As Europe experiences a second wave of the coronavirus (COVID-19) pandemic, many countries including the UK, Ireland, France, Germany, and Austria are in some form of lockdown. All other European countries are imposing varying levels of restriction in an attempt to control the virus. While many fertility clinics shut down earlier in 2020 as part of the COVID-19 response, they have not closed this time around — an enormous relief for those undergoing or planning to undergo fertility treatment. However, a plethora of questions remain unanswered, including if we can expect these fertility clinics to continue to remain open through this latest spike. At Carrot, we are in constant contact with fertility providers, so we have shared some of the answers for questions we’ve received from Carrot members in Europe.
Do clinics expect to continue offering fertility treatment through these persistent COVID spikes?
In every country where we spoke with local providers, the answer was a resounding “Yes, we expect to remain open,” followed by a caveat of unless the Government orders us to close. In countries like Ireland and the UK, the teams said the probability of this happening is highly unlikely and would only be in truly exceptional circumstances. However, in France, a fertility clinic team there said there is increased risk in the coming weeks of having to stop IVF treatment and, as a result, they are actively offering postponement of treatment to a later date.
In Ireland, the fertility care providers spoke to the core limiting factor of insufficient personal protective equipment (PPE) as the root cause behind fertility clinic closures earlier in 2020. However, clinics now have ample PPE as well as clear and sufficient safety processes and procedures in place to ensure the safe protection of both staff and patients. In Spain, a fertility provider who sees a lot of cross border reproductive care patients spoke to the core limiting factor of lockdown and closed borders as the root cause behind closing their doors temporarily earlier in the year. However, they point to the largely open borders now, albeit with testing and quarantine restrictions, as a reassuring factor that their patients will continue to be allowed to travel to them for treatment.
Finally, a universal trend across all countries is a clear move to remote support. Initial patient-doctor consultations and follow up medical contact is now conducted by Skype, Zoom, or other platforms, and many clinics say that even after the pandemic, they will maintain this virtual process as it has worked very well.
Are clinics testing patients for COVID-19? At what point(s) in their fertility treatment cycle?
COVID-19 testing of staff and patients in fertility clinics across Europe varies wildly. The majority of clinics in France and Ireland are not testing; rather, they are using questionnaires to assess patients starting treatment, with anyone experiencing symptoms not permitted access to the clinic. In the UK, half of the clinics we spoke to test for COVID as part of their treatment process and half do not.
Interestingly, for any cross border reproductive care patients in Spain, the Spanish Government will ask for a PCR test for COVID-19 when travelling to Spain from the 23rd of November.
What advice would your clinic give to patients who are considering undergoing treatment at the moment?
Every clinic that we spoke with across Europe has reduced the number of people in their clinics greatly; as one example, daily egg collections have been reduced by 50%. This is to ensure social distancing can occur effectively, to allow for deep cleaning between treatments, and to ensure medical teams can minimize their interactions by working in team bubbles. While these reductions are part of efforts to protect staff and patients, they have also led to increased waiting lists at some clinics. In Ireland, for example, an approximately two-month waiting list exists at some larger clinics, with egg retrievals being scheduled for January 2021 at the earliest.
All clinics advise patients to adhere to government guidelines. This is particularly important for those travelling cross-border for treatment. In addition, all clinics advised patients to stay in close contact with their clinic, as processes and procedures vary from clinic to clinic. For example, in many European clinics, partners are not being permitted in the clinics to reduce footfall.
Are there any changes that clinics have made to treatment cycles in response to the pandemic?
Apart from the reduced number of people at clinics, the thorough safety processes and procedures, and additional COVID-19-related paperwork, treatments themselves remain largely unchanged.
A number of clinics spoke to immunosuppressants, which many clinics refused to prescribe during the summer months following re-opening of clinics after the first pandemic wave. Some clinics are still not prescribing immunosuppressants, and others will prescribe them but patients may be asked to sign a waiver and advised to cocoon.
Is cross border reproductive care (CBRC) continuing at clinics at present?
All clinics that typically offer cross border reproductive care (CBRC) in countries that we contacted said that treatment was continuing as per usual, with one exception at a UK clinic not accepting patients living outside of England at present.
In Spain, which typically welcomes considerable volumes of CBRC patients from abroad, one clinic described how they are managing double-donor patient treatment entirely remotely except for embryo transfer, when the patient can fly in and out for implantation on the same day. As scans and blood tests are required in the preceding weeks, these can be done in the patient’s home country and the results emailed to their consulting physician in Spain. In addition, and as previously mentioned, all meetings with the consulting physician are conducted remotely.
CBRC patients are advised to stay on top of the ever changing travel restrictions and adhere to any isolation advice given by Governments.
At Carrot, we highly recommend the Re-open Europe tool to anyone planning to travel across borders in Europe for fertility treatment. This tool provides an overview of the health situation in European countries based on data from the European Centre for Disease Prevention and Control (ECDC). The information is updated frequently and available in 24 languages. It enables people to follow the evolution of the coronavirus situation in their own country and beyond. Re-open EU also provides information on the various restrictions in place, including on quarantine and testing requirements for travelers and mobile coronavirus contact tracing and warning apps. At Carrot, we believe that this tool should help you plan if you need to travel for care in Europe, while staying safe and healthy. It is important that people speak with their own consulting physician to ensure clear alignment in all areas of planning.
Other useful resources:
- European Society of Human Reproduction and Embryology (ESHRE) COVID-19 page
- Human Fertilisation and Embryology Authority (HFEA) patient guidance
Still have questions about how COVID-19 may impact your fertility treatment? Get in touch with our Care Team.