4 Effect on fertility services
4.1 Impact from other services:
Although fertility treatment is extremely time sensitive and there is a need to continue to provide fertility services, these are not done in isolation. The effect of factors highlighted in section 3 on other services such as primary care, general Gynaecological services, anaesthetics and testing laboratories, predicts that there may potentially be:
- Reduction in referrals for fertility from primary care
- Reduced ability of primary care to provide the initial investigations
- Reduction in referrals from secondary care where secondary care fertility services are not provided alongside tertiary services (i.e. clinics which provide only secondary care fertility services)
- Reduction in face to face appointments due to imposed restrictions resulting in fewer available appointments for Ultrasound scans, blood tests, semen analysis and tubal testing which are essential to determine the appropriate treatment pathway
- Limitation of number of procedures that can be performed in one day due to availability of anaesthetists or ward space
- Delay for those requiring elective Gynaecology surgery prior to fertility treatments as is unlikely to be at pre COVID-19 capacity until 2021,
- Continued pause in donor recruitment will further extend the existing waiting time for those requiring treatment with donor gametes
We are aware that associated services are also putting plans in place to try to ensure continuity of service with their own remobilisation plans.
4.2 Shortage of staff
It is anticipated that during winter months there may be a shortage of staff due to:
- The need to self-isolate due to the member of staff or a member of household testing positive for COVID-19
- The need to self-isolate due to overseas travel, a change in local restriction or government policy at short notice
- COVID-19 risk assessment may impact on patient-facing staffing in NHS especially where there are higher proportion of Black and Ethnic minority (BAME) staff, staff who had previously been shielding or pregnant workers https://www.gov.scot/publications/coronavirus-covid-19-guidance-on-individual-risk-assessment-for-the-workplace/
- Redeployment to other areas/services
4.3 Pace of Restart
Although fertility treatments have started across Scotland in all four tertiary clinics, the restart has been gradual. This was unavoidable due to the multidisciplinary nature of assisted conception and its co-dependence on other medical and laboratory specialities. Furthermore, additional processes to mitigate risk of COVID-19 infection and transmission and to ensure patient and staff safety were required to be put in place prior to commencing treatment.
Before IVF treatment is undertaken, there is a 3-6-week period of patients taking medication and undergoing monitoring in preparation of treatment. Hence patients who were contacted to advise their treatment was restarting in June, underwent IVF treatment in August. All centres initially reopened with reduced capacity and had to limit the numbers of patients treated daily in order to ensure safe working practice. Should an increase in capacity be achievable, it is anticipated that it will be at least a further 6– 9 months before services return to 2019 levels of activity and waiting times, provided there are no further restrictions/ lockdown. It is acknowledged that these approximate timelines may differ slightly for each clinic.
4.4 Impact on waiting times
The controlled and measured restart has compounded pre COVID-19 waiting list times both for patients waiting for fertility treatment, as well as those waiting for fertility clinic appointments and investigations (who will often, if appropriate, be added to the waiting list). Although extra time is being added to both groups as a result of COVID-19,to ensure patients remain eligible for NHS funded IVF, this will not mitigate the effect of age on fertility and success rates (Smith et al., 2020) which is significant as age advances.
Some patients who have previously had successful NHS treatment and have frozen embryos for possible siblings are moving gametes/ embryos to private clinics in order to have earlier treatment. This has a financial impact for the NHS as it increases the burden on NHS staff to arrange legal documentation and couriers for gametes and embryos.