The situation with coronavirus (COVID-19) is rapidly evolving, and it can be overwhelming to try and keep up with the latest news. Please be assured that SIRM® St. Louis is closely monitoring developments and continually looking to experts for guidance, both locally and nationally. Addressing patient concerns in a Q&A format is often easier for readers to absorb. We will continue to modify this list as much as needed.
Guidance and Care (as of March 24, 2020)
Q: How is SIRM® St. Louis responding to the public health emergency of COVID-19?
A: The key elements of the health system response to this challenge include limiting the risk of exposure and maintaining the capacity of the health care system to respond to the needs of those who are sick, from COVID-19 or other ailments. As a freestanding, single specialty treatment center, the resources we utilize to treat our patients do not draw from the same pool as those available to take care of patients suffering from COVID-19 and other serious conditions. This is in contrast to fertility centers based in hospital settings. Therefore, we have and will take the following steps in response:
1. We will continue to screen all patients for exposure and risk factors for COVID-19. Patients who fail the screening WILL NOT be seen in our facilities. If a patient becomes quarantined or sick from COVID-19, their treatment will be cancelled, and we’ll work to quickly reschedule in the future.
2. We continue to ask that children do not accompany you to the clinic, and that partners/family members not come into the office as ONLY the patient scheduled for bloodwork or ultrasound will be permitted in the office.
3. SIRM® St. Louis will continue to follow CDC guidelines for our staff in managing any possible exposure.
4. SIRM® St. Louis will continue to structure monitoring and waiting rooms to provide appropriate physical and time distance according to CDC guidance.
5. Our procedures are performed in dedicated rooms with sterile or disinfected equipment. One case at a time, one room at a time. Procedure and operating rooms are always disinfected between cases.
Q: What guidance does SIRM® St. Louis consider when assessing the level of care it will provide?
A: SIRM® St. Louis continues to diligently review the American Society for Reproductive Medicine (ASRM), ACOG (American College of Obstetrics and Gynecology), CDC and MDHSS (Missouri Health Department)recommendations in response to COVID-19. We examine the implications of all recommendations with a careful focus on our responsibility to our patients and to public health.
Infertility is a disease, and for many couples, it is time sensitive. As we see every day, our patients’ suffering is acute and real. Having children is fundamental to humanity, and we have dedicated our careers to treating the disease of Infertility.
We will continue to monitor the situation closely and change these plans as indicated so that patients can continue their care as safe as possible, as quickly as possible.
Q: What fertility care will SIRM® St. Louis provide during this situation?
A: As you know, the situation is changing daily, and therefore, we will continue our due diligence of prevention and adherence to public health guidelines. All care will be subject to the efforts to avoid community spread as described above. The newest guidelines from ASRM will be available no later than March 30, 2020.
1. All patients who are currently undertaking fresh and frozen IVF cycles in the month of March, can proceed with treatment. All fresh cycles will result in freezing all embryos with plans for deferred transfer. We have already connected with all FET patients to answer any questions regarding proceeding with their transfer.
2. Patients who require urgent stimulation and freezing of eggs/embryos, as in the case of fertility preservation for those diagnosed with cancer, can proceed with treatment at any time.
3. We will temporarily suspend initiation of any new treatment cycles, specifically ovulation induction, intrauterine insemination (IUI) and timed intercourse cycles. We ask that you notify us of the start of your April menstrual cycles in hopes of proceeding with treatment at that time.
4. All elective surgeries (hysteroscopies) and non-urgent diagnostic procedures (hysterosalpingograms (HSGs), saline infusion sonograms (SISs), and antral follicle counts (AFCs)) will be postponed until April 2020.
5. Until April 1, 2020, any scheduled semen analyses will need to be collected at home and then dropped off at the office. We will provide a container for partners to use for this purpose.
6. Obstetrical sonograms will be continued in the office as originally scheduled.
7. ERAs (Endometrial Receptivity Assays) will continue as planned for those already on medications.
Q: What are the symptoms of COVID-19?
A: Common symptoms of COVID-19 infection include fever, respiratory symptoms, cough, and/or shortness of breath. If you have any of these symptoms, please alert your primary care provider and SIRM medical team. Anyone with COVID-19 experiencing symptoms such as difficulty breathing or shortness of breath, persistent pain or pressure in the chest, bluish lips or face or an inability to arouse should seek medical attention immediately.
Q: What should I do if I have symptoms?
