It seems a long time since the middle of March, when the American Society for Reproductive Medicine (ASRM) & the European Society of Human Reproduction & Embryology (ESHRE) formally advised fertility patients against becoming pregnant as a ‘precautionary measure’ for their own safety during the global COVID-19 health alert. Within days, this shifted to clinics suspending treatment as a ‘social responsibility’.
This is infuriating; fertile couples have not been advised against conceiving. Infertility is a disease; people do not choose to be infertile & stopping treatment indefinitely is a form of discrimination against infertile patients, some of whom are being prevented from having a viable chance of a future pregnancy.
At the beginning of the pandemic, there was a prolonged period of confusion, with uncertainty for clinics and patients, not knowing whether to continue treatment or not. This was instigated by a disappointing lack of leadership by the Human Fertilisation and Embryology Authority (HFEA) and caused intense distress for patients. Eventually, following open letters from patients and clinicians a direction was issued that all treatment should stop on the 15th April, which the HFEA stated was based upon advice from the British Fertility Society (BFS) & Association of Reproductive and Clinical Scientists (ARCS).
The BFS/ARCS guideline to the sector to stop treatment was not made by their respective Executive Committees nor by a Task Force (as was the case with the ASRM), but by just 3 signatories, without any consultation with their membership or the wider sector. To date, no minutes have been published of the meeting in which such important guidelines were formulated (as required by the Articles of Association of the BFS). Whilst I am aware that these are unprecedented times, this was wrong on many counts. Not only has it had an impact on the mental, fertility & financial health of thousands of patients, but also the viability of the fertility business and potential staff employment. The HFEA is a government body, required to remain within the confines of the HFE Act. Clinics are licensed based upon their adherence to the HFEA code of practice NOT to the recommendations of the British Fertility Society Ltd, which is in essence a private company, registered with Companies House, and run as a financial entity. It is also to be noted that the membership of the BFS is open to fee paying members of the public (including parliamentarians, students, lawyers, journalists, etc..) and is not restricted to professionals working within the fertility sector. Given the aforementioned inclusive mixture of the BFS membership, it cannot be described strictly speaking as a “professional body”.
It is therefore critically important that we do not just accept this current situation but push for the creation of a formal and timely exit strategy. We need to start thinking & talking about this now, as restarting treatment will take time, due to the lag between scheduling and egg collections/ET/IUI.
Around the world, our colleagues are already trying to find a way forward. The Fertility and Sterility journal have a virtual real-time conversation in their Dialog where doctors and scientists share what they’re learning about COVID-19 and reproductive medicine. Both ESHRE & ASRM created a Task Force (the ASRM’s is composed of 19 highly regarded members assembled from various specialities within the profession) weeks ago to learn from the experiences of the international fertility community. Italian fertility specialists have written a detailed paper explaining how they have mitigated the virus risks, by adapting their reproductive medical system to its challenges.
The ASRM update their guidance regularly (maximum every two weeks) and hold webinars, inviting all members, to discuss this moving target, adjusting processes as required. Their recently updated guidance recognises that ‘it is likely the COVID-19 pandemic will be with us for some time, at least until an effective vaccine is available’, and that ‘the Task Force recognizes it is also time to begin to consider strategies and best practices for resuming time-sensitive fertility treatments’.
On the 14th April the BFS/ARCS issued a statement indicating that they had now set up a working party composed of only 6 members, who willadvise how and when the restrictions will be lifted. They have asked for contributions and views to be sent by email to a third party (o which is not part of the BFS/ARCS), the statement is not on their home page and there is no time scale mentioned in which replies should be sent or when decisions will be made. They also say ‘ultimately, any measures regarding licensed treatments will depend on the approach taken by the HFEA and the wider Government strategy’, whilst the HFEA say’ any decision will need to consider the views of the UK professional societies (BFS/ARCS)’. It feels as though they are going around in circles.
Patients deserve better than this. There needs to be an open, transparent, constructive, formal dialogue involving (at minimum) all of the clinic persons responsible (PR’s), not just a ‘send your views’ and we will consider them approach.
We all agree that the decision to suspend fertility treatment in the UK was sadly inevitable. NHS staff needed to be redeployed and it was not known (a few weeks ago) how the pandemic would affect the country. However, the way that it happened doesn’t appear to have followed proper due process. It has caused pain and confusion at an already difficult time. This must not be allowed to happen again. The exit strategy should be a transparent and controlled process, involving both professionals and patients, to ensure that it is fair and understandable.
The UK fertility industry and the regulator owes that to the patients
