Fertility societies and organizations recommend suspending new fertility treatments during the COVID-19 pandemic to avoid complications, mitigate risks, and support reallocation of healthcare resources, but continuing fertility preservation for cancer patients if no symptoms present. Guidelines advise "freeze-all" approaches for current patients and maintaining support for patients while protecting staff safety through telemedicine, social distancing, and strict sanitization protocols in IVF laboratories. The uncertainties of the pandemic are causing patient anxiety, so clinics aim to communicate regularly and prioritize care once restrictions lift.

1. COVID-19 & INFERTILITY
Dr. Jyoti Malik
Director- JJ Institute of Medical Sciences
Bahadurgarh, Haryana

2. No known difference between the clinical
manifestations of COVID-19 in pregnant and non-
pregnant women of reproductive age.
All 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”. March 19: Coronavirus Covid-19:
ESHRE statement on pregnancy and conception

3. Q: We are ready to start fertility treatments.
Is it okay to continue during the pandemic?

4. ESHRE News and Statements
2 April 2020
Assisted reproduction and COVID-19
An updated statement from ESHRE
ESHRE advises that assisted reproduction treatments should not
be started at present for the following reasons:
• To avoid complications from assisted reproduction treatment and
pregnancy
• To avoid potential SARS-CoV-2 related complications during
pregnancy
• To mitigate the unknown risk of vertical transmission in SARS-
CoV-2 positive patients
• To support the necessary reallocation of healthcare resources
• To observe the current recommendations of social distancing.
In cases of urgent fertility preservation in oncology patients, the
cryopreservation of gametes, embryos or tissue should still be
considered.
European Society of Human Reproduction and Embryology

5. AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
(ASRM) PATIENT MANAGEMENT AND CLINICAL
RECOMMENDATIONS DURING THE CORONAVIRUS
(COVID-19) PANDEMIC
Update #2 (April 13, 2020 through April 27, 2020)
When making recommendations for re-initiation of care, the Task Force
will consider:
• Prioritizing the health and safety of the patients, physicians, and staff.
• The progression of the pandemic in different areas of the country.
• The availability of testing to determine infection and immune status.
• The time-sensitivity of patient diagnoses.
• The utilization of resources that may be critically needed by local health
systems and hospitals on the frontlines of caring for COVID-19 patients.
• Federal, state, and local government regulations that may impact the
ability of returning to practice.

6. For those patients having started assisted reproduction treatment at the present
time, elective oocyte or embryo freezing for later embryo transfer (freeze-all) is
recommended.
Any risk of viral contamination to gametes and embryos in the IVF laboratory,
either from infected patients or professionals, is likely to be minimal (if at all)
because the repeated washing steps required for the culture and freezing
protocols will result in a high dilution of any possible contaminants. Even with
no specific d
it is assumed that sperm, oocytes and embryos do not have receptors for SARS-
CoV-2 and are unlikely to be infected. Furthermore, the zona pellucida
represents a high level of protection for oocytes and embryos.

7. Heathcare professionals and clinics should remain available to provide
supportive care, psychological support and clinical advice to their
patients, preferably via online consultation.
Good clinical and laboratory practice is strongly recommended by
ESHRE to guarantee safety for processed tissues and cells,
professionals and patients.
ESHRE Guideline Group on Good Practice in IVF Labs, De los Santos
MJ, Apter S, et al., Revised guidelines for good practice in IVF
laboratories (2015)†. Hum Reprod, 2016.

8. Mar 18 2020 BRITISH FERTILITY SOCIETY
Guidance for the care of fertility patients during the
Coronavirus COVID-19 Pandemic
• Patients who are in the stimulation phase of their treatment, but have not
yet received the trigger, should be advised treatment cancellation. In such
a situation, stopping FSH while continuing with GnRH antagonist (or
agonist as the case may be) is likely to protect against OHSS. Patients
should be counselled against unprotected intercourse to avoid the risk of
multiple pregnancy.
• Patients who have received HCG or GnRH agonist trigger may proceed to
egg collection and freeze-all, if appropriate facilities are available and
after a multi-disciplinary assessment of risk.
• Patients who develop symptoms after oocyte collection should not have
an embryo transfer.
• Embryo transfer, or Intra-uterine insemination should not be carried out in
women with suspected or diagnosed COVID-19.

9. STOPPING TREATMENT PROGRAMME
• All centres will stop initiating new fertility
treatments, including In-Vitro Fertilization, frozen
embryo transfer, surgical sperm retrieval,
insemination and ovulation induction.

10. FERTILITY PRESERVATION
• It is appropriate to continue non-elective fertility
preservation, for example sperm and oocyte or
embryo storage for cancer patients, provided they
show no symptoms of infection. It should be borne
in mind that these patients may be
immunocompromised, and shared decision-making
involving the patient, oncologist and fertility
specialist is key.

11. OPD & DIAGNOSTICS
• Clinics should facilitate telephone or video consultations. If
patients are attending for face-to-face encounters, care
should be taken to stagger appointment times to prevent
large groups of people congregating in waiting areas. Group
sessions and support group meetings should not go ahead
while social distancing is in place. Staff who can work from
home should be facilitated to do so where appropriate, by
provision of remote access to electronic case records as
confidentiality restrictions allow.
• Semen analysis should be suspended as it requires to come
to the clinic.

12. Q: How can I get through this? Not knowing when this will
end is making my anxiety so much worse.

13. PATIENT SUPPORT
• Patients are likely to have concerns about the effect of delay on their
chances of success
• The ongoing uncertainty about the length of delay will compound these
worries.
• Trained counsellors are needed to allay anxiety
• It is recommended that usual facilities for answering phone call queries be
enhanced.
• Clinic websites and apps have a role in keeping patients informed and
allaying anxieties in a difficult time.
• Maintaining contact with patients whose treatment has been disrupted or
deferred is important, and consideration should be given to prioritisation
when services are able to recommence

14. COVID-19: the perspective of Italian embryologists managing the IVF laboratory in
pandemic emergency
Lucia De Santis, Attilio Anastasi, Danilo Cimadomo, Francesca Gioia Klinger, Emanuele Licata, Valerio Pisaturo, Laura Sosa
Fernandez, Catello Scarica
Human Reproduction, deaa074, https://doi.org/10.1093/humrep/deaa074
Published: 08 April 2020
• Use proper personal protective equipment (eye protectors, face masks, gloves, shoe covers
and disposable laboratory coats).
• Form two teams consisting of Gynec, embryologist, anaesthetist, nurse and a witness. If team
A member comes in contact with a covid positive patient, the team can go for quarantine and
the other team B can take over.
• Identify external equally skilled embryologists to replace the internal staff, in case all staff are
quarantined.
• Keep 1-m distance and use a proper face mask.
• Train the internal personnel (clinicians, nurses, etc.) how to refill the cryo-banks in order to
safeguard the cryopreserved material in case of the lab staff being quarantined.
• Minimize the need for physical witnessing (e.g. do telematic witnessing).
• Sanitize the environment, equipment and devices with appropriate detergents (solutions of
quaternary ammonium) at the end of each procedure or after each access to the workplace.
• Clean incubators including sterile water, 70% alcohol, hydrogen peroxide, 0.26% peracetic
acid, 1% 7x, Barricidal, and Roccal.
• For wall cleaning alcohol, 7X, chlorhexidine gluconate, bleach and hydrogen peroxide

15. • Minimum staff necessary to maintain urgent services such as fertility
preservation for oncology patients , for gamete and embryo storage
banks should be kept.
• In circumstances of scientific staff becoming ill and forced to self-isolate,
centres should ensure availability of staff who are cross-trained .