Many in vitro fertilization (IVF) patients can face unexpected obstacles that interrupt treatment, such as financial strains, personal health crises, pandemics, natural disasters or even national emergencies.
When any of these situations arise, counseling IVF patients properly requires sensitivity and emotional intelligence. Reproductive specialists should be prepared to confidently answer common patient questions during these trying times.
Is It Safe to Stop Treatment?
Patients can stop their treatments safely at once, and they can resume safely when the forced treatment break ends. Because the medications used during fertility treatments are short term and stopped abruptly during the normal course of treatment — such as when it is time for an egg retrieval, or when the patient is confirmed not pregnant after an embryo transfer — the patient simply discontinues all medication.
When the patient wants to begin again, they will need to contact their doctor, who can remind the patient how to follow the previous treatment plan.
Are My Eggs, Sperm or Embryos Safe?
Before the physician can adequately answer this question when counseling IVF patients, the fertility clinic must first develop an emergency plan.
The American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) both outline the same three priorities for a sound emergency plan. They include the safety and protection of patients and staff; the security of cryopreserved and fresh tissue; and the protection of other important items, such as records, documents and equipment.
As part of the emergency plan that addresses this particular question, some of ASRM's recommendations include the following:
- Reasonable efforts should be taken to protect the tissue, including maintaining a stable environment — even if that environment is in another location.
- Signed informed consent should be given prior to an IVF retrieval or frozen transfer, including a statement about the reasonable efforts the clinic will make to protect the tissue. Ultimately, the clinic is not responsible for the loss of viability due to situations beyond providers' control.
- Informed consent should also include a statement about the possibility of the patient's tissue being moved to a safer location until the emergency situation ends.
- If there is sufficient warning before the emergency, liquid nitrogen tanks should be prepared for extended staff absences and possibly for moving locations.
In other words, the best approach is to have a plan in place prior to an emergency. This was highlighted by the COVID-19 pandemic, during which ASRM and ESHRE both released updates to their emergency plan recommendations.
In case patients do not completely understand or remember the emergency provisions of the informed consent documents they signed, an emergency plan serves as a written document physicians can follow in their talks with patients when this question arises.
How Can I Communicate With my Fertility Treatment Team?
Telemedicine has become extremely popular in recent years. If a clinic does not already have a telemedicine system in place, now is a good time to start.
However, fertility clinics should take a few steps to prepare first, including obtaining written proof that their liability insurance policy covers telemedicine malpractice; confirming compliance with state laws, medical board definitions and HIPPA rules; and ensuring accepted insurance plans include telemedicine coverage.
There are several approaches to counseling IVF patients using telemedicine: phone only, video only or a combination. If possible, make it easy for patients to book appointments online and choose their preferred communication method. Additionally, implementing online portals for secure emailing between patients and staff is often necessary to follow HIPAA regulations for encrypting sensitive medical information.
Perhaps the most important aspect of counseling IVF patients during a time of crisis is addressing the emotional side of putting treatments on hold. Physicians are encouraged to proactively reach out to patients to check in and offer reassurance. It is important for patients to know their treatment team is on their side.
