Fertility Treatment in Covid Times: Take Precautions, Do Not Worry
• What are the risk of pregnancy during the COVID Pandemic?
The risk of pregnancy during the Covid pandemic is a slight increase in the incidence of preterm labour. All the studies done so far in pregnant women having COVID have not revealed any increased incidence of any malformation etc., as is common with the ZIKA virus.
• How is COVID affecting fertility treatment?
Fertility treatment has been affected in the COVID pandemic. The couples have been waiting for the pandemic to be over to start there fertility treatment. However, the pandemic has been continuing since November last year. After the lockdown in India in March, 2020 the patients had thought that the things would normalize by May or June, However it is almost August now. Though the cases are reducing but we cannot say that the pandemic is over, so the fertility treatment has been delayed in many couples. However now the couples have kind of accepted this, perhaps the new normal and are slowly coming out for the treatment as no one knows as when we will see the end of this pandemic.
• What do you suggest for young couples trying for pregnancy during pandemic who are unable to access treatment?
Some treatment definitely need advanced fertility treatment like IVF or Laparoscopic surgery, however the pandemic has given the time for couples to be together and also be little more relaxed than what they were earlier because of work from home options. Especially, in metropolitan cities, where the life is very busy and there is long work hours and travel time, couples now who were finding it difficult to conceive because of lack of time or increased tiredness have certainly found that they are able to spend more time together. Therefore, in some cases incidence of pregnancy has increased. In this time we suggest that they should lead a healthy life, eat healthy food, do exercise in the form of Yoga and pranayam, have plenty of water, abstain from smoking and alcohol and have enough sleep time. The fertile period which is the mid cycle of the menstrual period is explain to every couple and asked to have regular intercourse during this time. Some couples who have poor sperm and egg quality have also been put on antioxidants in this time and have been asked to try naturally.
• What are the various fertility treatment options?
Couples who have been trying for more than 1 year need fertility investigations and management, the decision of the treatment modality, the age of the couple and the duration for which they have been trying, older couples need active treatment sooner than younger couple. Fertility treatment can be simple tips like the right timing for intercourse, lifestyle modification, addition of ovulation induction drugs or antioxidants, it could involve laparoscopic surgery for correcting poly-cystic ovaries or endometriosis or treating endometrial polyps and fibroids. It could also advance to Assisted Reproductive techniques like Intra-Uterine Insemination (IUI), In-Vitro Fertilization (IVF), Intra-cytoplasmic sperm injection (ICSI).
What is offered to which patients depends on multitude of factors including age, duration and investigation results.
• What precautions are you taking during the COVID time for your patients?
As healthcare is opening up, our centre is also opened up and we are offering fertility treatment to our patients in full swing. However certain key precautions are being taken and strictly observed.
At the entrance we are taking a full history of exposure, travel, fever and we are checking their temperature. After this they enter the centre and we are ensuring that they are wearing mask covered upto the nose and there are no exit valves on the mask, which are a threat to other patients and healthcare workers. We are ensuring not more than 2-3 couples are at the centre at a particular time, all admin staff are maintaining adequate distance, hand hygiene and facial mask. The same is being observed at the nursing station and doctor consultation room. Once the treatment plan has been made if the patient needs any surgery or IVF, the operation theater is sanitized and we are operating using full PPE kits. We are using regional anesthesia wherever required. Our labs are adequately sanitized and we have special liquid nitrogen container to store the gametes and embryos in this COVID era. Hydrogen-peroxide sanitation is used outside the lab and UV- light and Oosafe sanitization is done in the lab area.
• What treatment options do you offer for IVF failure cases?
Each IVF failure has to be assessed thoroughly right from history examination and investigation to come to the conclusion as to what is beneficial for this couple. Sometime a Laparoscopic and hysteroscopic surgery is required to clip the damaged tubes which keep on excreating toxic fluid back to the uterus ( hydrosalpinges) or we need to remove septum, polyps or fibroids, which have been missed out and not removed earlier. We change the stimulation protocol, we use immune therapy, endometrial scratching, freezing and repeat transfer, blastocyst, dual transfer, Laser Assisted hatching etc, to improve the chances in failed IVF cases. In certain cases third party reproduction in the form of donor egg, donor sperm or surrogacy needs to be offered.
• What do you suggest for the patients who are trying for fertility treatment in COVID era?
We all know that we actually do not know when the pandemic is going to be completely over. Fertility treatment is time sensitive, especially for older women. We therefore cannot hold on for treatment forever, the patients have already realized this and slowly started to come for the treatment. They should know if proper precautions are taken the risk of transmission can be minimized. They themselves should give the proper history of fever travel, not come to the centre if they or anyone in the family have fever. They should wear mask properly, not use exit valves mask, do regular hand hygiene, avoid public places, avoid socializing in this time, if these basic precautions are regularly and thoroughly observed we can drastically minimize the risk of transmission and continue with our fertility treatment.
• What do you foresee in the future?
I feel that the COVID pandemic era will remain in some form or other for a long time. It is really difficult to say whether it will be 6 more months, 1 year, 2year, 5 year or forever. We there for have to accept that a certain kind of new normal has to be accepted. The precautions that I have mentioned in the last paragraph have to followed by everyone strictly.
Yes we do miss our social contact but the COVID pandemic era has also revealed that even sitting in our home we can unleash various aspect of our life, without having to go through the rush of traffic and busyness of life. So I feel we need to accept what we have right now, be careful, be responsible and basically go ahead with life.