A: As fertility specialists, SIRM® St. Louis is not able to order testing for the COVID-19 virus for our patients. This test is both ordered and managed by the patient’s primary care team. At this time, any patient who exhibits flu-like symptoms of fever, cough, runny nose, will be asked by our staff to see their primary care physician. SIRM® St. Louis will require a note from your physician that you are not infected with COVID-19 virus before you can return to our clinic, or continue with treatment. This is for your protection, other patients’ safety and the welfare of our staff.
Q: How does COVID-19 spread?
A: It can be spread person-to-person through respiratory droplets from a cough or sneeze. It can also be spread by touching objects that have been exposed to these droplets. Most people will have a mild infection and will recover fully if the virus was contracted.
Q: Who is considered a more at-risk population?
A: According to the CDC, those at higher risk include older adults and those with serious chronic medical conditions like heart disease, lung disease, and diabetes. Healthy women and men of childbearing age are not as high of a risk however they can still be affected.
Q: What is the best way to prevent COVID-19?
A: The CDC recommends that all people follow basic hygiene guidelines to decrease the potential for viral transmission:
• Washing your hands often with soap and water for at least 20 seconds.
• Between hand washes, use sanitizer regularly, especially after touching doorknobs and keyboards in public places.
• Avoid touching your face (nose, eyes, mouth) with unwashed or unsanitized hands.
• Cover your nose and mouth with a tissue when you cough or sneeze, or cough into your elbow. Throw away any used tissues promptly and wash your hands immediately.
• Practice Social Distancing – when you are out in public, deliberately increase the physician space (minimum of six feet or two arm lengths) between you and others
• If you are sick, please stay home and take care of yourself.
Q: Should I wear a mask?
A: Please be aware that the typical masks we utilize for medical care do not provide protection against the COVID-19 virus. These masks only work to contain your secretions so that you do not infect others. Locally and nationally, supplies have been depleted from many stores and hospitals are beginning to run short on masks for health professionals, so please only wear a mask if you feel you might have the virus.
Q: Do you test for COVID-19 at SIRM® St. Louis?
A: We do not test for COVID-19, all testing must be done at your primary care provider (PCP) office. Any patient that has come in contact with a person known to be diagnosed with the COVID-19 virus or suspects they have been exposed should seek immediate care from their PCP.
Q: What should I do if I am not feeling well?
A: The health of our patients and staff remains our primary concern. We ask that if you are experiencing a cough, fever, runny nose, or shortness of breath, please DO NOT come to our office. This is to protect you, our other patients, and our staff. We recognize that there are many reasons to have a cough, runny nose and fever that are not associated with the COVID-19 virus, but we remain committed to the health of our patients and staff.
Q: What should I do if a family member is diagnosed with COVID-19?
A: If you or a family member is diagnosed with COVID-19 it is recommended to self-quarantine for a minimum 14 Days (potentially longer if illness persists) and during that time you would have to stop fertility treatment. The necessity to minimize exposure to others at a clinic is a significant concern and would limit one’s ability to continue IVF treatment given the monitoring appointments required.
Q: How are you preventing sick patients from coming to your offices?
A: Any patient that has traveled to an at-risk area is not permitted to have an appointment until at least 14 days after their return from the at-risk region. Any patient that has traveled to an at-risk area, and has waited at least 14 days after they have returned from the area, can only have an appointment if they are not experiencing flu-like symptoms.
Q: How are you ensuring the safety of patients in regard to the health of your staff?
A: All SIRM® St. Louis staff are already using universal infection prevention techniques. Due to the seriousness of COVID-19, we has implemented new policies and procedures based on the CDC recommendations to further reduce the risk of virus transmission.
In addition to regular handwashing and cleaning equipment between patients, we are asking employees and patients to minimize physical contact by avoiding handshakes, and celebratory or conciliatory embraces. We have asked employees to not share pens between staff and patients, so we encourage you to bring your own if you need them during your appointment. All patients are being asked to wait in their cars until they are called in for their appointment; our goal is to limit the number of people in the waiting room at any given time.
Q: How are you ensuring the safety of patients by providing a clean environment?
A: For additional protection, SIRM® St. Louis will have hand sanitizers, soap and other transmission reducing aids available for your use at the offices. We suggest you thoroughly wash your hands for 20 seconds upon entering our office, and again as you exit. In addition to these measures, our office will undergo a thorough daily cleaning to disinfect surfaces, doorknobs, and common areas to further reduce the possibility of virus transmission.
Q: What measures are you taking to ensure the risk of transmission is lessened?
A: We are implementing the following new policies to further reduce the risk of transmission to staff and other patients:
• If you are sick, please remain at home and contact your primary care physician if you need medical attention.
• We ask you not to bring anyone with you to your appointments unless they need testing or have to sign consents. No friends, family, children, etc.
• The nursing staff will call you after your daily monitoring instead of meeting with you.
