Universal Screening of Covid-19 in Asymptomatic Patients Starting Fertility Treatment in New York City

Robles, Alex; Robles, Brittany N.; Gemmell, Laura C.; Brady, Paula C.; Forman, Eric J.; Williams, Zev

doi:10.1016/j.fertnstert.2020.08.509

Cited by 4 publications

(3 citation statements)

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“…However, while broad recommendations from reproductive societies were suggested, no direct guidelines have been established (12). While there are limited studies evaluating these various screening options in the infertility population, a small study in the early months of the NYC COVID-19 pandemic demonstrated a low incidence of COVID-19 rates and safe resumption of fertility treatments through symptom screening and SARS-CoV-2 PCR testing before starting controlled ovarian stimulation (COS) (13). As more time has elapsed and NYC has experienced a second surge in cases, more data are available to better understand and evaluate ART practices during COVID in terms of cycle cancelation and fertility office COVID-19 prevalence rates to provide patients with actual outcomes, counseling on risks, and expectations about ART treatment during a pandemic.…”

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confidence: 99%

Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center

Shaw

Tozour²,

Blakemore

et al. 2021

Fertility and Sterility

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Objective(s) To evaluate the prevalence of COVID-19 and efficacy of a universal screening program in patients undergoing controlled ovarian stimulation (COS) Design Single center retrospective cohort study Setting Academic fertility center in New York City, the epicenter of the COVID-19 pandemic Patients All patients undergoing controlled ovarian stimulation from June 17, 2019 to February 28, 2021 Intervention Universal COVID-19 screening starting June 17, 2020 with SARS-CoV-2 PCR testing within five days of oocyte retrieval, patient-reported symptoms screen and temperature monitoring Main Outcomes Measure(s) The primary outcome was the number of positive COVID-19 cases in patients undergoing controlled ovarian stimulation cycles. The secondary outcomes were cycle outcomes compared to pre-COVID-19 COS cycles, adverse outcomes in COVID-canceled cycles, and the center-specific COVID-19 detection rates compared to New York City cases. Results From June 17, 2020 to February 28, 2021, 1,696 controlled ovarian stimulation cycles were initiated with only 7 positive COVID-19 cases for an overall positivity rate of 0.4%. When compared to pre-COVID cycles from June 17, 2019 to February 28, 2020, the volume of COS cycles was higher, while the overall cycle cancellation rate was lower during COVID-19. Cycle outcomes including oocyte yield and blast utilization rates were unchanged from pre-COVID cycles. Cases of COVID-19, while very low, occurred more frequently during surges in New York City rates. Conclusion(s) Assisted Reproductive Technology can be performed during the COVID-19 pandemic utilizing frequent universal screening and safe practices with low SARS-CoV-2 positivity, low cycle cancellation rates, and positive patient outcomes.

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confidence: 99%

Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center

Shaw

Tozour²,

Blakemore

et al. 2021

Fertility and Sterility

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“…In real-life clinical practice, triage-negative ART patients are usually screened with a PCR test once or even twice (Joint IFS-ISAR-ACE, 2020) throughout their treatment, with the inherent costs and risk of false-negative results, especially in those with no or minimal symptoms ( Watson et al , 2020 ). International data reveal a very low rate of positive PCR results in triage-negative IVF patients: 0.5% in 4259 asymptomatic women undergoing IVF in Israel; no positive PCR in a cohort of 151 ART patients from New York, NY, USA; 0.8% out of 263 IVF cycles revealing a new asymptomatic infection in May–July 2020 in another New York-based fertility center ( Gingold et al , 2021 ; Robles et al , 2020 ; Seidman et al , 2020 ) .…”

Section: Discussionmentioning

confidence: 99%

The prevalence of SARS-CoV-2 antibodies in triage-negative patients and staff of a fertility setting from lockdown release throughout 2020

