“My argument is that it is better to screen more for coronavirus and subsequently relax, than to create the potential for positive cases that will reduce staff availability and patient confidence,” comments Dr Thanos Papathanasiou, Medical Director at Bourn Hall Clinic. IVF treatment requires close interactions with staff and a paper by Dr Papathanasiou has highlighted considerable inconsistencies in the official guidance for testing.
To help professionals working in fertility medicine to balance safety and cost, Dr Papathanasiou has compared in a paper the clinical guidance given by four societies: European Society of Human Reproduction and Embryology (ESHRE); American Society for Reproductive Medicine (ASRM); British Fertility Society (BFS) and Canadian Fertility and Andrology Society (CFAS). The paper has been accepted for publication by the Journal of Assisted Reproduction and Genetics (12 June 2020).
Dr Papathanasiou continues: “Although there is guidance about when to test for COVID-19 it varies between scientific societies. This is because there is no relevant experience or research in the area of reproductive medicine; it is a new disease after all.”
Need to confirm good health
Assessment of risk is complicated, as it is known that some people carry the coronavirus and are infectious without showing any symptoms of the COVID-19 disease. Therefore, making the decision to treat based just on reporting of symptoms may not protect staff or other patients from infection. A test is needed to confirm good health, but not all clinics insist on this.
Dr Papathanasiou comments: “The Human Fertility and Embryology Authority (HFEA), the regulatory body, does not instruct how intensively clinics should screen as its priority is for the clinic to have a plan of action with risk assessments and an audit trail.
“As a result, it falls to individual clinics to decide how exactly they will set up their COVID-19 practices. Consequently, some will have stricter or looser protocols and this is causing confusion for patients.”
IVF treatment requires a number of face-to-face interactions over a period of several weeks so Bourn Hall has introduced a COVID-19 screening process, including self-assessment and health questionnaires and COVID-19 testing for patients and staff, for its clinics in Cambridge, Norwich and Wickford.
New ways of working
Bourn Hall has also introduced new ways of working to reduce footfall in its clinics, enable social distancing where possible and strict use of appropriate personal protective equipment (PPE). A concern for the clinics and patients is that the implementation of these measures will increase the cost of each treatment cycle. At present Bourn Hall is not passing on the increased costs to current patients other than an additional charge of £100 for each COVID-19 test.
Although a staged or ‘triage’ approach based on self-assessment questionnaires and testing was recommend by all the societies, the type of questions and the timing of testing differs. For example, some include occupation as a risk factor and only one asks about local incidence of disease.
“We will be making repeated assessments during treatment to confirm good health,” Dr Papathanasiou continues. “Even if this may mean treatment of an individual is cancelled as a precaution, safety is our priority. The good news is that this region has a relatively low number of incidents and we will be monitoring this closely within our decision-making.”