-19, such as preterm delivery and low birth weight. More reports are becoming available every day. It is not clear whether these outcomes were related to maternal infection. It is possible that other unforeseen complications may be discovered in the future.
A: RESOLVE: The National Infertility Association (www.resolve.org) has resources and various ways to get support. RESOLVE has an online support community, local support groups (now meeting virtually), webinars, and other content to help you connect, get support, and stay informed.
We know that the infertility treatment can be stressful. The conditions created by the COVID-19 pandemic certainly add to that stress. There are things you can do to help reduce that stress. Your clinic can provide you with a referral to a trained mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Many of these providers are prepared to offer telehealth options that may be covered by your insurance carrier. Here are some additional ideas:
Get accurate and current information to reduce anxiety. Utilize reliable sources such as the CDC, WHO and ASRM.
Limit your use of social media and other sources of news. Set a certain time of day for gathering news. Choose a time when you aren’t likely to be triggered. Stop using tech devices an hour or more before bedtime…turn them off.
Utilize relaxation or mindfulness apps to reduce anxiety and tension and improve sleep. Focus on the present moment. Some examples of these apps are Ferticalm (for women), FertiStrong (for men), Headspace, MindshiftCBT, and Personal Zen.
Distract yourself with non-COVID-19 related topics. Taking even ½ hour per day to focus on other things will help.
Pay attention to the messages you give yourself. Positive self-talk can be powerful. Saying things like, “This isn’t the situation I expected, but it doesn’t mean it won’t work out eventually” can be helpful.
Stay in touch with others in your support network. Use virtual connection via telephone or video chat to do this. Staying connected with others reduces the sense of isolation. RESOLVE is offering its peer-led support groups via virtual technology so that you can connect with others going through the same thing as you.
