Why did the government restrict access to surgical procedures?
The Australian Health Protection Principal Committee (AHPPC), which advises the Federal Government, is concerned that the national supply of critical personal protective equipment (PPE) will be depleted unless resources are prioritised.
Furthermore, we need to reduce person-to-person transmission through distancing and isolation. For each extra person that gets infected with the Coronavirus, the spread will accelerate far more rapidly. As the NSW premier Gladys Berejiklian advised on March 28, the best approach is for "everyone to act as though they have Coronavirus". Not following the government's instructions will mean more lives will be lost and prolonging the time that restrictions will have to remain in place.
The AHPPC has recommended cancellation of all non urgent elective procedures in both the public and private sector: only Category 1 and some exceptional Category 2 surgery will proceed. Procedures not affected in women's health services includes for example deliveries, treatment for miscarriages, ectopic pregnancies and cancers. Even in these cases, specialists will now consider the appropriateness of non-surgical options first. This approach has been endorsed by the Fertility Society of Australia, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australasian Gynaecological Endoscopy Society.
I am concerned to have a pregnancy now. Should I wait?
Based on the current evidence, there is no significant risk of mother-to-baby transmission, nor any effects on pregnancy or abnormalities in unborn or newborn babies. Newborns and infants don't seem to be at increased risk of complications. Breastfeeding is still encouraged, although women with the virus should be careful with hygiene and consider wearing a face mask while feeding. Finally, there have also not been any reports of more severe Coronavirus (COVID-19) related disease in pregnant women.
However, it is important to remember that the evidence is limited because of the short history of this pandemic. While there have been no recommendations to avoid pregnancy at this time, the FSA recommends strict adherence to hand hygiene and social distancing and any other precautions put in place by national, state, territorial and provincial health authorities.
There is no evidence that postponing treatment for a period of time (up to 2 months) will ultimately affect your ability to have a child. Therefore, where possible, women should consider postponing plans to start a family due to the increased strain on health services, including maternity services. However, should you conceive over the time of the pandemic, Australian and New Zealand health services are well equipped to manage your pregnancy.
I am pregnant so what can I do to reduce my risk of contracting Coronavirus?
Adhere to hygiene recommendations:
• Wash your hands with soap and water for at least 20 seconds, especially after you have been in a public place, after blowing your nose, coughing, sneezing, or using the toilet. If soap and water are not readily available, use a hand sanitiser that contains at least 60 per cent alcohol.
• Cover your nose and mouth with a tissue when you cough or sneeze. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow. Discard this tissue and wash your hands.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Do not share drinking bottles, crockery and cutlery.
• Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature, sore throat and/or new and continuous cough.
• Stay home if you can. Avoid non-essential travel of any kind and avoid use of public transport when possible.
• Avoid non-essential gatherings with family and friends. But emotionally it is important to keep in touch using remote technology such as phone, internet, and social media.
• Get vaccinated for flu (influenza) as soon as available. It’s safe to have the flu vaccination in pregnancy and this could help reduce the risk of further problems.
• Clean and disinfect high touch surfaces regularly, for example telephones, keyboards, door handles, light switches and, bench tops.
Stay up to date with government advice about how to reduce risks and follow those instructions.
• The Department of Health
• Download the Government's Coronavirus Australia App on the App Store or the Google Play Store
Contact your health care professional about your concerns by telephone or online services first.
I don't think my fertility treatment really can wait! What are my chances of conceiving once all of this is over?
Understandably, most patients will be disappointed and distressed that their fertility journey has been interrupted. It is, however, very important to focus on the fact that this is a postponement and not a cancellation.
It is also important to know that a postponement of your treatment until services can resume again, will not affect the chances of a pregnancy. There is no evidence that delaying treatment for a short period of time (up to 2 months) will ultimately affect your ability to have a child, even if you have concerns about your age or diminished ovarian reserve (low egg supply).
It is important you also contact your treating specialist to discuss your personal circumstances and what you can do to optimise your current fertility and the success of any future treatment, such as lifestyle changes.
