How to provide fertility treatment during COVID-19 pandemic.

PURPOSE OF REVIEW: The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. The objective of this review is to summarize how this pandemic has affected the activity of a Reproductive Medicine Center, which established a series of measures in parallel with governments decisions and scientific societies. RECENT FINDINGS: The control measures adopted for restarting the healthcare activity should be equitable and inclusive. Moreover, this pandemic has implied changes in treatments and strategies to be alert regarding the daily changing information. Finally, for ensuring a safe practice both for patients and staff, it is important to detect asymptomatic patients, so Reproductive Medicine centers must take special care with screening and testing procedures. SUMMARY: The pandemic has pushed up toward a new reality in terms of Assisted Reproductive treatments, where social distance and responsibility are protagonists. We face a new challenge of balancing between responding to the committed efforts of infertile couples to achieve pregnancy and safeguarding the health of the future parents and their children during this time of pandemic.

State of assisted reproduction technology in the coronavirus disease 2019 era and consequences on human reproductive system.

The outbreak of the coronavirus disease 2019 (COVID-19) has created havoc on the socio-economic aspect of the world. With billions of lives being affected by this wrecking pandemic, global fertility services were also not left untouched by its impact. The possibility of sexual transmission of SARS-CoV-2 virus, its impact on male and female fertility, pregnancy, its potential teratogenic effect, and handling of gametes in the clinical laboratories were major concerns among reproductive medicine specialists, which led down all the reproductive health services, including IUI, IVF/ICSI in most of the countries. Even the people did not intend to conceive during the pandemic crisis and were hesitant to avail such services. Discrete evidence regarding the pathophysiology of COVID-19 infection and its impact on the human reproductive system is not very clear. In this review article, we intend to incorporate all the evidence related to the COVID-19 infection and its impact on human reproduction available to date. It is our responsibility to provide rightful information and to keep our patients familiar with the existing lack of clear evidence. In this COVID-19 era, it is important that the fertility management be prioritized in sub-fertile couples with diminished fertility reserve and high-risk conditions, like malignancies, that may affect their long-term fertility prospects.

Fertility care amidst the COVID19 pandemic: the American experience.

The COVID-19 pandemic has claimed the lives of over one million people worldwide, and has affected all aspects of healthcare worldwide, including the delivery of care to patients with fertility-related diagnoses. In the United States, the response of US fertility clinics to the COVID-19 pandemic was coordinated by the American Society for Reproductive Medicine (ASRM). ASRM acted quickly to develop guidelines for limiting fertility treatment and clinic consultations during the early days of the pandemic, and then safely restarting fertility treatment. A survey of patients with fertility-related diagnoses who presented for care during the first months of the pandemic revealed that a majority of patients who presented for care during the early months of the pandemic experienced delayed or cancelled treatment cycles. Patients with infertility subsequently reported a desire to resume fertility care, but emphasized the importance of their clinic having policies and procedures in place to limit the risk of infection.

SARS-CoV-2 and the reproductive system: assessment of risk and recommendations for infection control in reproductive departments.

The World Health Organization has declared the outbreak of the coronavirus disease COVID-19, caused by SARS-CoV-2, a pandemic. This novel infectious disease has rapidly become a global health threat. Currently, there are limited data on the extent of reproductive system damage caused by COVID-19. We reviewed the potential risks for complications in the reproductive system caused by COVID-19 infection. In addition, based on the latest American Society for Reproductive Medicine (ASRM), and European Society of Human Reproduction and Embryology (ESHRE), recommendations regarding clinical and patient management, we provide a series of suggestions for infection control measures in reproductive medicine departments. With the gradual restoration of reproductive care services, reproductive departments in epidemic areas should actively seek to minimize COVID-19 infection of both healthcare workers and patients.

The effects of COVID-19 on pregnancy and implications for reproductive medicine.

COVID-19 was officially declared a pandemic in March 2020. Since then, our understanding of its effects on pregnancy have evolved rapidly. Emerging surveillance data and large cohort studies suggest that pregnancy is associated with an increased risk of intensive care unit hospitalization, invasive ventilation, and death. Pregnancies complicated by SARS-CoV-2 infection are associated with increased likelihood of cesarean delivery and preterm birth. Intrauterine transmission occurs, but seems to be rare. Critical gaps remain, and rigorous high-quality data are needed to better ascertain pregnancy risks and to inform antenatal and obstetrical management.

Where will telemedicine go from here?

The COVID-19 pandemic accelerated the adoption of telemedicine internationally. The reproductive clinics that thrived in this tumultuous time had access to fully electronic medical records with user-friendly telehealth platforms and remote support staff for physicians. However, complete transition from in-person visits to telehealth uncovered many opportunities for innovation. At-home semen testing is not yet widely recognized, and patients still require an in-person visit for ultrasounds, procedures, and physical examinations. Although emergency policies and waivers have made it easier for providers to legally practice across state borders and receive payments from insurance companies, they vary from state to state and have not been cemented into law. Finally, clinical training for medical students, residents, and fellows has been affected by decreased clinical and surgical volume. However, trainees have also proven to be the most adaptable, quickly shifting to remote learning practices through social media, online surgical atlases, and wide distribution of "virtual visiting professor" lectures. As countries have eased physical distancing guidelines, patients ultimately benefit from having the option of a telehealth appointment. Although there is still much work to be done to improve telehealth, the COVID-19 pandemic has at least proven that it is a safe method of patient care and teaching.

Telemedicine technology and implications for reproductive office operations.

Telemedicine had been very slowly making inroads into standard clinical practice. The onset of the COVID-19 pandemic resulted in the rapid implementation of telemedicine across most practices. The efficiency and permanence of telemedicine services depends on a multitude of factors including technologic choices, governmental and insurance regulations, reimbursement policies, and staff and patient education and acceptance. Although challenges remain and the extent of implementation is still evolving, it is clear that telemedicine is here to stay and that all those involved in health care need to be familiar with its opportunities and challenges.

Telemedicine in reproductive medicine-implications for technology and clinical practice.

The COVID-19 pandemic has caused the rapid adoption of telemedicine in most medical practices. This series of articles address issues that are often not well considered, such as the types of technological platforms available, the effects of telemedicine on staffing, space requirements, and the financial impact of remote visits. In addition, the limits of telemedicine compared to in-office visits are discussed, as well as the effects on trainees and possibilities for the future.