Manolea

Căpitănescu

Borş

et al. 2021

Human Reproduction Open

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STUDY QUESTION What is the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in triage-negative patients undergoing ART and fertility care providers after lockdown release and throughout 2020? SUMMARY ANSWER Out of the triage-negative patients whose blood samples were assessed for SARS-CoV-2 antibodies over 6 months, 5.2% yielded positive results with a significantly higher rate in health care workers (HCWs) and a significant month-by-month increase in those with evidence of antibodies. WHAT IS KNOWN ALREADY Patients of reproductive age are more prone to asymptomatic or minimal forms of coronavirus disease 2019 (COVID-19) as compared to older age groups, and the identification of those with active infection and those already exposed (and probably immunized) is important for safety and cost-effective use of testing resources in the fertility setting. Data on the prevalence of SARS-CoV-2 in ART patients are limited and encompass short time frames; current rates are unknown. There is also no consensus on the optimal way of screening triage-negative ART patients in moderate/high-risk areas. STUDY DESIGN, SIZE, DURATION A prospective longitudinal unicentric study on triage negative ART patients (n = 516) and clinical staff (n = 30) was carried out. We analyzed 705 serological tests for SARS-CoV-2 sampled between 17 May 2020 (the first working day after lockdown release) up to 1 December 2020, to assess the positivity rates for SARS-CoV-2 antibodies. PARTICIPANTS/MATERIALS, SETTING, METHODS We collected data on the serological status for IgM and IgG antibodies against SARS-CoV-2 in 516 triage-negative men (n = 123) and women (n = 393) undergoing ART at a private fertility center and 30 HCWs that were at work during the study period. Antibodies were detected with a capture chemiluminescence assay (CLIA) targeting the highly Immunogenic S1 and S2 domains on the virus spike protein. We also analyzed the molecular test results of the cases exhibiting a positive serology. MAIN RESULTS AND THE ROLE OF CHANCE The data showed that 5.2% of the triage-negative ART patients had a positive serological result for SARS-CoV-2, with an overall conversion rate of 2.1% for IgG and 4.6% for IgM. There was no significant difference in seroprevalence between sexes. The small cohort (n = 30) of HCWs had a markedly increased seroprevalence (12.9% for Ig M and 22.6% for IgG). The highest seropositivity in our cohort was recorded in November (16.2%). The IgM positivity rates revealed significant monthly increments, paralleling official prevalence rates based on nasopharyngeal swabs. No positive molecular tests were identified in cases exhibiting a solitary positive IgG result. We show that despite a 6-fold increase in the number of ART patients with a positive serology between May and December 2020, most of our patients remain unexposed to the virus. The study was undertaken in a high-risk area for COVID-19, with a 20-times increase in the active cases across the study period. LIMITATIONS, REASONS FOR CAUTION The geographical restriction, alongside the lack of running a second, differently-targeted immunoassay (orthogonal testing), could limit the generalizability and translation of our results to other fertility settings or other immunoassays. WIDER IMPLICATIONS OF THE FINDINGS The low positivity rates for IgG against the SARS-CoV-2 spike protein seen at the end of 2020 imply that most of the fertility patients are still at risk for SARS-CoV-2 infection. Until mass vaccination and other measures effectively diminish the pandemic, risk mitigation strategies must be maintained in the fertility units in the foreseeable future. Patients with a solitary IgG+ status are most likely ‘non-infectious’ and can elude further testing without giving up the strict use of universal protective measures. With increasing seroprevalences owing to infection or vaccination, and with the consecutive increase in test performance, it is possible that serological screening of ART patients might be more cost-effective than PCR testing, especially for the many patients with repeat treatments/procedures in a time-frame of months. STUDY FUNDING/COMPETING INTERESTS This research received no external funding. All authors declare having no conflict of interest with regard to this trial.

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“…The incidence of COVID infections among infertility patients compared to other groups of patients is unknown. A small New York City study during early limited COVID-19 testing demonstrated a < 2% COVID-19 positivity rate in asymptomatic infertility patients even as city-wide positivity rates approached 40% [ 10 ]. This disparity merits further research.…”

Section: Introductionmentioning

confidence: 99%

Rates of COVID-19 infection among in vitro fertilization patients undergoing treatment at a university reproductive health center

Abigail

Berger

Lee

et al. 2022

J Assist Reprod Genet

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Background The coronavirus disease 2019 (COVID-19) caused an unprecedented challenge for in-vitro fertilization (IVF) patients. The incidence of COVID-19 infection among this population is a fundamental knowledge gap. Objective The purpose of this study was to determine the rate of COVID-19 infection among IVF patients compared to other gynecologic surgery patients. Materials and methods This retrospective study evaluated the incidence of COVID-19 infection among patients undergoing IVF, female fertility-related surgeries (FRS) and other gynecologic surgeries at a single academic institution in Los Angeles, California. All patients underwent routine COVID-19 polymerase chain reaction (PCR) screening prior to treatment. Result A total of 2742 patients underwent asymptomatic COVID-19 screening before a surgical procedure or IVF between March 1, 2020, and April 5, 2021. The rate of COVID-19 infection among patients who underwent preoperative testing for a non-fertility-related gynecologic procedure was 1.74% (28/1612). In comparison, the positive test results for those who underwent either FRS or IVF were 0.56% (1/180) and 0.34% (1/290), respectively, representing 6.70% (2/30) of positive tests for the whole cohort. The infertility patients had a significantly lower positivity rate compared to the other gynecologic patients during preoperative COVID-19 testing (0.43% vs 1.74%, p = 0.03). Conclusion(s). Our study demonstrated that there was a significantly lower incidence of COVID-19 infections in infertility patients undergoing IVF or FRS compared to other gynecologic surgery patients. Future studies should evaluate the cost-effectiveness of routine screening in both the gynecology and infertility patient population, especially in the setting of different variant surges and vaccination rates. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-022-02581-2.

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Universal Screening of Covid-19 in Asymptomatic Patients Starting Fertility Treatment in New York City

Cited by 4 publications

References 0 publications

Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center

Universal SARS-CoV-2 polymerase chain reaction screening and assisted reproductive technology in a coronavirus disease 2019 pandemic epicenter: screening and cycle outcomes from a New York City fertility center

The prevalence of SARS-CoV-2 antibodies in triage-negative patients and staff of a fertility setting from lockdown release throughout 2020

Rates of COVID-19 infection among in vitro fertilization patients undergoing treatment at a university reproductive health center

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