Follow these guidelines by Dr. Mohit Saraogi, a renowned specialist from the IVF Centre in Mumbai, to ensure the safety of you and your future baby’s infertility treatment during this pandemic.
The COVID-19 pandemic has brought about a new normal that the world had neither anticipated nor prepared for. With a distinct boundary of what is essential and what isn’t, it is only natural for people to be uncertain about their present and future. Couples who aspire to become parents through assisted reproductive techniques face a similar predicament with the burgeoning cases in the country that have led to lockdowns in many parts.
If you and your partner are looking to start fertility treatment or are in the middle of one, these guidelines are what you need to know to ensure your and your future baby’s safety.
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Can patients with comorbidities such as diabetes, hypertension, etc., seek treatment during the pandemic?
It has been found that the severity of COVID-19 is a reflection of the comorbidities a person has. Anyone with diabetes, hypertension or other high-risk conditions such as chronic pulmonary-renal/hepatic diseases or persons taking immunosuppressants related to organ transplants or receiving multiple medical therapies must consult their specialists. This is not limited to treatment during the pandemic and under normal circumstances as they may pose challenges. Only after getting a go-ahead from their doctors should patients make an informed decision; consent for the same will be documented and will be provided, proper counsel.
Do I have to take the RT-PCR test before every visit to the clinic?
Patients and their partners are strongly advised to get a negative RT-PCR test report before commencing treatment. This must be repeated before any assisted reproductive technology (ART) procedure is considered invasive and requires regional or general anesthesia such as egg retrieval, hCG trigger, or embryo transfer. It is advised that the test is done less than three days before the procedure. To avoid getting infected, we strongly recommend that patients, partners, and potential donors (where applicable) self-isolate from the beginning of ovarian stimulation until the procedure is finished.
Is a negative RT-PCR enough to begin treatment?
Additional steps have been taken to ensure patient safety as mandated by the ICMR’s guidelines for commencing ART services during the pandemic. Two weeks before starting treatment, patients are required to fill an ART risk assessment triage questionnaire; the same must be filled before every OPD clinic visit and before starting ovarian stimulation medication.
What if a patient tests positive in the middle of treatment?
In case patients undergoing ART procedure test positive mid-treatment, they are advised to wait until they have recovered and cannot spread the infection to others, says the finest IVF doctor from Mumbai.
National and State guidelines regarding a negative test must be adhered to before resuming treatment. The same is also applicable to donors.
If a patient or her partner is symptomatic or tests positive after egg retrieval, it is advisable to postpone the embryo transfer. In such a scenario, eggs, sperms, or embryos must be frozen, as the case may be, for future use.
Tested negative – what should a patient do?
In cases of asymptomatic or symptomatic cases treated at home, recovered patients should provide a medical certificate to begin treatment. In severe instances where the patient required respiratory support, they must give a clearance report from the treating physician or local Registered Medical officer (RMO).
Will there be a mandatory appointment system in place?
Taking an appointment before visiting a clinic is appreciated and also mandatory in some instances. Social distancing is paramount at patient reception, arrival and check-in process, consultation, ultrasonography, counseling, sample collection, and other communal areas. Thermal screening is imperative before entering a clinic, and physical barriers between staff and patients, including the appropriate use of PPE, are required inside the clinic.
Several ART clinics may also provide teleconsultation and semen consultation services to minimize the number of trips taken to the clinic, depending on the patient profile.
When should a patient cryopreserve their gametes or embryos?
In the COVID-19 context, the doctor from the IVF Centre in Mumbai says that cryopreservation of gametes and embryos is required if either or both partners test positive for the infection. There can be two broad scenarios: (a) If the male partner tests positive after egg retrieval, the eggs are frozen. (b) If either the male or female partner or both test positive after retrieving eggs and sperm, the resultant embryo is frozen until they get a medical clearance.
As a precautionary measure for known COVID-19 positive patients, cryopreservation practices similar to those observed in infectious diseases such as HIV are implemented for their safety. This includes high-security straws or vials, vapor phase or separate liquid phase storage, separate cryo-containers, and closed system vitrification process.
What about donors?
For donors, a triage questionnaire to check for high-risk individuals is filled; if the donor has a positive RT-PCR result for COVID-19 during the cycle, a cancellation may be considered. Since specific research has found the novel coronavirus in semen, albeit non-conclusively, all anonymous samples are mandated by the FDA to be quarantined for six months. Similar quarantine may be performed with a known donor’s specimen, depending on the will of the patient and physician.