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COVID-19 – Exciting Announcement – Your Fertility Journey Can Continue – Advice for Patients
Today (April 21), the Prime Minister, Scott Morrison, confirmed that the suspension on elective surgery and importantly, IVF will be removed following the ANZAC Day weekend. This has come about as a result of the low incidence of COVID-19 in Australia and the lower than expected demand on our hospitals.
We are delighted by this news and thrilled that our patients can now resume, or commence their fertility journey.
The Reproductive Medicine team are ready and waiting to help you move forward. If you want to start treatment and have not yet seen a fertility specialist, call 1800 628 533 to make a telehealth appointment.
If you are continuing treatment, call your fertility nurse on 02 6041 2677 or email on info@reproductivemedicine.com.au to determine what this means for you.
Please be assured that a range of additional initiatives have been implemented to minimise the risk of transmitting COVID-19 between our patients, our team and the broader community.
We know it has been an incredibly upsetting and anxious time for many of you. We want to thank all of our patients for your ongoing understanding and patience during the last few weeks. We so look forward to seeing you all again!
The request from Prime Minister Scott Morrison remains the same, that all elective surgeries, other than category 1 and urgent category 2 cases must remain suspended until the COVID-19 pandemic has passed.
This affects Reproductive Medicine’s (part of the Monash IVF Group) ability to perform egg collection (OPU) procedures.
Reproductive Medicine Albury understands that these measures are important to ensure the health and wellbeing of patients and healthcare workers, as well as ensuring that Australia’s healthcare system is best placed to fight the COVID-19 pandemic.
We recognise that this is an extremely challenging time for people who require fertility treatment. We will continue to do everything we can to provide you with advice, support and treatment, where we are able to do so safely.
Reproductive Medicine Albury has completed all treatment for existing patients in cycle.
Until the state wide ban is lifted, we are unable to begin new fertility treatment for patients.
This is following government and industry body advice regarding postponing elective surgery and enforcing Social Distancing and “Stay at Home” recommendations to assist those healthcare practitioners at the frontline. For these reasons RMA recommends that you postpone your treatment.
You can read the Fertility Society Statement on fertility treatment during COVID-19 here.
We understand this is a difficult time and strongly encourage you to speak to your Fertility Specialist who will consider your medical circumstances and advise you of your best option under these difficult circumstances.
We are very keen to resume all suspended services as soon as possible and we will continue to monitor Government policy and advise patients as soon as there are any further changes.
Absolutely, we are still here for you and available for all enquiries, questions and consultations please call us on 02 6041 2677.
Yes, all of our doctors are offering remote consultations and face-to-face consultations when required.
Yes, we are available, all of our doctors are offering remote consultations and face-to-face consultations when required, please call us on 02 6041 2677.
We would like to reassure all patients who have eggs, sperm or embryos in storage with RMA that we will continue to provide the greatest care in monitoring these until our fertility services are allowed to resume. Please know that our scientists and laboratory staff are still on site.
RMA has also introduced the following initiatives to support patients or people considering fertility treatment during this time:
Please know that we will be here to help you re-start your fertility journey as soon as we are able. The team at RMA are incredibly passionate about what we do and we are looking forward to helping you in the future as soon as it is safe for us to do so.
We recommend that you visit the RMA website and follow us on social media to obtain the most up to date information.
Thank you for your understanding during this difficult time.
COVID-19 was declared a pandemic on 11 March 2020 by the WHO.
Background
COVID-19 is a respiratory illness caused by a novel strain of coronavirus, the Severe Acute Respiratory Syndrome (SARS)-CoV-2. This virus is considered to be genetically related to the virus that caused the 2003 SARS outbreak and the first cases of COVID-19 were reported in December 2019 in the city of Wuhan, Hubei Province, China. Common signs of COVID-19 include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. Primary transmission is believed to occur through respiratory droplets from coughing and sneezing and contagion requires close proximity (less than 6 feet distance) between individuals[1]. The role of asymptomatic or pre-symptomatic viral shedding in transmission is not fully understood[2,3]. The incubation period for COVID-19 is 3 to 7 days but can be as long as 2 weeks from infection to symptoms[4].
The SARS-CoV-2 virus has spread rapidly across the globe and on 18th of March 2020, the World Health Organization reported 191,127 cases and 7807 deaths from COVID-19, worldwide[5]. The Department of Health of the Australian Government reported 454 confirmed COVID-19 cases and 5 deaths as a result of the disease until the 18th of March 2020.
