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Webinar

COVID-19 and fertility care in the U.S.

Transcript

TAMMY: I want to welcome and thank everyone for joining this webinar about the impact of COVID-19 on fertility care and treatments like IVF, IUI, egg freezing, adoption and more. These are difficult, uncertain and stressful times, and I want to send my deepest condolences to anyone who was impacted by the coronavirus, directly or indirectly. If you are a Carrot member, a reminder that you have unlimited access to your Care Team for information, guidance, and emotional support. Simply log into your app at carrotfertility.com. A quick reminder that this discussion will be focused primarily on members in the U.S. For our many thousands of members outside of the U.S, we will soon announce a webinar focused on your geographies, too. We’ll be posting that on our COVID-19 resource center, which you can easily find from our homepage at carrotfertility.com

In the meantime, you can stay up to date by referring to the WHO and your local and regional authorities. We’ve listed some of these on the resource center landing page I just mentioned. The Q&A is now open, so please feel free to submit questions at any point in the discussion. We'll try to get to all of them, but for any we don't get to today, we'll be sure to get you answers on our website as soon as we can. You can submit anonymously if you would prefer not having your name included. 

I am honored to be joined by two incredible fertility doctors, whom I will introduce now. I want to thank them for being here with me today. 

Amanda Adeleye, MD, is a reproductive endocrinologist and infertility physician. She is an assistant professor of medicine at the University of Chicago and a fellow of the American Congress of Obstetricians and Gynecologists. She is devoted to using research to close fertility-related health care disparities. Dr. Adeleye’s research interests include increasing access to care and education for the LGBTQ+ community. 

Lina Akopians, MD, is a board certified reproductive endocrinology and infertility physician at Southern California Reproductive Center in Beverly Hills, California. Her research has focused on the development of spinal cord and pain pathways, endometriosis, polycystic ovary syndrome (PCOS) and oocyte cryopreservation. Dr. Akopians has received a multitude of awards and scholarships, including Magna Cum Laude from UCLA and the Alpha Omega Alpha (AOA) recognition for her medical education. She has authored and co-authored numerous publications covering a range of topics in the fields of neuroscience and reproductive health.

Thank you both for being here with us today, and for your time being on this webinar. 

Dr. Adeleye, perhaps now is a good time just to go over, what is COVID-19? What do we know so far, and what are some of the facts that we do have?

DR. ADELEYE: First of all, thank you so much for that kind introduction Tammy. So, COVID-19 is the infectious disease caused by the most recently discovered coronavirus. It is a respiratory disease caused by a coronavirus which is newly experienced in humans and why the term novel is used. The virus has been named SARs CoV2 and the disease it CAUSES has been named “coronavirus disease 2019” aka “COVID-19”. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The complete clinical picture is unknown but symptoms may present as fever, dry cough and shortness of breath. And reported illnesses range from mild to severe systems and can manifest 2-14 days after exposure. Individuals with mild cases typically recover within a few days, but those with a mild to severe case, it can take several weeks to a month or even result in death.  

So, who is considered high risk? We don’t have enough information on COVID-19 to truly understand the full scope of risks but what has been reported by WHO and CDC. At this time, pregnant women don’t appear to be at a higher risk for contracting the virus but due to the changes that occur during pregnancy, it could make them more susceptible. As, such pregnant people should be considered an “at risk” population. This means to take additional precautions.It is presumed that people with chronic illnesses and the elderly may be more susceptible to the illness and should take every precaution to reduce exposure to the virus.

Now, moving on to some precautions you may want to take:

Avoid exposure

  • There is currently no vaccine for the coronavirus so the best way to help prevent the spread of the illness is social distancing (avoiding large crowds and keeping a 6 feet gap between individuals).
  • The virus is spread from person to person through droplets possibly in the air from someone who coughs or sneezes. 
  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes.

Reduce risk

  • Wash your hands for 20 seconds 
  • Avoid touching your face (mouth, nose, eyes, etc) after contact with objects or individuals 
  • Avoid close contact with those who are sick and put distance between yourself and other people. This includes precautions such as not shaking hands with other people and keeping a 6-foot distance from others.

