Resuming assisted reproduction services during COVID-19 Pandemic: An Indian experience

Abstract

Purpose: The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered. The purpose of the study was to assess the preparedness of ART clinics and staff to resume services and patients reasons to initiate treatment and key performance indicators (KPIs) of ART labs during pandemic. Methods: Semi-descriptive report of two private in-vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Time required for replenishing laboratory supplies, and staff preparedness to function under new norms of pandemic was documented. Infection mitigation measures at workplace and triaging strategy were evaluated. KPIs of the clinics were evaluated. Results: One-third of the patients consulted through telemedicine accepted or were eligible to initiate treatment upon clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and only 9 percent delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands could be achieved within a week, but supply of consumables was a major constraint. 52 cycles of IVF were performed including fresh cycles and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval was associated with reduced procedure time and no intervention for airway maintenance, compared to general anaesthesia. Self reported pain scores by patients ranged from nil to mild on a graphic rating scale. Conclusion: This study provides a practical insight and will aid in forming guidelines for resumption of IVF services during pandemic.

Expression map of entry receptors and infectivity factors for pan-coronaviruses in preimplantation and implantation stage human embryos

“…Considering the high rate of human-tohuman transmission and viral shedding from both symptomatic and asymptomatic individuals [39], high asymptomatic to symptomatic patient ratio [40] and ability of the viruses to survive on inanimate objects for extended periods and at sub-zero temperatures [41,42], the clinics offering assisted reproduction services are at risk of spreading COVID-19 [43]. With the resumption of services for assisted reproduction in many parts of the world [44,45], the clinics must be aware of the risks that the virus poses on gametes and early embryos. Indeed, we and others have demonstrated that ACE2 is expressed in the different types of embryonic and trophectodermal cells [14][15][16][17][18].…”