ABSTRACT
Objective: On March 17th, ASRM published guidance for REI clinics regarding infertility treatment during the COVID-19 pandemic. The recommendations advised against initiation of new fertility treatment cycles outside of emergent fertility preservation. Our objective was to evaluate what SART-member fertility clinics communicated to the public and their patients via clinic websites during this time period. Design: Cross-sectional study. Materials and Methods: Between 4/20/20 and 4/24/20, SART-member fertility clinic websites were reviewed for REI-specific COVID-19 messages (REI-CM). The REI-CM was evaluated for: type of treatment offered, and to whom;adherence to updated ASRM guidance;and citation of ASRM (or other) guidance. Each website was evaluated by two reviewers and arbitrated by a third in the case of discrepancies. Practice size, type, and location were abstracted from SART. Clinics were classified by whether they were under a shelter in place (SIP) order and the duration of that order. Chi squared analyses were performed to determine associations between clinic demographics and patterns in messaging. Results: 381 SART-member clinics maintained active websites. Of those, 249 (65.3%) had REI-CM. The presence of REI-CM was more common in private than academic practices (73% vs 38%, p<0.001) and with increasing practice volume: 38% of clinics with <200 annual cycles vs 91% of clinics with >1000 cycles (p<0.001). There was a trend toward increased REI-CM use in states with a SIP order for ≥30 days (70% of 212, p=0.064). ASRM guidance was cited in 61% (n=152) of REI-CM;however, only 33% (n=82) outlined treatment practices that reflected ASRM guidance published at the time of the data extraction. Adherence to ASRM guidelines was more common in academic than private practices (54% vs 31%, p=0.02) but was not correlated with size of practice or geographic region. Conversely, 18% (n=44) of practices announced treating patients on a “case-by-case basis” with definitions ranging from specific (“women with AMH <0.7”) to vague (“as determined by our providers alongside our patients”). Additionally, 9% of REI-CM (n=23) announced continued treatment regardless of a patient’s clinical urgency. This messaging was more common in groups doing >1000 cycles a year (18%, p=0.009), with a trend toward practices in the northeast (16%, p=0.113) and in states with SIP orders lasting <30 days (14%, p=0.09). Clinics treating all-comers were less likely to cite ASRM than other clinics (41% vs 62%, p=0.045). However, 75% (n=14) cited COVID-19 guidance from WHO, CDC and state and local governments. Conclusions: While public messaging may not reflect the actual practices of a clinic, this study reveals heterogeneity in how clinics incorporated ASRM recommendations and responded to the early stages of the COVID-19 pandemic. Academic practices were more likely to indicate their adherence to ASRM recommendations. High volume groups were more likely to communicate with their patients about what treatments they offered and to treat patients outside ASRM guidance. Lessons learned may inform optimal response in future waves of COVID-19. References: American Society for Reproductive Medicine. Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic. Available at Accessed on May 26, 2020
ABSTRACT
Objective: On March 17, 2020 ASRM published “Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic” a statement for clinical management of infertility care based on the anticipated burden of COVID-19 at that time. Receptivity of these initial recommendations has varied across the media, patients, and women’s health providers. Our objective is to evaluate the perception of the initial ASRM COVID-19 associated recommendations held by women’s health providers. Design: Cross-sectional study. Materials and Methods: After IRB exemption was obtained, an electronic survey was sent to all women’s health providers, including physicians, mid-level providers and nurses, in all subspecialties of obstetrics and gynecology at a single large academic center. All data is being collected anonymously and stored in a REDCap database. Preliminary analysis was done with REDCap to be followed by further statistical analysis once data collection is complete. RESULTS:Of the 278 eligible providers, the survey response rate is 40% (n=112), representing 8 OB/GYN sub-specialties and all categories of providers. The majority of respondents are female (81%) and ≤40 years of age (67%). Most providers view infertility treatment as elective, specifically defined as not a medical necessity (44%). Of the 29% of providers who reported provision of infertility care, 69% reported practice changes between March 16- 31and another 19% initiated practice changes after March 31st. Six percent of the surveyed providers continued all fertility treatment in the same manner as before the pandemic;15% cancelled all fertility treatment immediately, 33% completed treatment for patients currently in cycle but cancelled new cycle starts and 30% continued some treatment on case-by case basis. Safety concerns for the practice (94%), shared decision making with patients (84%), and ASRM guidance (69%) were amongst the most important factors to impact continuation of fertility treatment. After reviewing a summary of initial ASRM recommendations provided within the survey, 67% of all participants viewed the recommendations as fair, and 71% as reasonable. Most (43%) agreed that ASRM recommendations should be enforced for all patients despite patient opinion. Sixty-six percent agreed that some degree of infertility treatment should be allowed currently, however the least supported treatment type was in vitro fertilization (32%). Regardless of infertility diagnosis, 70% did not feel that women should refrain from planned conception during the pandemic. Conclusions: Considering the immediate and long term impact of the COVID-19 pandemic on fertility care delivery, a better understanding of perceptions regarding infertility management during this time is important. In doing so, we must consider the full spectrum of women’s health providers. Our study shows overall support for the initial ASRM recommendations from women’s health providers within our institution. We intend to use the methods used for this study to conduct a larger assessment of women’s health providers nationwide.