Updated Treatment Policy in Light of COVID-19

Updated April 29, 2020

In view of the ASRM update released late last week, CARE is planning on resuming treatment cycles in a graduated fashion. 

• Week of May 4^th, we will begin frozen embryo transfer cycles.
• Week of May 11^th, we will begin stimulation for fresh IVF cycles.
• Currently, we are performing diagnostic testing in the office including HSG, hysteroscopy, ultrasounds (antral follicle count, pregnancy monitoring and pelvic ultrasound) semen analysis, DNA fragmentation testing, sperm cryopreservation.  We will continue to do initial physician consultations and follow-up consultations via telehealth.
• Additionally, we will continue with screening patients prior to entry into the clinic, requiring patients to wear a mask and allowing only the individual having the appointment to enter the clinic.
• For our existing patients who are ready to begin IVF or have questions, please contact our IVF coordinators directly at 817-540-7070. 

As we resume care, we will prioritize those treatments that will allow us to predict staffing requirements most accurately. Our goal is to have as few patients and staff within the facility as possible. 

Intrauterine insemination treatments are less predictable than IVF or frozen embryo transfers because timing is based on a patient’s own cycle. The timing of ovulation and needed insemination typically cannot be known until the day of a spontaneous LH surge. For this reason, we are not resuming IUI treatments at present, but will continue to re-evaluate. We hope that we can resume all treatments as soon as possible. 

We are excited to help our patients resume their fertility journey.  Please realize that there continue to be unknown aspects of how COVID-19 may impact pregnancy. 

For more information, please see the below COVID-19 Pregnancy Information. 

COVID-19 Pregnancy Information

COVID-19 is a rapidly evolving pandemic.   At this time, very little is known about COVID-19, particularly related to its effect on pregnant women.  At the present time, there are no recommendations specific to pregnant women regarding the evaluation and management of COVID-19.

• There is very little known regarding a pregnant woman's susceptibility to catching COVID-19. The currently available data on COVID-19 does not indicate that pregnant women are at increased risk. However, pregnant women are more susceptible to and at greater risk of mortality and complications from other respiratory infections such as influenza and SARS.
• There is little known regarding the impact of COVID-19 on pregnancy. Prior data suggest that high fever in early pregnancy may be associated with an increased risk of birth defects and miscarriage.  Some infections in later pregnancy may result in stillbirth and preterm birth.

Adverse infant outcomes including pre-term birth have been reported among infants born to mothers positive for COVID-19 during late pregnancy. However, this information is based on limited data and it is not clear whether these outcomes were directly related to maternal infection or not. Currently, it is unclear if COVID-19 can cross the placenta to directly harm the fetus. Although it is unclear what the optimal medical treatments are for this infection, a variety of medications are used to combat the illness.  It is possible some of these medications may cause harm to the pregnancy or fetus.

For those seeking fertility treatments it is important to know: 

1. At present CARE FERTILITY does not have access to testing for COVID-19.
2. If you are directly exposed, infected or diagnosed with COVID-19, or have symptoms with any febrile illness or have flu-like symptoms which could possibly be COVID-19 (even in the absence of a positive COVID-19 test), your treatment cycle will be cancelled.
3. Your treatment cycle may be cancelled if CARE FERTILITY is not able to support treatment as a result lack of essential staff or supply shortages.
4. Your treatment cycle may be cancelled if there is a change in regulations at the local, state, or federal level such as an edict to stop providing services or procedures, or CARE FERTILITY is required to shut down.
5. You may become exposed to COVID-19 while receiving treatment by other patients or a CARE FERTILITY provider.
6. The risks of COVID-19 on pregnancy, if any, are unknown but could include, birth defects, miscarriage, stillbirth, preterm birth or other pregnancy complications.
7. Your treatment cycle may be cancelled if new data arises that mandates cancellation of treatment for the safety of me or my future pregnancy.
8. You have the option to postpone treatment in order to minimize the potential risks delineated above.   

If the cycle is cancelled for any reason, including but not limited to the statements above, this may affect your insurance benefits and or you may be financially responsible for any services performed, including any medication expenses incurred. 

You have an opportunity to ask questions and have them answered to your satisfaction.  The understanding of this disease is rapidly evolving and new risks may come to light. 

