The European Society of Human Reproduction and Embryology (ESHRE) working group on COVID-19 (ESHRE COVID 19 WG) was constituted in early March as a group of assisted reproductive technology (ART) experts (clinicians and embryologists) working to investigate and offer updates on the possible consequences of the SARS-CoV-2 pandemic upon human reproduction and fertility in general. The main goals of the working group are to keep track of emerging data and to make recommendations and guidance documents mainly for professionals but also for patients. The President of Fertility Europe, the European patients' association and a long-term partner of ESHRE, was invited to participate in order to guarantee that the voice of the patients is taken into account.
Two different guidance documents have been produced and updated by the WG, corresponding to the different phases of the SARS-CoV-2 pandemic. The first document, released in early March and in its final version on 1 April, was prepared as a cautionary measure during the continuously increasing prevalence of SARS-CoV-2 infection in Europe. This 'Guidance document in Fertility Services during the pandemic' was based on the limited information existing on COVID-19 and pregnancy, most of it coming from third trimester pregnancies with no data on early pregnancy. The group recommended at that time a precautionary approach to assisted reproduction, advising that ART treatments should not be started, consistent with the position of other scientific societies in reproductive medicine and subjected to local and national governmental advice. The main arguments were to avoid possible complications in pregnancies arising in SARS-CoV-2 positive women, to avoid the potential risk of vertical transmission of the virus to the fetus and new-born and to protect the limited healthcare resources, under a very high level of pressure, especially in more severely affected countries.
The second document, 'Guidance for recommencing ART treatments' (23 April), was written when a return to non-urgent medical activities commenced in most European countries. Safety and risk minimisation for both patients and professionals were the main objectives. Triage and testing strategies were detailed together with adaptation of ART services including sanitation, staff and patient education and measured access to the centre. Specific guidance was given with respect to ovarian stimulation monitoring, oocyte retrieval, the IVF and cryopreservation laboratories and embryo transfer procedures. A Code of Conduct was suggested to avoid unnecessary exposure both in a work environment and at home.
In order to measure the ART activity in centres across Europe, the ESHRE COVID-19 WG contacted the members of the Committee of National Representatives in each European country with a focused questionnaire. The replies and the constant contact with the representatives allowed the creation of multiple timed EU ART activity maps, at present spanning six weeks.
As mentioned before, most of the information about COVID 19 and pregnancy has been reported in third-trimester pregnancies and at delivery. There is an urgent need to assess the impact and possible consequences of SARS-CoV-2 infection at the time of implantation and in early pregnancy. For this reason, the WG has also initiated a live, detailed survey to collect such information in COVID-19 positive pregnant women who became pregnant through ART.
As new data are being reported through peer-reviewed and also non-peer reviewed articles, the group are constantly monitoring and updating the scientific literature relevant to reproductive medicine. Information regarding the presence or absence of SARS CoV-2 in reproductive tissues and gametes is essential in understanding the potential for infectivity and such data are still scarce. It is of utmost importance to promote research in COVID-19 and human reproduction. Scientific societies should encourage professionals to pursue such research and lobby for funding.
Finally, the ESHRE COVID-19 website page has a dedicated area for Frequently Asked Questions both from professionals (ESHRE members) and patients, providing a platform for quick and accurate response to emerging questions.
As the pandemic is constantly evolving, periodic updates of the guidance documents, ART activity reports and literature are conducted.
ESHRE COVID-19 working Group members: Baris Ata (TR), Luca Gianaroli (IT), Kersti Lundin (SE), Edgar Mocanu (IRL), Satu Rautakallio-Hokkanen (FI, Fertility Europe), Juha Tapanainen (FI), Anna Veiga (ES) supported by Nathalie Vermeulen (ESHRE Senior Research Specialist).