Fertility specialist practice in the Philippines during the COVID- 19 pandemic

@#<p style="text-align: justify;"><strong>Objective:</strong> To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.</p><p style="text-align: justify;"><strong>Methods:</strong> A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.</p><p style="text-align: justify;"><strong>Results:</strong> There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).</p><p style="text-align: justify;"><strong>Conclusion:</strong> There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.</p>

Age-specific serum anti-Mullerian hormone reference values for infertile Filipino women in a tertiary in vitro fertilization center in the Philippines / Philippine Journal of Obstetrics and Gynecology

Background@#Anti-Mullerian hormone (AMH) levels have been used as an invaluable tool in reproductive medicine for over a decade, especially in predicting ovarian reserve and follicular response during in vitro fertilization (IVF) cycles. Age-specific reference values of AMH levels have been derived from mostly Western and few Asian population groups but none from the Philippines. In this study, we attempted to determine the first age-specific AMH reference values from infertile Filipino women to be able to provide local infertility centers a guide in treating Filipinos and those with similar racial and lifestyle characteristics. @*Materials and Methods@#This was a retrospective cross-sectional study that was conducted at the Center for Advanced Reproductive Medicine and Infertility at St. Luke's Medical Center Global City. Age, serum AMH levels, body mass index (BMI), and cause of infertility of Filipino women who underwent IVF from August 2015 to March 2020 were taken. AMH was assayed using the automated Access AMH Immunoassay (Beckman Coulter). @*Results@#A total of 1463 women who underwent IVF and with valid AMH results were initially found but only 1233 were included in the study. Mean age was 36.67 + 4.35 years and mean BMI was 24.43 + 4.14 kg/m2. There was minimal effect of BMI on AMH levels and increasing age (R2 = 0.0068), but there were significant differences of mean AMH levels among the general causes of infertility. The mean and median AMH values decreased with advancing age (R2 = 0.1391) although the mean values were consistently higher than the median values. The mean level of the AMH was 2.32 ± 1.90 ng/mL with a 0.16 ng/ml (confidence interval: 0.14–0.19 ng/ml) level decrease per year of increase in age. By age category, the following were the derived AMH values (ng/ml) at the 25th to 75th percentiles: 25–29 = 1.52–4.92; 30–34 = 1.60–4.10; 35–39 = 0.95–3.13; 40–44 = 0.44–1.99; 45 = 0.47–1.08. The mean AMH in this study appears to be similar to several but lower than most other reported AMH nomograms from other population groups. @*Conclusion@#The first age-specific AMH reference values for infertile Filipino women are presented and may serve as a useful diagnostic marker in local infertility centers, especially those treating Filipino patients or others with similar characteristics.

The impact of the COVID-19 pandemic on fertility centers in the Philippines

Objective@#The aim of the study was to determine the impact of the COVID – 19 pandemic on fertility centers in the Philippines as reflected in the change in caseload for the different types of fertility procedures and modifications in the physical set up of laboratories, staff and patient screening.@*Methods@#A descriptive cross-sectional study using a questionnaire was administered to all Philippine Society for Reproductive Medicine (PSRM) accredited fertility centers on November 2020. The study underwent ethics and technical review approval. The medical director or manager of the centers was requested to answer the questionnaire. All data were collated, summarized and analyzed.@*Results@#All seven PSRM accredited fertility centers participated in the study. There was an overall decrease in fertility procedures performed in all the centers with most of the centers reporting a less than 50% decrease in oocyte pick up, less than 75% decrease in frozen embryo transfer and around 50 – 75% decrease in intrauterine insemination cases. All fertility centers implemented social distancing, triaging of patients by symptoms, use of personal protective equipment for doctors and staff, placing alcohol dispensers at the reception area and limiting the number of people allowed inside the center. Clinical visits were now scheduled and revisions in informed consent were done. @*Conclusion@#The majority of local fertility centers experienced a significant decline in fertility procedures. Modifications to the conduct of their clinic for safety of their staff and patients were compliant with local and international guidelines.

Uterine Isthmic Atresia: Hope for a rare mullerian anomaly

@#The true incidence and prevalence of congenital Mullerian duct anomalies are difficult to determine. Some patients may present as adolescents with apparent primary amenorrhea, cyclical abdominal pain and sexual difficulties. It is important to ascertain a correct diagnosis for timely and appropriate interventions necessary to prevent sequelae that often affect the future fertility of these patients. This is a case of a fifteen year old with severe cyclical pelvic pain and hematuria with amenorrhea. Work up included a transrectal ultrasound and a magnetic resonance imaging of the pelvis revealing presence of a uterine corpus and cervix but absence of uterine isthmus. A conservative surgical approach was planned. The patient underwent end-to-end anastomosis of the cervix and uterine corpus. At present, the patient is regularly menstruating with no pelvic pain.