So now, thinking about COVID-19 and fertility, there is currently not enough data on how COVID-19 will impact pregnancy, the transmission of the virus during pregnancy and our future reproductive health. It is currently being studied and we are seeing more information being released everyday. In the interim, the guidance aims to take every precaution while managing patient care by complying to health recommendations released by ASRM, WHO, CDC, and local and state health departments. During this webinar we aim to discuss the latest recommendations and answer any specific questions you may have surrounding COVID-19.  


TAMMY: Thank you so much. We have collected and organized a number of questions that have come in so far. At this moment, feel free to submit additional questions, but right now these are the most common ones we’ve gotten prior to this webinar. So let’s just address these four first, and then we’ll take in new questions that come in. First and foremost, Dr Akopians perhaps you can take this one, should people attempt to get pregnant right now? What if they’re planning to pursue egg freezing or IVF in the coming months? How should they think about that?


DR AKOPIANS: The amount of information we have today will drastically change over the next few months. At this time we know very little about the impact the virus has on our reproductive health. There is not a lot of information if this affects our oocytes or sperm and to what degree. According to ASRM guidelines released yesterday March 17, 2020, new treatments should not be started, continuation of care should be individualized and embryo transfers should be postponed. Those already pregnant should take extra precaution to avoid exposure, such as social distancing. Many of the guidance in place are out of an abundance of caution and those who are already pregnant should not be alarmed. There is a call to action to emphasize how we all can take precautions in order to reduce exposure or how to proceed in the event we are exposed. We know there is an ongoing effort to monitor any adverse events to those pregnant. Additionally, ESHRE on March 14 2020 put out a statement that noted cases on women that tested positive for COVID-19 out of China delivered healthy infants free of the disease. But then again this is such a small number of cases, that precautions are still warranted.


TAMMY: Dr Akopians, can you just define for those that may be listening and not know, what does oocytes mean?


DR AKOPIANS: Eggs, egg freezing.


TAMMY: So oocyte preservation is just another way of saying egg freezing. 


DR AKOPIANS: So for those who were planning to start cycles in the coming weeks and months, we suggest that you continue to stay informed of the quickly-evolving situation and keep in close contact with your clinic about their recommendations as they are following ASRM and CDC guidelines regarding cycles.


TAMMY: And again, those links will be available on our website. So you can go to the webpage of Carrot, ASRM, WHO, or the CDC. Dr Adeleye, we just heard some great guidance for those who may have been planning on going through a cycle in the coming weeks or months, but what if they’re mid-cycle with IVF? And what if they were planning to travel out of state in April for their retrieval? How should they think about proceeding or  canceling their treatment? 


DR ADELEYE: The US-CDC advises that patients who are pregnant or those (men and women) planning or undergoing fertility treatment should avoid non- essential travel, especially travel to known areas with high rates of infection. Make sure you visit the CDC website to understand those locations considered high risk and speak to your provider regarding your plan of care. Each physician may have specific guidance on cycle management for patients who are in treatment and have their own “clinic action” plan. ASRM presented guidelines to  postpone the initiation of new treatment cycles. This includes IUI, IVF, embryo transfers and non-urgent egg and sperm cryopreservation (freezing). Those who have already initiated treatment cycles should be counseled on ASRM’s recommendation to freeze embryo(s), and defer plans to transfer until further notice. In terms of travel I hope that addresses the question. 


TAMMY: I think a lot of people have an understandable instinct to hurry and maybe freeze their reproductive material— whether it’s sperm, eggs, or embryos— as soon as possible before things potentially get worse. Dr. Akopians, can you talk to some of those folks and tell them how you would maybe advise them on how to think about that, or how to collaborate with their providers on that.


DR AKOPIANS: Given the unknown, regarding what affects the virus will have on eggs as well as sperm, I think it’s best to be very cautious, and to really follow the ASRM guidelines. But as indicated, every clinic is going to have their own “plan of action” and what that would be. So it’s very important to also speak to their own individual physicians to discuss their care.


TAMMY: That makes sense. Dr. Adeleye, do you have any thoughts on that as well? Should people hurry up and  start to freeze their sperm and eggs right now before things start to get worse?


DR ADELEYE: I agree with Dr Akopians, I think it’s wise to be in contact with your clinic in regards to the approach of your treatment. And recognize that it’s likely there will be a significant delay in treatment, whether that’s on the scale of one to several weeks. But I think everyone is very motivated to resume treatment once it’s deemed safe. Right now the focus is really on limiting the spread of the virus. Both to ourselves and to other people in the community.


