The COVID-19 pandemic has brought an unprecedented challenge to healthcare across the globe, and access to fertility services is not exempt. In fact, perhaps because fertility care is often deemed non-essential, the impact of the pandemic has been felt by patients undergoing IVF or other fertility treatment in nearly all affected regions.
In order to address these problems, the International Federation of Fertility Societies (IFFS) and World Health Organisation (WHO) held a jointly hosted webinar, 'COVID-19 Impact on Access to Fertility Services', on 27 July.
The webinar, moderated by Dr Marcos Horton (President of the Scientific Committee of the Sociedad Argentina de Medicina Reproductiva) and Dr Rishma Pai (Mumbai Obstetrics and Gynaecological Society, India), took a broad viewpoint on the many fertility healthcare concerns that have arisen as a result of the pandemic. The online event included informative presentations from healthcare and fertility experts across the globe and discussed challenges from both an international and country-specific perspective. Importantly, the final session discussed how patients themselves have been impacted by changes to their care.
Dr James N Kiarie, head of the WHO Contraceptive and Fertility Care (CFC) Unit, was the first speaker. This part of the talk focused on work done by WHO to provide reliable information for healthcare providers during the COVID-19 pandemic. His talk primarily referenced a guide published by WHO, 'Maintaining essential health services: operational guidance for the COVID-19 context', which has been written to advise the global medical community on how to provide ongoing care both during and in the aftermath of the pandemic. In particular, the second version of this document, published in June, includes guidelines on which aspects of fertility care should be prioritised during this time.
On a positive note, these indicate that those with limited ovarian reserve should be prioritised for care, and that cryopreservation of embryos and eggs should be considered for longer-term storage where treatment must be paused. These two suggestions were reiterated throughout the webinar, and I felt that all speakers wanted to reinforce the point that those with the most urgent fertility concerns should not feel that their needs are being forgotten. This part of the seminar was both informative and clearly presented. Although I see WHO updates in the media, as a non-medical and non-industry research scientist, this was the first time I saw the type of resources that they make available to the global healthcare community.
The second part of the seminar was given by Dr Steven Ory, Professor of Obstetrics and Gynaecology at Florida International Hospital. A moratorium on infertility services was declared early on during the pandemic. As a result, the IFFS launched an Interim Surveillance Survey, which aimed to gauge how different countries were being impacted by this at different times. Dr Ory presented this data to provide an overview of the fluctuating status of fertility care as a result of COVID-19. Perhaps unsurprisingly, 82.5 percent of the countries surveyed reported closed or limited access to all fertility treatments. Where clinic closures had occurred, one third were the result of government mandates, closely followed by voluntary closure or on the recommendation of professional societies. However, in line with what had previously been outlined with regards to prioritising urgent treatment, two-thirds of the clinics surveyed had made provisions for patients with specific high-priority treatments. A follow-up survey is expected soon.
This section of the seminar was followed by updates from fertility experts in three different countries: Zi-Jiang Chen (Professor of Obstetrics and Gynaecology, Shandong University, China), Dr KK Iswaran (Malaysia) and Dr Oladapo Ashiru (President of the Africa Fertility Society, Nigeria), although owing to technical difficulties, Dr Ashiru's talk had to be moved to the end.
From the previous presentation, it was clear that fertility treatment had been impacted in the vast majority of surveyed countries. Therefore, I felt it would have been more helpful to have each country-specific update address the same questions, instead of talking in different contexts. Nonetheless, Dr Iswaran touched briefly on the potential risk of vertical transmission from mother to unborn child and the outcome of mothers diagnosed with COVID-19 close to birth, and I thought this was a very relevant talking point. Further, all three updates emphasised the importance of safety measures such as physical distancing and wearing masks for patients and healthcare staff as clinics begin to open again.
The final section of the webinar was provided by Dr Jacky Boivin, Professor of Psychology at the University of Cardiff. The psychological impacts of any fertility treatment can be far-reaching, and the additional stress of a pandemic and a pause to treatment is likely to exacerbate any existing fears or concerns. In this talk, Dr Boivin presented the results of a survey into the psychological implications of COVID-19 on fertility patients. Unsurprisingly, of the 450 (mostly UK-based) participants, 82 percent of those surveyed had had treatments or tests postponed, eliciting a largely negative response and with some perception that clinic closures were unfair or discriminatory.
It was important to note that Dr Boivin's talk was not wholly negative. Although there is a degree of uncertainty around fertility treatment at the moment, she did highlight how some patients aimed to use this time to try and improve their health through diet and/or exercise, and emphasised that there were support options that patients should always be made aware of.
Despite not being involved in the fertility treatment community, I thought this webinar was an informative and useful session. It is perhaps inevitable that fertility treatment, amongst other non-essential healthcare, would be affected by the pandemic. However, it was clear from this webinar that clinicians want treatment to resume when it is safe and appropriate to do so, and that both IFFS and WHO are working to ensure that the most patients in most urgent need are prioritised. Lastly, as emphasised in the final talk, the psychological impact of the pandemic on fertility patients has not been forgotten by healthcare providers.
Although these are uncertain times, this webinar highlighted that WHO works across the spectrum of medical disciplines to provide guidance and resources to healthcare providers.