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By the time of writing, epidemic in Italy, one of the countries at the epicentre of the European COVID-19 outbreak, has entered phase 2 with high levels of caution. The overall system has been burdened with the paralysis of standard practices dedicated to the delivery of health services. This interruption has included the provision of assisted reproductive treatments to infertile couples, apart from fertility preservation services to oncologic patients. On behalf of a tissue establishment inside a public hospital, we experienced a reduction of 65% of demands for fertility preservation. The unexpected and unavoidable shifts of health networks required to overcome the COVID-19 pandemic have indirectly created a new barrier obstructing the access to fertility preservation services. It is known that gaps in the organization of oncofertility cares and the lack of patients' awareness regarding fertility preservation strategies are the most common barriers to services. The delicate working conditions due to COVID-19 have amplified those barriers, complicating the chance of counselling cancer patients of fertile age about fertility preservation options. The restart should include strategies to reduce the risk of a missed reproductive counselling, limiting the chance for the virus to become a further barrier.

BackgroundIn the absence of international guidelines indicating the usage of vitrification rather than slow-freezing, the study aim was to analyze a large cohort of slow-frozen/thawed embryos to produce a rationale supporting the standardization of IVF cryopreservation policy.MethodsThis retrospective analysis included 4779 cleavage stage embryos cryopreserved by slow-freezing/thawing from September 2009 to April 2017 at a single Center. Biological and clinical outcomes of three different commercial kits adopted sequentially, i.e. Vitrolife Cleave Kit® from Vitrolife (kit 1) vs. K-SICS-5000 Kit® and K-SITS-5000 Kit® from Cook Medical (kit 2) and Freeze/Thaw 1™ Kit® from Vitrolife (kit 3) were collected and compared in the light of cryoprotectants composition.ResultsKit 3 compared to kit 1 and kit 2 showed significantly (P < 0.001) higher embryo survival (79.9% vs. 75.6 and 68.1%, respectively) and frozen embryo replacement (91.5% vs. 86.5 and 83.3%, respectively) rates, and significantly (P < 0.001) lower blastomere degeneration rate (41.5% vs. 43.6 and 52.4%, respectively). No significant difference for clinical outcomes was observed among kits. Only a slight positive trend was observed for kit 3 vs. kit 1 and kit 2 on delivery rate per thawing cycle (7.12% vs. 4.19 and 4.51%, respectively; P < 0.058) and live birth rate (3.07% vs. 2.59 and 1.93%, respectively, P < 0.069). Thawing solutions of kit 3 were similar to those of any warming protocol.ConclusionsA defined concentration of extracellular cryoprotectants in thawing/warming solutions had a beneficial effect on the embryo cryosurvival rate. Results could provide the rationale for the adoption of a single standardized warming protocol.