06 May The reopening of IVF clinics during the Coronavirus pandemic – an interview with Alpesh Doshi from IVF London
Alpesh Doshi is the consultant clinical embryologist at IVF London and has kindly offered to come and speak to us about the realities of-reopening IVF clinics during the ongoing Coronavirus pandemic. This is a transcript of our interview on the 5th May 2020.
Q: Considering treatment was stopped due to safety concerns, is it safe to re-start treatment and get pregnant during this global Covid-19 pandemic?
A: It’s very distressing for patients to have treatment halted and also still not knowing how long this pandemic will last, or how long they will have to wait for treatment. HFEA is the regulator for IVF clinics and they have said that clinics can apply from the 11thMay to start fertility services again.
It is a misconception that clinics are going to be open from 11thMay.
There is a 50-question document for clinics to self-assess their readiness to treat patients during the pandemic. Clinic need to establish it is safe to go through treatment. Clinics have to put so many measures in place to protect staff and patients. We can never eliminate the risk but we can do what we can to minimise the risk. The clinic has to prove to the regulator that they have put measures in place to minimise the risk to patients and staff.
HFEA have said that within 5 working days after submitting an application they will provide a response but the opening of the clinic is dependent on the review of the self assessment questionnaire and that being approved.
Q: Understandably some patients are wanting to start asap, what advice do you have for those couples?
A: It is my duty to let our patients know that they always have an option to defer treatment for those who want to. There is a lot unknown about this virus, yet we are trying to bring safety to this situation. In younger patients (less than 35 with good ovarian reserve) they may prefer to wait. In those with declining ovarian reserve or age is impacting their fertility, they may want to start sooner.
Q: How is the clinic managing things like social distancing and contact between staff, patients etc?
A: To prove to the HFEA that we are safe to resume treatment, we need to prove that our Covid-strategy is maintaining social distancing measures. For example all patients are being booked 30 mins apart, we will be having them wait in their car in the car park until they get a call to say it’s time to head inside. We will never have more than 1 or 2 patients in the clinic at any one time. We also have PPE in place to protect staff and patients. Patients should not be alarmed or insulted by clinical staff wearing masks or visors, this is simply going to have to be the new norm and it is not a reflection on the patients.
Q: I am hearing a lot about PPE being difficult to get hold of even for hospitals and care homes. Do you envisage any issues with this?
A: IVF London already have a lot of PPE stocked in the clinic as well as on order so we don’t envisage a shortage of PPE. The clinic will also be testing patients for Covid-19. This is not a blanket requirement but IVF London will be testing both partners during the stimulation phase. According to ESHRE guidelines – if patient tests positive when tested, their treatment will have to be abandoned. Once tested, the results take 48-72 hours to return. Clinic staff will also have access to testing.
Q: During the two week wait, do you have to self isolate as a vulnerable person?
A: The advice is to have your embryos frozen if possible and freezing them rather than have them transferred back. If there is concern about declining fertility let’s freeze the embryos.
We don’t know a lot about the virus, so far we are reassured that the virus does not seem to be transferred to the foetus but we are waiting for more data. It’s a new virus which has only been around for a few months so we don’t know what the effects are if you get sick during early pregnancy since nobody who has been infected during early pregnancy has yet given birth. We don’t know that there is no risk of miscarriage if you get very sick and get a very high temperature. Contracting the virus may be to the detriment of the pregnancy.
At IVF London a code of conduct will need to be signed by patient and staff. Staff are pledging that they are minimising impact of risk brought to the patient. Staff need to make sure they minimise their external risk of coming into contact with the virus, which puts patient at risk, and we ask the patients to do the same to minimise the risk to us.
Q: Should I be self isolating during the 2 week wait? Will I be classified as a vulnerable person?
A: You will be required to maintain your social distancing and taking precautions during that time. This in practice does mean that yes, you will be asked to isolate at home. This is a conversation that you may need to have with your employer if you are expected to be travelling to your workplace during this time. It would be ideal if you could be ultra cautious during this time.
Q: What about drug availability, is there any suggestion that there may be a shortage of drugs needed due to customs and import issues?
A: There are no known issues, we have contacted our pharmacies and all of them have enough drugs in stock so we are not envisaging any problems with the supply of medicines needed for IVF.
Q: And how about access to ultrasounds?
A: Quite a few clinics are open as they are not under the regulation of the HFEA who told IVF clinics to cease treatment. As a clinic when we open, we would want to facilitate the ultrasounds that are required.
I must stress that this is not going to be your standard IVF cycle. You will have online consultations as much as possible, of course you will be asked to come in for a blood test for example but we will use technology to communicate digitally and minimise the number of visits as much as possible.
Q: How are you prioritising patients and are you taking on new patients?
A: IVF London are a very small clinic and we have enough staff to manage the workload, therefore we do not have a very long waiting list. We intend to get in touch with all our patients and find out when their period dates are, and prioritise in the order of their periods starting. The wait will not be that long; we are looking at one month here or there.
Q: What is your advice for those who are worried about maternity care after a positive pregnancy test? Usually you have NHS treatment and with IVF pregnancy you tend to have more appointments than natural pregnancies.
A: NHS hospitals have redeployed staff to frontline and some pregnancy clients currently are not having the usual 10-week scans for example. We don’t know how long this will last for. Some NHS hospitals are taking a view that this is not an emergency procedure unless there is some emergency such as bleeding, however the normal scans are not seen as ‘urgent’. There are private ultrasound clinics, who do offer options for those patients who feel they need additional reassurance and have to wait for NHS appointments.
Q: What about other related treatments and investigations, for example Endometriosis – when will they become available again?
A: Endometriosis and other investigations are all on hold in NHS but in the private sector there are telemedicine appointments available and some are also assessing women for scans and so on. Quite a few of the consultants are resuming some of their services and starting to see patients.
Q: Are embryos safe in storage if the clinics are closed and staff working from home?
A: I want to reassure patients that if you have embryos in storage please don’t worry as your embryos are safe. Staff are attending clinics to keep liquid nitrogen topped up, as a healthcare provider the clincs are prioritised for liquid nitrogen supplies.
If there is a temperature drop any time there is an alarm that goes out to many clinic staff to make sure embryos are kept safe.
There are a lot of unknowns at the moment but it is so important to keep on top of mental wellbeing. It is hard for us as doctors to not be able to provide the help we know our patients need and want, but right now there is a lot patients can do at home.
Nutrition, of course is really important at this time as you are advising your clients.
Also make sure you are looking after your mental wellbeing. Planning fertility treatment during this time has added stress and anxiety and clinic staff understand this. Try to keep calm, get comfort in knowing you are not in this alone, we are trying to help you with the best possible information that we have. We are all on this journey together and we want to help you in every way we can.
Don’t feel that this is something that within 2 months this will be back to normal. Make a calculated decision based on the knowledge that we may be in this situation in the longer term.
I found this such an informative interview and I hope this has helped you begin to think about how you will navigate these next 6-12 months, and whether you choose to have treatment as soon as possible or wait a while.
If you want some help on your path to parenthood, I am temporarily offering £100 off my online fertility course to support you through this current crisis. The course covers the natural approaches I recommend everyone takes to preparing for a healthy conception and pregnancy – regardless of whether you are planning to conceive naturally or via IVF.
The link to more info is here and the code for £100 off is LOCKDOWN.