Fertility clinics across Canada that shut down services in March because of COVID-19 are beginning to resume treatments now that concerns about overwhelmed hospital systems and protective gear shortages have started to fade.
For most, this reopening is happening in phases over a number of weeks alongside a host of new safety measures being put in place.
At the Hannam Fertility Centre in Toronto, which will start seeing patients again on Tuesday, everyone entering the clinic will have their temperature taken at a distance with an infrared thermometer. All staff and patients will be required to wear masks. And daily operations have been restructured to eliminate long waiting-room queues.
“In March, no one knew what was going on, there were a lot of fears … but a lot of those things never came to pass,” said Tom Hannam, the clinic’s founder.
Dr. Hannam said they will be starting with a select number of procedures that are the most time-sensitive and then ramp back up to something that resembles normal over the next couple of weeks, once they’ve had a chance to test their new workflow.
It’s the same strategy being taken by the Genesis Fertility Centre in Vancouver.
“We’ve started – very slowly – seeing some patients for ultrasounds [last week]. Not more than two or three a day, really as needed on an urgent basis. [This] week, I anticipate that we’ll start to increase,” said Sonya Kashyap, the clinic’s medical director. Dr. Kashyap hopes to be doing egg retrievals by the end of May and embryo transfers by the first week of June.
The Canadian Fertility and Andrology Society – which is not a regulatory body, but which provides guidance to the industry – released a notice to members on April 29 outlining steps to be considered should they plan to reopen.
President Eileen McMahon said when the CFAS endorsed the postponement of new insemination, in vitro fertilization and frozen embryo transfers nine weeks ago, it was the right thing to do given concerns about hospital resources and protective gear stockpiles. But with the rate of new infections steadily slowing and provinces beginning to relax some restrictions, Ms. McMahon said they felt comfortable revisiting that decision.
“Fertility care is medically necessary,” she said. “All of our hearts have gone out to the patients because we understand that it’s very difficult to be told you need to wait for care, when people who don’t have infertility were not told to not get pregnant.”
Dr. Hannam said health care resources were definitely top of mind when he decided to close his clinic’s doors, but so was safety. COVID-19 is so new that back in March, there were many unknowns about how the virus affected pregnancy and babies.
In this area, two more months of data have brought good news.
“We’re generally actually fairly reassured by the literature coming out,” said Chelsea Elwood, an obstetrician and gynecologist in Vancouver who specializes in reproductive infectious diseases.
Dr. Elwood said doctors were initially worried that having COVID-19 may put pregnant patients at risk of preterm labour, but this doesn’t seem to be the case. Statistics show that 6 per cent to 15 per cent of infected mothers-to-be deliver preterm, which is not much higher than the typical rate. (In British Columbia, that’s 8 per cent.)
Scientists still aren’t sure how common it is for a fetus to be infected in utero, but it appears to be very rare. Newborns who have contracted the disease after birth generally have very mild symptoms – if any at all, Dr. Elwood said. The one area that remains a question mark concerns the impact of COVID-19 on early pregnancy, since women who became infected in the first trimester would not have given birth yet.
But there is good reason to feel reassured, Dr. Elwood said.
“I can tell you based on the physiology with this virus … it doesn’t seem to be [having an impact on] growth or development,” she said. “If you’re thinking about getting pregnant … the pandemic should not stop you.”
Another worry that Dr. Hannam had was what the health care experience would be like for pregnant patients during a pandemic. Doctors and midwives have scaled back the number of face-to-face interactions, meaning fewer ultrasounds and heartbeat checks, and most facilities have asked patients to attend those appointments alone. There were concerns about the level of care mothers may receive if hospitals were overrun and fears that hospitals would ban partners from the delivery room, as the Jewish General Hospital in Montreal briefly did in April.
But the worst never came to pass.
Michelle O’Connor, the clinical leader manager of obstetrics, gynecology and the neonatal intensive-care unit at St. Michael’s Hospital in Toronto, says things have run smoothly during the lockdown.
Around the end of February, staff in the maternity ward developed a new set of protocols for operating during a pandemic and then began running simulation exercises to make sure everyone felt comfortable.
“We are still allowing one support person throughout labour and postpartum. Unless we think they are COVID-positive and that would be a safety factor,” she said.
Not having her husband in the room was one of Liane Fong’s biggest fears before she gave birth in early April. Ms. Fong, 37, was just a few weeks away from her due date when the country started shutting down. Her doctor warned her the visitor policies could change if the situation deteriorated.
But when the day rolled around, Ms. Fong and her husband drove to North York – in record time, because there was no traffic with everyone isolating – and things went mostly as planned. The couple had to cancel the doula they had hired, because only one person was allowed in the room with the expectant mother. And Ms. Fong wasn’t able to receive gas and oxygen for pain management, because of concerns about contamination. There were also no private recovery rooms available, because staff had had to allocate space that could be used to isolate infected patients.
But for her the hardest part has been not being able to share this moment with her family and friends.
“My parents have not met the baby in person. We parked in their driveway on the way home from the hospital and they stood outside our car and put food in the trunk,” she said.
“But I know I’m still going to see my parents hold my baby for the first time. I just don’t know when.”
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