For up to date information on the status of COVID-19 in Australia please refer to the Federal Health website: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert#current-status.
For up to date information on the status of COVID-19 in New Zealand please refer to the following website: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus.
More information about the virus, its transmission and epidemiology, as well as the pathophysiology and clinical management of COVID-19 can be found at the following links:
Australia and New Zealand, like so many other countries, is currently facing an epidemic of unprecedented scale which poses significant challenges on the health sector, including the provision of care to individuals who are trying to conceive or preserve their fertility. The Fertility Society of Australia (FSA), recognising the importance of providing its members and the public with appropriate and timely guidance on best practices in reproductive care, has established the COVID-19 FSA Response Committee. This Committee is comprised of experts in the field who have been tasked to regularly review the available literature and make evidence-based recommendations. Given the rapidly evolving knowledge in the field and in line with national response to the COVID-19 crisis, these recommendations will be revised as necessary.
With these recommendations, the FSA aims to provide its members (which include clinicians, scientists, nurses and counsellors) and the public evidence-based guidance that prioritises the needs and safety of patients and all staff involved in the provision of fertility care and is in line with the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19). This plan calls for a proportionate response on the basis of the ethical framework agreed by the Australian Health Protection Principal Committee (AHPPC). This framework outlines the values that need to be taken into account during such a response, such as equity (providing care in an equitable manner), individual liberty, privacy and confidentiality, proportionality, protection of the public, provision of care, reciprocity, stewardship and trust.
Any recommendations made have also taken into account the statement by the AHPPC on COVID-19 on the 17th of March, 2020 which states that “the health sector must continue to undertake its core functions..” and that “interventions may need to continue for more than 6 months, and must be feasible and sustainable”[6].
Effects on the mother
Due to the recency of the outbreak, there is little information on the impact of COVID-19 on pregnancy. Pregnant women do not appear to be at an increased risk of complications following infection with SARS-CoV-2 compared to the general population and it is expected that the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms[7-13]. This is in contrast to the SARS-CoV and Middle Eastern Respiratory Syndrome (MERS-CoV) viral infections which have been shown to be associated with severe complications during pregnancy (including miscarriage, intrauterine growth restriction and preterm birth) in also low number of cases[14-18]. There are case reports of preterm birth in women with COVID-19, but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous. Iatrogenic delivery was predominantly for maternal indications related to the viral infection, although there was evidence of fetal compromise and prelabour premature rupture of membrane, in at least one report[19]. As evidence accumulates, this knowledge might need to be updated and caution is warranted.
Mother-to-baby transmission and effects on the baby
Confirmed mother-to-baby transmission during pregnancy has not yet been reported. Two cases of possible mother-to-baby transmission (transmission from mother to baby antenatally via the placenta or intrapartum) have been reported (one of which in the media but not yet in a peer reviewed journal)[19, 20] but it remains unclear whether transmission was prior to or soon after birth. Expert opinion is that the fetus is unlikely to be exposed during pregnancy[21]. A case series published by Chen et al tested amniotic fluid, cord blood, neonatal throat swabs and breastmilk samples from COVID-19 infected mothers and all samples tested negative for the virus[7]. In a different study, three placentas of infected mothers were swabbed and tested negative for the virus[8]; and in another case series by the same team, of three infants born to symptomatic mothers tested for the coronavirus, none had positive tests[22]. As there is no evidence of intrauterine fetal infection with COVID-19 it is therefore currently considered unlikely that there will be congenital effects of the virus on fetal development[21].
So far, there is no clinical evidence to link infection with COVID-19 with compromised fertility in men or women. One research team from Huazhong University of Science and Technology in China recently suggested that men with COVID-19 should be evaluated for any adverse effects on their fertility after their recovery[23]. This suggestion is based on the theoretical knowledge that the SARS-CoV-2 virus uses specific receptors to invade the cell which are also present in the testes. It needs to be emphasized that no cases of male infertility following an infection with COVID-19 have been reported to date, although this could change in the future.