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Posted on April 19, 2020

Governor Abbott’s announcement on Friday, April 17, 2020 was encouraging news for Texans.  Dr. Kevin and Dr. Kathy have spent the last few days charting the safest way CARE Fertility can begin to care for our patients.  Please realize that while the opening of medical practices was encouraging news, it does not mean that the risk of COVID-19 is over.  We have been constructing a plan that addresses re-opening our clinic for patients while keeping their safety and the safety of our employees at the forefront.

Beginning Tuesday, April 21, 2020, please call for appointments at 817-540-1157.  Our focus on Monday, April 20^th, will be the education of our staff for how we can safely implement these appointments.  We ask that if you feel unwell or have been exposed to someone with suspected or confirmed COVID-19, please reschedule.

On Thursday, April 23^rd we will begin offering diagnostic testing: pelvic ultrasound including antral follicle count, phlebotomy (blood tests), hysterosalpingogram, office hysteroscopy, semen analysis, DNA fragmentation and sperm cryopreservation (freezing). 

We will continue to do the following:

• You will call from the parking lot to check-in.
• We will call you when we are ready for you.  Only the individual having the appointment will be allowed into the clinic.
• The medical assistant or nurse will check your temperature.  If your temperature is over 99.5 degree you will be asked to reschedule.
• Currently, all of us are instructed to wear a mask or face covering when we are in public.  Please follow the same guidelines for our clinic.  If you do not have a mask or face covering, you will be asked to reschedule.
• All physician consultations including new patients and existing patients will occur via telehealth.  Consultations to discuss test results and future treatment plans will also be handled in this manner.

Your health and the health of our employees and everyone’s family is of the utmost importance to us.  We realize how frustrating the pause in evaluation and treatment has been for our patients.  We hope to be able to begin treatment cycles in the next few weeks.  Please know we have missed all of you and hope you have been safe and healthy. 
 

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Please know that we are closely monitoring the situation and following the guidelines from the CDC (Center for Disease Control), FDA (Federal Drug Administration), ASRM (American Society of Reproductive Medicine) and local public health agencies as we continue to provide our patients with excellent care.

Be aware that the COVID-19 situation is very dynamic and policies and procedures are subject to change as the climate of this pandemic changes. Please reach out at 817-540-1157 with any questions.

Watch Dr. Kathy Doody’s video providing guidance and encouragement for patients and families struggling with infertility.

New Patients
Be assured that we are continuing to care for patients while staying mindful of the evolving situation. All new patient visits will be conducted via phone or telehealth.  New patient consultations can be scheduled by clicking here or calling us at (817) 540-1157.

Current Patients
We are communicating with and continuing to care for patients who are currently undergoing treatment.

We remain committed to supporting families on their fertility journey and are available to patients by phone and telehealth options. Please feel free to schedule an appointment by clicking here or calling us at (817) 540-1157.

We are following the most current Guidelines issued by ASRM on March 17, 2020, in response to the coronavirus (COVID-19) global pandemic.  At this time, we are not initiating any new treatment cycles and temporarily suspending elective surgeries and diagnostic procedures.

Note: The guidance will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.

For additional questions about fertility treatment, the Society for Assisted Reproductive Technology has answers to FAQs.

To learn more and get guidance on COVID-19 prevention and care, please visit: Centers for Disease Control (CDC) and the World Health Organization (WHO).

From all of us at CARE, we remain your advocate and thank you for being part of our family.

The Doctors of CARE Fertility
Dr. Kathy, Dr. Kevin, Dr. Nackley, and Dr. Thomas


Everyday Hygiene and Prevention

• Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer with at least 60% alcohol.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Clean and disinfect frequently touched objects and surfaces – especially mobile devices – using a regular household cleaning spray or wipe.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash. If you do not have a tissue, use your sleeve (not your hands).
• Practice social distancing, following guidelines of the CDC, health agencies and local authorities.
• Stay home if you are sick or feeling unwell until you are symptom-free for at least 24 hours. If you are well but have family members who are sick, you should self-quarantine yourself until symptom-free. If you have been in areas where suspected infections have been reported, please stay home!
• If you are in an “at-risk health category,” you should avoid meetings or places with greater than ten people.
• Re-evaluate any travel to areas with risk of community spread.