THE EFFECT OF TELEMEDICINE DURING THE COVID-19 PANDEMIC ON IVF TREATMENT

ABSTRACT

OBJECTIVE: To assess the effect of telemedicine during the COVID-19 pandemic year on the treatment decision of new patient for IVF (in-vitro fertilization) protocols, medication doses and clinical outcomes compared to new patients seen in-person during the previous year, in an academic fertility practice. MATERIALS AND METHODS: This is a retrospective cohort study, in a university-based fertility clinic. All new patients seen via telemedicine between March 11, 2020, and March 10, 2021, were compared with all new patients seen in person between March 11, 2019, and March 10, 2020. Statistical analysis included t-test, Fisher exact test and Pearson chi square. The primary outcome was clinical pregnancy rate. Secondary outcomes included protocol type, dosage of Gonadotropins, duration of stimulation, type of trigger medication (HCG vs. GnRH- agonist), number of oocytes retrieved, fresh embryo transfer rate, “freeze all” rate due to OHSS reduction and implantation rate. RESULTS: The study included 715 new patient in the fertility clinic;365 patients seen in person (March 11, 2019 - March 10, 2020), and 350 patients seen via telemedicine (March 11, 2020 - March 10, 2021). The following were similar between the Covid year and the previous year Female age (35.9±5.06 vs. 36.4±4.9, P=0.21), number of oocytes retrieved at the first IVF cycle (12.8±9.0 vs. 12.77±8.5, P=0.92), and stage of embryo transferred (cleavage stage 66 (41.3%) Vs. 86 (47.3%) and Blastocyts 94 (58.7%) vs. 96 (52.7%) P=0.27). There were more cases of male factor infertility and less cases of unexplained infertility in Covid year compared to the previous year (29% vs. 19%, P=0.001 and 9% vs. 16%, P=0.003 respectively), however, there was no difference in other diagnoses made at new-patient visit. There were no differences between the groups in the following outcomes: type of protocol (P=0.41), FSH dosage (P=0.25), number of days of stimulation (P=0.10), maximal estradiol value (P=0.97) type of trigger medication (Hcg 227 (72.8%) vs. 266 (74.9%), P=0.38 Agonist 86 (27.2%) vs. 89 (25.1%), P=0.3), and fresh embryo transfer rate (47.7% vs. 51.2%, P=0.36). There were less cases of “freeze all” to reduce OHSS risk in the Covid year (3.1% vs. 13.4%, P<0.0001). There was no difference between the groups in the clinical pregnancy rates (35.3% vs. 36.3%, P=0.91) and implantation rates (29.2% vs. 32.7%, P=0.42). CONCLUSIONS: New patients seen in person and those evaluated via telemedicine are likely to receive similar treatment protocols, medication doses and are likely to have similar duration of stimulation. IVF outcomes are not affected by telemedicine consultation, either. IMPACT STATEMENT Telemedicine consultation for new-patient visits is feasible in an academic fertility practice for IVF treatment and may be particularly useful during the pandemic.