The Fertility Society of Australia recommends that:
For individuals attempting to conceive or preserve their fertility
For healthcare providers and staff of fertility clinics
Fertility clinics need to formulate clear strategies to mitigate the risk of COVID-19 such as:
Links:
https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov
https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus
https://www.who.int/health-topics/coronavirus
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/
COVID-19 FSA Response Committee
Dr Chris Copeland
Dr Lyndon Hale
Prof Roger Hart
Dr Richard Henshaw
Dr David Molloy
Prof Luk Rombauts
Prof Christos Venetis
At Reproductive Medicine, our primary concern is, and always will be the health and safety of our patients and our team. In light of recent news on COVID-19 (Coronavirus), we are writing to update you with the specific actions we are taking to ensure your health and safety. To minimise the chance of you and our team being infected by Coronavirus we are asking for your assistance by following the instructions below:
1. Firstly, if you have an appointment or meeting scheduled at the clinic and you have any respiratory or viral symptoms we ask that you please contact your clinic by phone and do not present at your clinic for that appointment. Appointments and meetings include a specialist consultation, nurse interview, counsellor appointment, finance appointment or any other meeting where you are required to attend the clinic.
Consultations with your fertility specialist or nurse interview session may be able to be converted to a phone consultation on the day of your booked appointment, although this will depend on the nature of the consultation.
2. We ask that if you have travelled overseas to any country, or had close contact with someone who has positively tested for Coronavirus, that you do not book a treatment until you have been in self quarantine for 14 days after contact, or after returning from travel.
Reproductive Medicine will not allow patients to book in for a stimulated IVF cycle until this 14-day period has elapsed.
3. If you are booking in for an IVF cycle and have any respiratory symptoms and /or a fever (temperature 37.4 degrees C or higher) please let the clinic know and we will plan to delay your IVF treatment by one month. While we understand this delay may cause stress to many patients, it is an unavoidable restriction necessary to minimise the chance of other patients and employees from contracting Coronavirus. Cancelling early in the cycle is better than having to cancel your cycle later after starting medications.
4. If your cycle needs to be delayed as a result of Coronavirus, you will not be charged any out of pocket fees for this cancelled cycle. If you have started your cycle but are unable to proceed to egg pickup, you will not incur any out of pocket fees for your cancelled treatment.
5. If you have already commenced your stimulated IVF cycle and become unwell we ask that you take your temperature, self-isolate at home and contact your clinic. If these symptoms are only mild “cold” like symptoms (runny nose and sore throat) and you have no fever (temperature 37.4 degrees C or higher) we may still proceed with treatment. However, this decision will be made on a case by case basis and we ask that you do not attend your clinic before discussing your symptoms with our team.
If you are invited to continue treatment you will be asked to perform hand-hygiene on arrival at Reproductive Medicine. Please note that medications such as Panadol and other anti-inflammatories (Nurofen etc.) may hide a temperature for 4 hours. As such, we ask that you take your temperature at least 4 hours after taking these types of medications.
6. If you are booking in for a frozen embryo transfer (FET), intrauterine insemination (IUI) or ovulation induction (OI) cycle and have any respiratory or viral symptoms please notify the clinic. If these symptoms are mild and you have no fever we suggest that you self-isolate at home for 48 hours and we will then contact you to reassess your condition. If the symptoms remain, or you have developed a fever, we will cancel the cycle and delay treatment by a month. If your symptoms have resolved we can still proceed with treatment.
7. Coronavirus typically presents with a fever, shortness of breath, dry cough and muscle aches and pains – symptoms more similar to the flu than a common cold. If you have any of these symptoms, especially if you have had contact with another person with known Coronavirus or have been overseas, we would ask that you not attend Reproductive Medicine and instead present to a Coronavirus clinic, “respiratory clinic”, “fever clinic” or hospital for assessment. Reproductive Medicine is not equipped to test patients for Coronavirus and will not be performing Coronavirus swab testing under any circumstances.
Upon presentation for all appointments at Reproductive Medicine, you will notice a series of initiatives that we have commenced to reduce the risk of spreading the Coronavirus to you and others. This includes increased frequency of cleaning of all high risk surfaces such as handrails, door handles and EFTPOS machines.
In addition, we are installing additional hand-sanitiser stations at key entry points, and we respectfully request that you use these upon arrival. For examinations in an enclosed space such as ultrasound scans, procedures and blood tests, we may routinely take your temperature beforehand. We understand that many of our patients may find this intrusive, but we ask for your patience as Reproductive Medicine takes its duty of care to our patients and staff very seriously.
Finally, we wish to reassure all of our patients that the team at Reproductive Medicine are continuing to monitor developments in an effort to minimise impacts on our day to day business operations.
Thank you in advance for assisting the Reproductive Medicine team during this time.
Kind regards,
Michael Knaap
Chief Executive Officer
References