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Caitlin Whyte: COVID-19 is affecting all areas of life from our social schedules to our work patterns and of course our healthcare. It's even affecting the world of obstetrics, gynecology, and fertility. Today we're going to talk about the changes that have taken place, the guidelines, the industry is following how the virus can impact fertility, and the future of fertility in the time of COVID-19 joining us to help answer some of these unknowns is Dr. Christopher Sipe, the Medical Director at Fertility Centers of Illinois with locations throughout the Chicago area. This is the Time to Talk Fertility Podcast. I'm your host, Caitlin Whyte. So Dr. Sipe, the rules that people are expected to follow, they seem to change every day on a local state and even a federal level. How are your treatment policies changing?

Dr. Sipe: Well, we're reacting to the local, state and federal policies and laws that are being passed. In addition, we've got medical societies that are making recommendations as far as treatment for patients. For instance, the American society of reproductive medicine, which is the governing body of most infertility clinics, on March 17th, recommended that we finish up any cycles that have already been started that we recommend to our patients that they not do a fresh transfer, that we cease doing non-urgent medical procedures, stop all elective surgeries and do as much telemedicine as we can.

Host: Do you expect that there will be any additional changes in the future?

Dr. Sipe: Yes, we do. The society guidelines came out on the 17th. They informed us that they're going to make recommendations as of March 30th. So we are expecting to get some new recommendations, but you know, between the 17th and the 30th, a lot has changed with the COVID-19 virus and lots has changed in the world around us and especially in the United States. So I don't see them changing their guidelines much. A group of fertility practices did ask some questions because infertility is a disease and as a disease it doesn't go away without some type of treatment. So one of the thing that's important to us to remember is that during the COVID-19 pandemic, that not only do you have that virus to deal with, but you have every other normal medical problem that people can fall under. You have people with appendicitis that need surgery, you have people who are having heart attacks. If people have high, high blood pressure, need to see their physicians. So just because COVIDs here doesn't mean that all the rest of the medical problems go away.

Fertility is definitely one of the issues that needs to be addressed because it's very time sensitive, and a one month wait two months away probably doesn't make a huge difference in a patient outcome. However, I think most medical experts and most of us feel that this is not a problem that's going to go away anytime soon. I know in the State of Illinois that they've closed schools and are trying to reduce things until April 20th but I haven't spoken to a single health professional who feels that the virus will be gone by April 20th. In fact, I think most people feel it's going to be around four months to even potentially years. And so the current guidelines that are everyone is doing are really to try to flatten the curve, which means decrease the severity number of cases, but extending the duration of potential exposure. And that's great for keeping people alive. It's not so great from a fertility standpoint, and maybe other diseases and not quite elective surgeries. So those are things that we're trying to navigate around for our patients.

Host: So what is your daily practice look like? Are you seeing patients right now?

Dr. Sipe: We are still seeing patients because we're finishing up many of the IVF treatment cycles that have been started you know, before or shortly on the date that we got the notification. We expect to complete those IVF cycles in the coming five days. At this time we hadn't started any new IVF cycles. We've also stopped trying to get people pregnant early next week. So those are the big ones from a treatment standpoint. At the same respect, we've also instigated a much more rigorous cleaning schedule and as a medical practice we're already cleaning everything in between patients and now we've extended that into office visits. We've started spacing people off of social distancing in the waiting areas. We've also started spacing out the procedures that we've been doing to try to finish things up. So we've been doing a lot of different things to try and follow the national guidelines and local guidelines for decreasing risk of infection transmission.

Host: That leads me into my next question. How has the Coronavirus impacted how the clinic is run in terms of keeping everyone safe?

Dr. Sipe: Well, safety of our patients and our staff has been our number one priority. We did come up with a list of three priorities that we felt would govern every decision we make. And the number one thing was health. The number two thing was making sure our patients get taken care of, that their infertility is treated and the number three thing is to make sure once this pandemic passes that there will be at Fertility Centers of Illinois to help our patients again. So we've really focused on those three missions to help our patients. Really from a disease standpoint, we haven't had any employees come down with the COVID infection. We were notified yesterday afternoon that we do have a patient that was positive, I think was in last week, and we're following all the specific guidelines that are out there to help manage that patient. She's with her PCP and working up there and she's actually, she's young, so she's doing very well, not needed to be hospitalized.

Host: So for those who have had some sort of treatment change, especially those going from a fresh embryo transfer to now a frozen transfer at a later date, how could this impact their chances of success?

Dr. Sipe: A lot of that depends upon what your plan was going in and what your cause of infertility is. If you look at pregnancy outcomes these days, there are some instances where a frozen transfer actually has a better pregnancy rate than a fresh. So we don't see this as a necessarily bad thing for patients. We don't think that they're going to have a lower pregnancy rate by having to do a frozen transfer. So, and a lot of people have decided to do genetic testing of embryos, which has to be done on a fresher frozen embryo, but then leads to a frozen transfer in the future. So for a good number of our patients who have opted not to do a fresh transfer, they have opted to do preimplantation genetic testing. So that they know the genetic makeup of the embryo and decrease their genetic transmission risk to the fetus.

Host: Do you have any idea when patients will be able to resume treatment again?