• We are offering phone and Skype consults for return patients, but note that these may not be covered by insurance.
• We are triaging every person before they enter the clinical space.
• All patients are being asked to wait in their cars until they are called in for their appointment; our goal is to limit the number of people in the waiting room at any given time.
Q: Should I cancel my upcoming appointment?
A: There is no need to cancel your appointment unless you have the symptoms of COVID-19 (cough, fever, respiratory issues, or shortness of breath). If you do have these symptoms, please DO NOT come into our office and please contact us by phone to let us know. We are happy to reschedule for you.
Q: Will my appointment be changed or canceled?
A: SIRM® St. Louis remains open and treating patients during this chaotic time. Guidelines around public health and safety continue to evolve but at this time we do not anticipate changing or cancelling patient appointments unless they show signs or have been exposed to COVID-19.
Q: Should I stop fertility treatment if I am diagnosed with COVID-19?
A: If you are undergoing active fertility treatment and diagnosed with COVID-19, the ASRM suggests that you consider freezing eggs and avoiding an embryo transfer until you are disease-free. This may mean converting an IVF cycle to egg retrieval and freezing eggs or embryos. ASRM’s recommendations also state that patients, including prospective egg and sperm donors, as well as gestational carriers, who meet the diagnostic criteria for COVID-19 infection, should avoid becoming pregnant. For patients undergoing active fertility treatments who contract COVID-19, or show signs of active infections, SIRM® St. Louis will cancel their procedure to avoid further transmission of the virus.
Q: Could my treatment be canceled?
A: SIRM® St. Louis remains open and treating patients during this chaotic time. The Surgeon General of the United States recommended a policy to cancel all elective surgeries. Most hospitals in the areas have canceled surgeries and procedures. Because fertility treatments are time-sensitive and success diminishes over time, we feel patients should be allowed to continue to pursue infertility services in the current environment.
Following the Surgeon General’s recommendations after Friday, March 20, 2020, SIRM® St. Louis will no longer be able to perform hysteroscopy at our facility. Please consider that we follow all federal, state, and local guidelines as well as the recommendations of the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) in conjunction with the Center for Disease Control and Prevention (CDC). In these unprecedented circumstances, there is always a chance that new regulation, medical recommendation or development could disrupt treatment. Your care team will advise you regarding changes that may impact your treatment plan. You are also invited to reach out to your care team with any questions or concerns.
Q: Should I avoid becoming pregnant right now?
Yes – ASRM advises that all women undergoing new fertility treatment should not undergo any procedures that could cause pregnancy. This includes intrauterine insemination (IUI), embryo transfer and frozen embryo transfers. This may mean converting an IVF cycle to retrieval and freezing of eggs/embryos. Patients who are currently undertaking frozen embryo transfers (already on medications) are safe to proceed with transfer.
Q: How does COVID-19 affect pregnancy?
A: Very little is known about COVID-19 related to its effect on pregnant women and infants, and there are currently no recommendations specific to pregnant women regarding the testing or management of COVID-19. We do not have information from published scientific reports about the susceptibility of pregnant women to COVID-19.
In general, pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy.
Q: How does COVID-19 impact a baby?
A: According to the CDC, it is unknown at this time how COVID-19 can impact the health of a baby after birth. It is still unknown if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery. In the small number of cases to date, no infants born to mothers with COVID-19 have tested positive for the virus. The COVID-19 virus was also not found in samples of amniotic fluid or breastmilk. This reassuring information shows that there is likely no cause for concern if a pregnant woman is confirmed to have COVID-19.
Q: How does COVID-2019 impact intended parents?
A: Currently, there are no specific guidelines related to intended parents. Based on limited data and studies from previous coronaviruses (SARS-CoV and MERS-CoV) and a small number of COVID-19 cases, intended parents are not at a higher risk of contracting COVID-19. However, based on limited data and studies from previous coronaviruses (SARS-CoV and MERS-CoV) and a small number of COVID-19 cases, pregnant women may be at a higher risk for severe illness compared to the general population. We do not know if COVID-19 can cross the placenta during pregnancy, but there have not been any new cases of newborns screening positive for COVID-19. Please see more information on the CDC’s Pregnancy & Breastfeeding page.
Q: Where should I go for additional information?
A: If you have any additional questions, we encourage you to reach out to us. You can also find more information online at these trusted resources:
1. Missouri Department of Health & Senior Services (MDHSS)
2. Center for Disease Control/Public Health (CDC)
3. Food and Drug Administration (FDA)
4. American Society of Reproductive Medicine (ASRM)/SART
5. American College of Obstetrics and Gynecology (ACOG)