Resuming Assisted Reproduction Services during COVID-19 Pandemic: An Initial Indian Experience

Abstract

Background: The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered. Aim: The study was conducted to assess the preparedness of ART clinics and staff to resume services; patients' reasons to initiate treatment; and key performance indicators (KPIs) of ART laboratories during the pandemic. Setting and Design: This was a semidescriptive, prospective study in two private in vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Materials and Methods: Time required for replenishing consumables and clinic preparedness to function under “new norms” of pandemic was documented. Infection mitigation measures and triaging strategy were evaluated. KPIs following resumption were analyzed. The Student's t -test was performed for comparing parameters. Results: Thirty percent of the patients consulted through telemedicine accepted or were eligible to initiate treatment on clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands was achieved within a week, but procuring consumables and injections was time-consuming. Fifty-two cycles of IVF were performed including fresh and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval were associated with reduced procedure time and no intervention for airway maintenance compared to general anesthesia. Self-reported pain scores by patients ranged from nil to mild on a graphic rating scale. Conclusions: This study provides practical insight for the resumption of IVF services during the COVID-19 pandemic.

Assisted reproductive technology in Japan: A summary report for 2020 by the ethics Committee of the Japan Society of obstetrics and gynecology

“…The COVID‐19 pandemic affected ART treatment cycles worldwide by causing the cessation of new treatments, delays and postponements of treatment, and changes or interruptions of the stimulation protocols for couples undergoing ART. 22 , 23 , 24 , 25 , 26 , 27 In Japan, literature on the effects of the COVID‐19 pandemic on ART facilities, services, outcomes, and patients is limited and detailed analyses have yet to be conducted. However, the COVID‐19 pandemic was considered to have little effect on decreasing the total number of ART cycles implemented during 2020 compared with other European countries.…”

“…28 Similar concerns and desires were voiced by patients in other countries who also experienced cancellations or delays in ART cycles. 25 , 26 After the first statement issued by the JSRM to patients, a web questionnaire survey conducted in August 2020 by a non‐profit organization in support of patients with infertility issues revealed that many patients were concerned about COVID‐19. Many wanted to continue ART treatments, especially those aged >40 years, and a large number of patients asserted that infertility treatments are not “non‐essential and non‐urgent” matters, which posed an important ethical dilemma at the time.…”

Impact of COVID-19 pandemic on clinical and embryological outcomes of assisted reproductive techniques

“…An Indian study by Jirge et al provides practical insights for the resumption of ART services in India and found satisfactory Key Performance Indicators (KPIs) for cycles conducted in the COVID era; however, clinical indicators were not compared. [ 24 ]…”

Obstetric challenges during COVID-19 pandemic: A narrative review

“…The COVID-19 pandemic also negatively influenced IVF and ART. A study showed that 62% of women undergoing infertility treatment deferred their procedures due to lack of safe transportation, 20% of cases delayed treatment due to financial reasons, and 9% of couples declined due to fear of the pandemic [ 9 ].…”