TAMMY: Dr Adeleye, I know there’s new information coming out all the time, but as far as we know could COVID-19 affect someone’s long term fertility health?


DR ADELEYE: As we’ve been talking about, we are still learning more information about the COVID-19 virus everyday and we are still learning about how this may impact our reproductive health. This is why there are no direct answers at this time if there is any direct long term impact on fertility health.


TAMMY: I’m looking through a list of some questions that have come in, and will bring up the ones that look most common and have come up frequently. Dr. Akopians, you can take this one on— many of us are located in the Bay Area, in northern California, and places like the Bay Area have instituted a shelter-in-place rule or lockdown orders. How does this impact folks care, and are there any exceptions to healthcare appointments that you can continue to go to?


DR AKOPIANS: There are generally exceptions for scheduled healthcare visits. You can still get your health needs addressed. Contact your health care provider to see if they are providing regular services that they’re still offering. Some services, especially elective procedures, may be postponed or canceled, but I encourage everyone to contact the office as each place will have their own plan of action. In addition, ASRM guidelines yesterday encouraged practices to proceed with telehealth communications. So one of the things that could change over the next few weeks will be that in-person consultations can be converted to phone consultations, or a video type conference.


TAMMY: If you’re a Carrot member in this webinar, and you need help calling or communicating with your fertility clinic or provider, the Carrot Care Team is ready to support you. Feel free to use the app to reach out to a member of our Care Team.


Another one that I’m seeing here is related to medications. I think many people who are involved in fertility treatments know that medications are such a big part of that care. I’ll just read out one of those questions here “Given the daily changes to the situation I’m concerned with wasting money on my fertility medications if I need to cancel my cycle mid-cycle. Any advice on how to stay in close communications with my very busy clinic on the changes they are making?” I think this is a great question. Dr Adeleye, do you have any thoughts on this?


DR ADELEYE: Many fertility clinics are preparing internal policies on how to respond to patients and how to maintain communications as more information unfolds. Many practices will provide general updates to their website as well. Make sure you understand what is the best way to communicate with your practice, depending on your specific situation, they may triage inquiries as practices are taking high volume calls at this time.


TAMMY: Yes, on this point I would just like to reiterate that the Carrot Care Team is here to help you communicate with your clinic during this time. We certainly have empathy for clinics as well, I’m sure they’re getting a ton of inquiries and questions from existing, previous, and new patients.

Another question that I’m seeing here is about the work that people do. The question is “I work in a high-risk environment (healthcare worker, emergency response) and am currently mid-cycle with my clinic. Any suggestions on reducing risk?”, Dr Adeleye?


DR ADELEYE: Great question, since I already work at a larger medical center part of the University, I’m certainly experiencing this as well. What I tell you is evolving, as a precautionary measure, some scientific societies advise fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid becoming pregnant at this time. For those patients already having treatment, ASRM recommends considering deferred pregnancy with delaying  embryo transfer given limited data regarding potential risk of COVID-19 on pregnancy, the fetus and child well-being. All patients should be instructed to stay home if they are experiencing symptoms of COVID-19 —that can include a cough, fever, shortness of breath— or have come in direct contact with someone diagnosed with COVID-19, or have travelled to an area with a high volume of COVID-19 cases. Patients should contact their personal physician for medical advice and intervention. Then notify their fertility doctor for further instructions that follow their internal policies. 


TAMMY: Got it. And what about partners? Partners who work in high exposure and risk fields like in a hospital or as an emergency worker? Could having a partner who works in these fields impact the current cycle as well, and is there anything to be done on that front? Separately, I’m also seeing, maybe Dr. Akopians who can then take this, the question is “What if I, or someone I know, gets diagnosed? How does that impact my cycle?”


DR AKOPIANS: So I think if you have someone who you are in intimate contact with that works in a high exposure and risk field, or someone you know is positive with COVID-19, you should follow the CDC guidelines in practicing social distancing from that individual. CUrrently there are no guidelines to test these individuals for positivity, but I would follow the current recommendations from the CDC for social distancing, and taking all the precautions that we’ve discussed so far in order to keep yourself safe. 


TAMMY: I have a question here about the impact of all of the news and how it affects mental and emotional health. The question is “All of the news is taking a toll on my mental health. I am currently in a critical point in my treatment, the 2 week wait, do you have any tips on how to focus on my mental well being during this time.” Dr Akopians?