Dr. Sipe: That's the very important question. And every single patient asked that and everything a reproductive endocrinologist is asking that to society [inaudible 06:41] society, I don't think there's a real answer at this point. I wish there were cause then people when they know a date that they can get things started, they can handle the stress and the delays much better. I know that depending upon where you are in the country, there still are some in fertility practices that are still moving forward because they have a very low incidence of COVID-19 but there's other areas that have completely shut down. Now for instance, our sister practices in New York pretty much shut down due to the high number of cases there. My best guess is we would be able to resume doing treatments is probably sometime in the next four to 12 weeks. But my, what I would probably guess is that we're going to be doing those on a limited basis once again to decrease transmission risk to both our patients and our staff and to space things out for health. And we probably won't be doing fresh transfers, probably still be recommending just creating the embryos to freeze. The benefit of embryo freezing is it does buy the couple times. So their fertility won't be going down as an embryo sitting in the freezer because the embryos already been created.

Host: I know information is few and far between at this point, but is there any idea of how the virus could impact fertility?

Dr. Sipe: You know, right now it doesn't seem to have any direct effect on fertility or the chance of getting pregnant. Obviously when a couple, when one member of a couple is ill, they're probably not going to be trying to reproduce at home. So there'll be some delays in how natural conception occurs. But from a fertility standpoint for us, if someone's got an active infection, we're not going to treat them until that infection has resolved. That's on an effort to decrease transmission risks. There has been no, a couple of studies in China and understand that the Chinese experience with COVID-19 is only about three months into it. Or a little over three months, and so they've looked at some pregnant women. Most recent study was 33 pregnant women who delivered, who were infected with COVID. Three babies were impacted with positive COVID. However, that testing on those infants wasn't done for two days later. And it's entirely possible that the babies could have acquired it from the surroundings or from mom outside of the womb. We're waiting for any data on the risk to pregnancy, but at this time it does not seem to be a major risk to the pregnancy and the fetus itself in utero. But data's still was coming out to help us to make those decisions and understand better.

Host: So with all of these shutdowns and lockdowns and closing of offices, I mean, what are you doing as a physician to serve your patients during these times?

Dr. Sipe: Well, the most important thing is being there for them. So although I'm supposed to technically be on spring break this week and down on a beach in Florida, I am obviously staying home much like most of the United States. And I have actually added a lot of phone consults to my week this week. So I could reach out to patients and talk with them to try and discuss, you know, their care, what we think we should do next, when we might be able to do things next. And to really help try and calm their anxieties about the delays in treatment, what that means for them specifically. We've also got health psychologists on staff that have been trying to set up group meetings online or individual access for patients who are having even a more difficult time than some. We've also got those same health psychologists are available for our own staff to help deal with some of the stress and anxieties. We're doing a lot of things to try and keep people calm and we're watching all the recommendations and governmental policies to see when we might be able to really start helping them because that's what's going to help them the most is just feeling like they're moving forward with building their family.

Host: So with what we know, which I know you keep mentioning is very little at this point. For those trying to conceive. Do you recommend that they stop for the time being,

Dr. Sipe: You know, the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine, which are the two major governing bodies for pregnancy in the United States have not come out and issued any guidelines to say do not get pregnant. I mean, we all remember a few years ago at the Olympics how the Zika virus was out there and very quickly those agencies came out and said, you should not get pregnant if you've been to a Zika pandemic zone because it causes direct fetal risk and birth defects. With COVID-19 no one's made that recommendation to avoid pregnancy. So as far as anyone can tell right now it is safe to become pregnant. We know that any woman who is pregnant, whether she gets influenza A, COVID or other type of major virus, can have complications caused by the virus itself, but we haven't seen anything unique to COVID-19 that increases the risk of birth defects or pregnancy complications above other viruses.

Host: So it seems like everyone is feeling pretty anxious and uncertain about the future. And I'm sure for couples who were going through fertility treatments that's only heightened with all of this delays and you know, stopping and starting of treatments, what are some words of hope for them? How can we ease couples during this time?

Dr. Sipe: Well, the most important thing is that this is a pandemic and it will pass. As with any flu season, the flu comes and it goes. People get sick, people get better. And so we know at some point this is going to pass. It's not necessarily going to be in the next two weeks, probably not going to be in the next two months, but at some point it will pass. And fertility doesn't really drop that quickly over one to two months, you know, six to 12 months wait can impact someone's fertility, especially the older they are. And so I'm hoping that the American Society of Reproductive Medicine is going to start relaxing some of their restrictions on some of our older clients. So that we can start helping them. If it looks like this is going to last longer than most of us hope. Just know that every infertility clinic is trying to do their best to help all patients. Fertility Centers of Illinois being the second largest IVF provided the United States is definitely at the forefront of trying to work with the different societies to help change and draft some of the resolutions that are out there so that we can help our patients sooner rather than later. And we're always available to talk on the phone either as an established patients or new patient consult to really help you cope with your not only the COVID infections, but also cope with your infertility and your infertility journey.

Host: Well, Dr. Sipe, Thank you so much for the information during this strange, and of course, uncertain time. That was Dr. Christopher Sipe, the medical director at the Fertility Centers of Illinois. Find out more about how the practice is dealing with the Coronavirus pandemic by calling (877) 324-4438 or head to FCIonline.com to schedule an appointment. If you enjoy this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do. This has been the Time to Talk Fertility podcast. I'm Caitlin Whyte. Stay safe.