COVID-19 Update: April 23, 2020
Canadian Infertility Awareness Week – April 19-25, 2020
This week is Canadian Infertility Awareness Week. Now more than ever, we want to ensure the voices of our patients – and all those trying to conceive – are heard, especially as many wait in limbo to start fertility treatments, held captive by COVID-19. We are encouraging our patients to reach out and seek support as they cope with a range of emotions: fear, stress, anger, sadness, worry.
Here are some of your options:
MSF Virtual Support Group: Our Social Worker, Jodi Goldstein, is setting up a virtual support group for Mount Sinai Fertility patients. The group aims to reduce isolation, increase support, and provide a forum to vent, share, and strategize. The group is a way of linking people together during a time that can feel very lonely. Sessions will occur by Zoom (video conference) every Thursday from 12pm-1pm. To join this group, e-mail Jodi at [email protected].
Private Counselling: Jodi Goldstein is also available for private sessions. As a way of helping our patients, MSF is offering the first session for free.
Fertility Matters Canada: This non-profit organization provides on-line resources and webinars. We encourage you to visit their web site at www.fertilitymatters.ca and see what they have to offer. They often host on-line events and sessions through their Facebook page.
Other On-line Resources
A number of mindfulness apps are available through Google Play and Apple that focus on sleep and meditation. Here are a few suggestions:
• Headspace www.headspace.com
• Calm www.calm.com
• Aura: www.aurahealth.io
Please note, mention of these apps does not mean an endorsement.
COVID-19 and Fertility Services in Ontario
COVID-19 came on swiftly causing immense disruption to our society. Fertility clinics and their patients have not been spared from this disruption. Many have asked why fertility treatments have fallen victim to the pandemic and further question why fertility has not been considered an essential service. These are valid questions. Like other Fertility clinics across North America, our decision to pause fertility treatments was made with a number of considerations in mind.
By March 17th, both the American and Canadian Fertility Societies had published guidance documents for fertility clinics in response to the pandemic. In Canada, the Canadian Fertility and Andrology Society (CFAS) is the main professional body for fertility through which those practicing in the field of fertility voluntarily contribute to and recognize national guidelines. In the guidance document published by the CFAS, the Society recommended that fertility clinics take decisive action to reduce transmission of COVID-19. These recommendations stipulated that clinics:
- Complete all IVF cycles currently in progress
- Cancel embryo transfers and inseminations
- Postpone new fertility treatment cycles including IUI, IVF, FET, aside from urgent sperm and egg cryopreservation for cancer patients
- Perform consultations by telemedicine or phone to minimize in-person interactions
- Suspend all diagnostic and elective procedures and surgeries
As of March 18th, MSF complied with all of these recommendations and, to the best of our knowledge, every fertility clinic in Canada has also followed these guidelines, which still remain in place today.
We are still here for our patients…
Despite the current pause on fertility treatments, MSF staff are still hard at work at the clinic preparing for a resumption of fertility services. Our staff are available by phone to answer questions and support patients as they plan for when we resume treatments. We are also continuing to support our patients by offering the following:
- Fertility consultations & follow-up appointments through phone and video conference
- Early obstetric care (ultrasound, obstetrician referral)
- Urgent fertility preservation of sperm and eggs for oncology patients across Ontario
- Quality measures to ensure the safety of all frozen eggs, sperm and embryos
- Genetic consultation & Social Work counselling by phone/video
- Virtual patient support group and private counselling sessions
- Shipments of sperm and eggs
Getting Back to Business
For the foreseeable future, all fertility clinics in Canada will have to change how they function in order to minimize COVID-19 risks to their patients and staff. MSF is leading the way when it comes to preparations. With in-house expertise in Women and Infant Health, Infectious Disease, and Occupational Health and Safety, we are confident that will be able to establish a safe environment when services resume. MSF is also very engaged and in constant communication with the Canadian Fertility and Andrology Society. Currently, we are actively working on national guidelines to support safe resumption of fertility treatments. We all want to get back to serving our patients; we will do so in a way that is safe and responsible.
When will fertility Services Resume?
On April 14, the province of Ontario extended the State of Emergency for an additional month. Under these circumstances, it is difficult for us to anticipate a restart date. However, as we see some easing in the rates of COVID-19 transmission in Ontario, we are more hopeful for a return to services soon; perhaps as early as end of May. Patients can take some comfort in knowing that short delays of one to three months are not likely to affect pregnancy outcomes. However, we also recognize that time becomes a more a significant factor the longer treatments are postponed. At MSF, we will be watching for the following cues to resume fertility treatments:
- Guidance from the Canadian Fertility and Anthology Society
- An end to the State of Emergency in Ontario
- Adequate availability of personal protective equipment (PPE)
- A Healthcare system that is no longer under stress
Resumption of more elective medical procedures in Ontario as supported by the Ontario Medical Association and Minister of Health in Ontario.
How will MSF manage a return to service?
Mount Sinai Fertility will be ready!. Maintaining patient and staff safety will be of primary importance. While we cannot eliminate risk, we are working with experts in infectious disease, occupational health, and our clinical teams to re-design our work environment and use of space to minimize risk. Initially , we expect to start slow, allowing for the earliest possible resumption of care. Many have asked how we will prioritize patients once restrictions are lifted. First and foremost, we want to manage expectations. We anticipate that the demand will exceed our capacity and for this reason patients should expect that they may not be able to start treatment in the first month that they call with their Day 1. Initially, we will contact those patients who had started a treatment cycle, but whose treatments were canceled in March due to COVID-19. We will also contact those patients who were booked to start a funded IVF cycle in April. We are currently working on a fair and equitable approach to accommodate patients and will communicate this process once it is available. In the meantime, patients who are interested in starting a treatment cycle can contact their fertility specialist for a follow-up appointment by videoconference to identify any outstanding tests or investigations that need to be completed prior to the start of a treatment cycle.
