COVID-19 Care Plan: A Message From All of the RBA Physicians

Posted on March 30, 2020

RBA DOCTORS’ PLANS FOR YOUR CARE DURING THE COVID-19 PANDEMIC

Frustration, disappointment and hope – these three words summarize our feelings about the coronavirus pandemic’s impact on our ability to care for you. You must feel the same. Thankfully, we have a multi-phase structured plan that focuses on progressing your care forward during these tough times. We are all looking forward to the day you will safely hold your baby in your arms.

PHASE 1 (Now)

We are currently in Phase One which simply focuses on “hunkering down” so that we all may contribute to “flattening the curve”. As a result of initial, and continuing, guidelines posted by the American Society of Reproductive Medicine (ASRM) [statement here] we are temporarily not starting any new IVF, Embryo transfer, IUI, or ovulation induction treatment cycles. Elective surgeries remain cancelled. At this point, existing patients who were in the midst of an active treatment cycle have either electively stopped, completed, or have nearly completed their treatment course.

However, we are currently actively offering the following services:

TELEMEDICINE PHONE CONSULTS Request a Consultation
OBSTETRICAL VISITS
EMERGENCY VISITS
GENETIC COUNSELING by phone
BUSINESS OFFICE CONSULTS (by phone to prepare for future treatment)
LIMITED LABORATORY, SEMEN ANALYSIS, and IMAGING APPOINTMENTS

1. No more than four patients allowed in the office at one time
2. Appointments required to maintain appropriate social distancing

PHASE 2 (Mid-late April)

In accordance with the most recent ASRM guidelines, we will re-evaluate our Phase One plan by April 13th, and if updated ASRM guidelines permit, by mid to late April, hopefully, we will begin specific, limited operations including:

1. IVF cycles with embryo creation and cryopreservation
2. Elective oocyte preservation IVF cycles
3. Elective surgeries
4. Possible ovulation induction cycles (Clomid or Femara) with or without IUI’s
5. Continuation of other Phase One services (telemedicine, etc)

Of course, prior to initiating limited operations, RBA will also need to follow any state, local and/or federal government regulations that are in place (Remember, no promises with start dates – only HOPE!). We also hope to have rapid testing for coronavirus readily available before initiating treatment.

What about getting pregnant during Phase Two with ovulation induction, IUI’s or embryo transfers?

Our primary reason to come to work (or provide telemedicine consults from home!) is not to just assist you with becoming pregnant, it is to know that we have helped you safely become a parent or helped you get a healthy sibling for your existing child or children. This is where our frustration really builds. We want you to get pregnant, but we must remember our goal – healthy mom & healthy baby. This is not a race – not during these times. However, for some of our patients (actually many), we intensely recognize that this is indeed a scary race. The coronavirus situation is dreadfully real if you are ≥ 35 years old or have diminished ovarian reserve (low AMH or DOR). We all hear that clock ticking. Thankfully, we have a plan for you (it will actively vary depending on the latest available daily scientific/clinical data):

1. If you are in a healthy, low risk patient group, wishing to pursue embryo transfer, IUI or ovulation induction and you are not coronavirus immune, then we will hopefully be able to so by middle or end of April. If you are known to be coronavirus positive, we will obviously need to wait until the infection resolves favorably. Again, ongoing regulation or guideline changes and/or emerging medical data may prevent us from offering these services at any time
2. If you are in a high-risk patient group: including asthmatics, diabetics, cardiac disease or renal disease patients, immunocompromised patients, significant autoimmune disease patients, patients 40 years old or above, or if your BMI is ≥35 we will need to discuss approval on an individual basis by physician committee before pursuing pregnancy.
3. For all other patients during Phase Two and patients not yet ready to conceive – thankfully, we can at least partially “stop the clock” by relying on pioneering embryo and/or oocyte vitrifying (freezing) technology developed over many years at RBA. In fact, we will strongly encourage you to pursue IVF with embryo freezing or egg freezing if you are ≥35 years old or if you have diminished ovarian reserve (low AMH) at younger ages. By doing so, you can rest assured that frozen eggs or embryos will not age while you delay pregnancy to suit your needs.

PHASE 3 (Unclear time period)

We feel that Phase Three is the near-final phase during this pandemic where accurate tests and reasonable treatment options are widely available for the coronavirus. Nobody knows when this will occur, but we are hopeful that it will happen well before fall 2020. Remember, experts are predicting several viral “surges” – perhaps in the summer and fall as well as several other times over the next two years. Considering these likely surges, we feel that it is all the more important for you to start preparing now to pursue IVF or fertility preservation in between these outbreaks.

Telemedicine consults are available now to arrange for your treatment cycle
Request a Consultation

PHASE 4

Vaccines and testing are widely available. The pandemic (in the US) is over. We will have all come out of this pandemic wiser and hopefully stronger.

FINAL THOUGHTS

In summary, we are all in this together to get a great outcome despite the constraints imposed by the COVID-19 pandemic. We are thankful for the robust technology available at RBA that enables you to have strong options for managing your infertility journey. As physicians thinking of your future pregnancy, we encourage you to use your new-found “extra time” to not only clean out your closets but to also prepare for the best pregnancy you can achieve by getting in great physical/nutritional/emotional shape, quit smoking/vaping before pregnancy (goes for males too!) and start folic acid containing prenatal vitamins – it’s the perfect time to do so.

From the doctor’s and staff at RBA, we wish you good health and future babies,

Andrew Toledo, MD

Daniel Shapiro, MD

Scott Slayden, MD

Robert Straub, MD

Jessie Rubin, MD

Monica Best, MD

Michael Witt, MD

Zsolt Peter Nagy, MD, PhD