Coronavirus (COVID-19): fertility treatment - plans for restarting treatment - framework

2 Principles of Restarting Fertility treatment

Prior to re-introduction of fertility treatment, clinics must formulate a robust and measured plan to resume services which will ensure safe and effective treatment in combination with minimising patient and staff risk of Covid-19. This is an unprecedented situation and there is limited literature to guide a restart strategy. Hence, we will use guidance issued by the professional bodies (ESHRE & BFS/ARCS)^[2,3], regulatory authority (HFEA)^[4], public health and Government^[5]. We will also learn from experiences of colleagues in other countries who are ahead of UK in this pandemic ^[6] and take in consideration of risks in pregnancy^[7].

At all times any decision about fertility treatments will ensure that critical requirements are met as advised by HFEA (Table 1 & 3), abide by principles laid down by the First Minister^[5](Table 2) and professional bodies (Table 4) in the framework for decision making in relation to COVID-19.

Table 1: Criteria in critical decision making (as per HFEA letter to PR on 23/04/20)^[1]

• That Government restrictions on social contact and travel are lifted or eased
• That restarting fertility treatment would not have a negative impact on the NHS
• That there was no evidence that Covid-19 impacted on the health of pregnant women or their babies*
• That fertility clinics are able to provide a safe service

* There is further evidence to when this document was released.

Table 3: Criteria for opening up clinics (as per HFEA letter to PR on 01/05/2020) ^[4]

• Record the measures that the centre will be taking to comply with current guidance on safe and effective treatment and the mitigating actions taken in relation to each risk;
• Record the risk assessments undertaken by the centre to identify risks arising from the provision of treatment and the mitigating actions in relation to each risk;
• Record the practical and logistical measures the centre will be taking to deliver treatment safely and in a manner that mitigates the risks arising from, or associated with, Covid-19 for both patients and staff;
• Record all new or revised standard operating procedures or protocols which have been developed to enable treatment to resume safely whilst maintaining compliance with the Government's current requirements relating to freedom of movement and social distancing.

Table 4: Five key principles (outlined in BFS /ARCS document released on 06/05/2020)^[3]

• Resumption of fertility services must take place in a manner that minimises the chances of spread of COVID-19 infection to patients and fertility clinic staff.
• Centres should ensure a fair and transparent approach to any prioritisation policy.
• Resumption of treatment should not result in an undue burden on the NHS.
• Patients considering treatment should be fully informed about the effect of the ongoing pandemic on their treatment and give informed consent to having fertility treatment at this time.
• The fertility sector should adopt sustainable changes in working practices that help to build resilience against any future increases in the spread of COVID-19 in the community.