How will we inform patients that service is resuming?
Weekly updates will be published on our web site in the News & Updates section. We will also notify active patients via e-mail.
What protective measures will the clinic put in place when operations resume?
Many patients may be nervous about attending appointments. This is understandable as you want to remain healthy while you are trying to conceive. Guided by infection control specialists at Sinai, we will operate with your safety at the forefront of our priorities. Some of the steps we will take include:
- Enhanced cleaning and disinfection of spaces, such as waiting rooms
- Increased use of personal protective equipment for both patients and staff
- Spacing of appointments so as to minimize the number of patients on site
- Active screening of all patients and staff prior to entering the clinic
- Restricting access for visitors, partners, and family members
- Continued use of videoconference appointments so as to minimize travel and visits
- Adherence to other COVID-19 related guidelines established by Sinai Health
Patients can expect the experience to feel quite different than what they are used to. However, we expect changes will enhance the overall experience. We care about safety, but are also focused on ensuring you have a positive experience. We are here for you and with you.
What will happen if there is another State of Emergency declared after re-opening?
MSF will follow all guidelines set by Public Health, Sinai Health and the CFAS. This means that if there is another state of emergency declared in the future and fertility services are not deemed essential, we will need to pause services at that time.
Frequently Asked Questions:
We have received hundreds of questions from our patients wondering how their fertility and their attempts to conceive will be impacted by COVID-19. In this next section, we provide answers to some commonly asked questions.
What can I do while I wait for fertility treatments to resume?
Waiting is hard. However there are some things you can do in the meantime.
- Stay healthy – MSF has published a video on pre-conception health, which is available on our web site.
- Take care of mental and emotional needs – Join our support group and/or reach out for a counselling session with our social worker, Jodi Goldstein.
Book an appointment with your physician – If you have questions about the next steps in your care or upcoming treatment cycles, reach out to your fertility specialist to book an appointment. The appointment will be conducted through phone or video conference.
Reach Out to Us – We continue to have staff on site who are able to answer questions and concerns through phone, voicemail and e-mail.
Advocate – Conceivable Dreams is the leading non-profit organization in Ontario that advocates for patients and funding. If you want to protect the Ontario Fertility Program, please visit www.conceivabledreams.org to learn more. You can also reach out to your MPP and local Councilor to advocate for continued funding for the Ontario Fertility Program.
Should I keep trying to get pregnant naturally?
When deciding if you should keep trying to conceive naturally, it is important to be aware that the risks associated with acquiring the coronavirus in the first trimester are still unknown. However, any severe illness during pregnancy can lead to pregnancy complications. Another consideration would be that access to medical diagnostic and treatment options may be limited at this time. There have been some pregnancy complications reported in women who are COVID-19 positive at delivery, including preterm delivery and low birth weight, although in general, they are not common. The long terms risks to the fetus are unknown at this time.
Will MSF prescribe medications to assist in conceiving?
Unfortunately, at this time the physicians at MSF will not be prescribing medications to assist patients in conceiving.
What if I am already pregnant?
If you are already pregnancy, it is important to take all precautions possible to reduce your risk of exposure to the coronavirus and follow Public Health recommendations:
- Wash your hands with soap frequently
- Avoid touching your face
- Practice social (physical) distancing
- More information is available on the Women and Infants section of Mount Sinai’s web site at www.sinaihealth.ca/covid-19-and-pregnancy
What if I do conceive naturally?
If you do conceive naturally during this time, we would like to you to contact our clinic for early obstetrical care and for referral to an obstetrician. Alternatively, if you prefer, you can follow up with your family physician.
What is MSF doing to ensure fertility medications and other medications prescribed by my MD are available?
We have spoken with our medication suppliers and they have reported that there has been no disruption nor do they anticipate any disruption to the delivery of fertility medications and supplies.
I wanted to take advantage of the multi-cycle program, how does this closure impact this program?
We will review this on a case by case basis. The multi-cycle PGT program is offered in partnership with our genetics reference lab and they have agreed to extend the timeframe by 3 months. If the closure extends longer than that, we will revisit this matter with them.
I wasn’t anticipating the financial implications of COVID-19 and its impact on my fertility treatments. What are my options for financing my treatment and medications?
The ability for patients to cover the costs of treatment may have been severely compromised by COVID-19. We refer our patients to iFinance Medicard Patient Financing, www.medicard.com, which has been of help to some of our patients.
Ontario Fertility Program (OFP)
To date, the Ministry of Health and Long Term Care of Ontario has not communicated any changes to the program. It is possible that OFP funded clinics will not be able to use all of their IVF funding by the end of the current budget year, which ends March 31, 2021. The Ministry is aware of this and is assessing the impact of COVID-19 on the Ontario Fertility Program. MSF, along with other fertility clinics in Ontario, will have started at least 2 months behind schedule on its funded IVF patients for the new budgetary year that began April 1, 2020. In a typical year we would be able to catch up after a 2 month closure. While MSF will do its best to accommodate patients in the current budget year, we must prioritize quality and safety.
How will the IVF waitlist be managed now that there is a pause in treatment?
The patients who are on the Funded IVF waitlist will maintain their original position on the waitlist. When services resume, we will schedule a fixed number of cycles each month, depending on capacity and safety. We will advise patients of their approximate wait time once the capacity is known.
Patients who are approaching the age of 43 may be at risk of losing their funding as a result of COVID-19. MSF will identify these patients and will contact them directly in the coming weeks.
What will happen if I defer my spot on the waitlist?
With so many patients on our wait list, we are unable to accommodate a deferral in the date allocated to you. However, you will have several months’ notice in order to plan your cycle.