Publication - Advice and guidance

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

In response to the direct threat of COVID-19 to patients, the wider Scottish population and NHS Scotland services, all NHS funded Scottish centres took the decision to pause services from 17 March 2020. This document sets out the plans for restarting fertility services from 18 May 2020.

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

6 Uncertainties

6.1 Testing strategies

Although European (ESHRE) guidance provides a good framework for creating a COVID-19 free environment in fertility clinics, the testing strategies they advise are not approved in the Scotland yet. In addition, there are still uncertainties about sensitivity, specificity and availability of various tests especially in asymptomatic patients. https://www.gov.scot/publications/coronavirus-covid-19-getting-tested/pages/overview/

It is important for consistency that all clinics are following similar protocols, hence further guidance from virology was sought..

We liaised with the Clinical Lab/Virology Cell in Health Protection Scotland for further advice on guidance for Fertility treatment and COVID-19 testing. We propose the flow chart as in figure 1, based on these discussions.

Figure 1: Flow chart for test and decision making
Figure 1: Flow chart for test and decision making

If pre-test probability9 is high, treatment will be cancelled irrespective of the test.

The time point of testing prior to OR (oocyte retrieval) is taken in line with other pre operative testing. Testing will be requested at last monitoring USG, which is approximately 40-48 hours prior to the procedure.

Patients (as per consent) will be asked to follow government guidance for isolation preoperatively during the course of treatment,

There will be no financial implications/ full access to NHS funded treatment if the treatments are cancelled due to COVID-19.

6.2 Use of Personal protective equipment

Safe distancing will be practiced wherever possible. It is accepted that some processes (e.g. diagnostic, operative and laboratory work) will require working within close proximity to colleagues. Although most procedures are not aerosol generating, appropriate PPE (https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe) and application of infection control measures will be required for each area to reduce the risk of infection.

A suggested guidance for PPE for specific processes in fertility treatment is given in Table 5.

Securing PPE will be a challenge when we are competing with other specialties.

Table 5: PPE requirements for specific fertility procedures

Setting (triage negative/ test negative)

disposable gloves

Plastic apron (single use)

Fluid resistant overall

Fluid resistant surgical mask

Eye/face protection

Reception

sessional use

patients

single use

Examination / USG/ HyCoSy

single use

single use

sessional use

venepuncture

single use

single use

sessional use

Egg collection

(operator)

single use

Single use

sessional use

sessional use

Egg collection (other staff in room)

single use

single use

sessional use

ET/IUI

single use

single use

sessional use

Andrology lab

single use

single use

sessional use

Embryology lab

single use

single use

sessional use

Use non embryo/gamete toxic cleaning material for clean room and egg collection/ embryo transfer procedures

6.3 Second wave

Although the current lockdown may ease, we recognise that there is a possibility of second wave especially during winter flu season, and thus a possibility of restrictions being re-imposed. Although it is not possible to predict timing and/or duration, this may cause further impact on provision of fertility services, which will need to be factored in, to decision making at a later date.


Contact

Email: anthea.taylor@gov.scot