DR AKOPIANS: We recognize the amount of stress that surrounds the uncertainty of how this may impact your cycle. Most clinics are being proactive to stay in contact with their patients about any changes that may occur with their treatment. Some practices may have specific referrals to mental health specialists to help support you during this time. So I would encourage contacting your specific clinic and see what they have in place in order to help you get through this difficult time. 


TAMMY: And Carrot  has a number of emotional well being experts, family therapists, etc. Dr Akopians, do fertility clinics sometimes refer out to therapists and specialists who have an expertise in fertility treatments?


DR AKOPIANS: Yes, absolutely. 

TAMMY: Dr Adeleye, I know we may not know much, but what sort of research is currently being done to know whether or not COVID-19 can pass through and infect the baby? Is there anything you can share in regards to what research is being done or currently exists?


DR ADELEYE: We have not seen any sufficient evidence that the virus can be transmitted to the baby in utero. We are starting to see information coming out of studies from China that tested amniotic fluid, cord blood and the infants, and what they are seeing is, at this time, little evidence that there is any vertical transmission. If I recall there was one case, where a mother was diagnosed with COVID-19 neonates, so the baby that was born was also diagnosed. But it was unclear if that was vertical transmission or possibly from contact with various hospital staff or other community members. But because there is insufficient evidence and we are in the initial stages of getting more information we should continue taking cautionary measures. 


TAMMY: I know we sort of chatted about this already, but an additional question is coming in so I just want to make sure they get an answer. Obviously we’re not giving anyone full medical advice, we want folks to talk to their doctors. But just to confirm— if you’re about to start a full round of IVF and stimulation, is it wise to cancel? This person says they are 39 years old, Dr. Adeleye?


DR ADELEYE: So the current guidelines would say not to start treatment. So the current concerns are not that you may not be healthy, but if any member of the community- either the nurses, doctors, or other medical assistants- gets sick, or another patient at the facility gets sick and you’re in treatment, that clinic may have to shut down. And you don’t want to start stimulation and be unable to finish it because your clinic wasn’t able to treat you. In addition, as we previously discussed, the guidelines also recommend against starting cycles right now if you have the intent of getting pregnant because we don’t dknow fully the impacts of COVID-19 on preganancy and offspring.


TAMMY: There is a question here that asks “Are you aware if storage fees for sperm and eggs are being waived at this time?” I’ll just jump in here for a quick moment to mention that storage fees are covered by your Carrot benefit. You can apply any employer sponsored dollars you have towards paying any storage fees, but for both the doctors on the phone who have storage facilities in their practices, should they call the clinic to find out? Is there anything more that you know?


DR AKOPIANS: I think this is a decision that will be made by the individua clinics, so the best answer would be to contact your clinic directly to see what their policy on that would be. 


TAMMY: Dr. Akopians, there’s a question here where a person is contemplating moving their embryos from a  clinic in Seattle to a clinic in Minnesota for GC services, given COVID-19 as that’s where their GC is located. They’re nervous about issues with travel, do we have any suggestions?


DR AKOPIANS: Though not currently prohibited to move embryos from location to another, this may be subject to change as the COVID-19 situation continues to evolve. Given the trend on guidelines, travel restrictions, and treatments being postponed, this should likely be postponed.


TAMMY: We have one last question here, I know we have less than a minute to wrap up, so I can answer it. The question is “We don’t yet have information about the long term effects of COVID-19 on fertility or their outcomes, but getting long term evidence seems like it could take many years. Are there pieces of evidence that we can expect in the next few weeks, or months, that can inform our decisions about IUI and IVF?”

I think in general, Dr Akopians and Dr. Adeleye feel free to jump in, people are just hungry for information as it comes out. There are a lot of questions here, that are similarly, where people are looking for the latest facts, research, and news. We will do our very best to post them on our COVID-19 resource fertility center at carrotfertility.com, and then any questions we were not able to answer today we will try to batch together and post an answer on our website. In closing, I just really want to thank everyone for participating here today. Thank you for joining us, feel free to visit our website to see more information and reporting from this webinar. We will post it later today, and will continue hosting webinars as we learn more about COVID-19 and its impact on fertility for members in the US, EMEA, APAC, LATAM, and around the world.

I want to give a special thank you to Dr. Akopians and Dr Adeleye for joining us here today, and for sharing with us your precious time to help support our members with the latest information.