I only need a frozen embryo transfer. What concerns should I consider?
A recent study has shown that 1 in 10 infections occur from transmission of the virus by asymptomatic people (people without symptoms). As the flu season starts, it will also be more difficult to tell who carries the virus even among people with symptoms, because it will not be possible to test everyone. This will increase the risk of infection by travelling to and from a clinic and by entering facilities where other people gather and work.
Minimising the risk of person-to-person transmission (such as by travelling to and from a clinic and by entering facilities where other people gather and work) and prioritising the use of PPE is therefore essential to save lives. This means postponing all medical services that are not urgent. Strict adherence to government instructions will ensure that restrictions on medical services such as fertility treatments can be lifted as soon as possible.
It is good to know that cryopreserved embryos, eggs and sperm can remain in storage indefinitely without any compromise of their potential to produce a pregnancy.
We have covered the specific risks of COVID-19 infections and pregnancy in a question above.
I feel so distressed and I am not sure I will cope with the wait. Where can I get help?
Feelings of disappointment, frustrations and distress are normal reactions to news about treatment postponement. At times these feelings may appear so overwhelming that finding calmness seems impossible. If you are feeling emotionally affected by COVID-19 decisions your IVF clinic counsellor, IVF nurse and treating specialist can provide information about how to access online emotional support services from experienced infertility mental health care providers. In addition, a list of fertility counsellors who are available to provide you with support can be found here. Online support can also be obtained through Beyond Blue and Lifeline. Strategies to help you cope are available at Black Dog Institute. Be reassured, strategies to help you cope are available and patient groups such ACCESS, Australia's national infertility network, can provide information on ways to keep you connected with others who have experienced a delay in the fertility treatment.
What will happen with my frozen eggs, sperm or embryos?
Even in times of low and no activity, IVF units continue to manage the frozen eggs, sperm and embryos under their care. Every unit accredited in Australia and New Zealand is mandated to ensure all frozen eggs, sperm and embryos are well looked after. Staff in the laboratory will be allowed to come to work to provide these essential services. Importantly, cryopreserved eggs, sperm and embryos can be stored indefinitely.
How long will these restrictions be in place for?
In Australia, only Category 1 and some exceptional Category 2 surgery are allowed from April 1, 2020 until further notice. It is expected that these restrictions will be frequently reviewed by the government and the FSA will update its website if these restrictions are changed. No timelines have been given in Australia.
New Zealand has an alert system which is currently at level 4. At this stage it is in place for 4 weeks, starting from midnight Wednesday 25th March. Level 4 means Fertility clinics in New Zealand are not undertaking any new treatment. Clinics may be offering phone or video-link consultations. Patients should contact their clinic with regards to early pregnancy scans. Clinics may still offer fertility preservation treatment prior to cancer treatment. When the alert level reduces to 3 Fertility clinics may resume starting new treatment. Patients should contact their individual clinics to confirm this.
I want to get prepared now so I am ready as start as soon as possible when services return to normal. How can I best do that?
All fertility units will do their utmost to recommence normal services as soon as possible. Each clinic may do this in different ways, and you should check your clinic’s website and social media pages for further information. You can also contact your treating specialist to discuss this and ways to optimize your chances in the meantime.
I don't agree with the statement from the FSA. Aren't these recommendations going too far?
Other important non-emergency treatments are also being postponed during this pandemic. Fertility treatment is not being singled out. Orthopedic surgery, eye surgery, kidney stone procedures, dental procedures, and many other treatments are also being postponed due to the Covid-19 pandemic in public and private hospitals. If you are concerned about your personal circumstances, you should contact your treating specialist.
It may be useful to know that many other fertility societies around the world have made similar recommendations in recognition of the severe impact the Coronavirus will have on healthcare systems. These links often provide useful information for patients but remember that overseas recommendations do not necessarily apply to Australia and New Zealand. The recommendations of the FSA will change over time and we hope to announce the easing of restrictions as soon as possible.