CFAS Communication on COVID-19 

Updated March 31st, 2020

 
Dear CFAS Members:
 
The Canadian Fertility and Andrology Society has been closely monitoring the regional and national COVID-19 outbreak information. We recommend that all members honour the rules and regulations of their provincial bodies. At this time, most guidelines are unchanged and some are in fact stronger than two weeks ago.
 
Given that the number of total cases of COVID-19 (confirmed and probable) continues to rise in Canada, our directives remain to:
 
  • Conduct consultations by telemedicine or phone
  • Complete current IVF cycles utilizing freeze-all only
  • Suspend all diagnostic and elective procedures and surgeries
  • Postpone any new cycle starts (IUI, IVF, FET), aside from urgent cryopreservation for oncology, until further notice
 
We recognize that clinics have an obligation to perform regular required quality control and maintenance especially of laboratory equipment and cryopreserved material.
 
This guidance document will be revisited at least every two weeks, or as more information becomes available, given that the situation is evolving and changing.
 
Thank you again to each and every one of you for working hard under such challenging circumstances and for doing your part to play a meaningful role in protecting us all.
 
 
Sincerely,
Eileen McMahon, President (2019-2020)
Goldi Gill, Executive Director
CFAS Board of Directors
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Updated March 18th, 2020

Dear CFAS Members:

The Canadian Fertility and Andrology Society takes the health and safety of our members, staff, and broader communities seriously. We support national public health measures to flatten the transmission curve of COVID-19. Specifically, measures to drastically reduce face-to-face interaction. If we do not apply measures, the number of cases is expected to grow exponentially. The time to act is now. 

What we know:

The Chief Public Health Officer of Canada, Dr. Theresa Tam, is recommending that we need to act quickly to help flatten the curve to reduce the impact of COVID-19, by practicing social distancing. 

Prime Minister Justin Trudeau is advising we take steps to limit the spread of COVID-19 by limiting the number of people we come in close contact with, maintaining a distance of 2 m (6’) from others, and avoiding non-essential trips outside the home.  

Travel is no longer the only mode of transmission for the novel coronavirus; community transmission is occurring in a number of provinces.

On March 15, 2020, the Ontario Medical Association strongly recommended social distancing. They also recommended physicians identify and reduce non-essential visits and temporarily put on hold non-essential care and elective surgery to protect all health-care providers, patients and the public, and most importantly, to manage what is expected to be tremendous demand on the system from spread of the virus.

On March 16, 2020, Newfoundland Health Authority directed that all non-emergency appointments at outpatient clinics be rescheduled and has indicated that elective surgeries have been rebooked.

On March 17, 2020:

  • Alberta declared a public health emergency under the Public Health Act.

  • Manitoba’s Chief Public Health Officer, Dr. Brent Roussin, stressed the importance of social distancing.

  • The Nova Scotia Health Authority and IWK Health Centre suspended non-urgent and elective services, limited public gatherings and ordered all bars to close.

  • Ontario declared a state of emergency in order to protect the public.

On March 18, 2020:

  • The Government of British Columbia declared a provincial state of emergency.

  • The Government of New Brunswick has advised all residents to self-isolate.

  • The Government of Saskatchewan declared a provincial state of emergency.

  • Quebec Premier François Legault stressed the need to "respect the rules" and recommendations set forth by health officials to slow the spread of the virus.

What we are doing:

We are actively monitoring the evolving COVID-19 situation to provide updates to our membership, while being cognizant of the fact that public health interventions have the potential to significantly impact fertility care, civil liberties and economic status.

What this means for our members:

It is our hope that specific measures to minimize non-essential contacts with the health care system will reduce transmission to our members, families, and patients, thereby slowing the increase in the number of cases and protecting our medical systems from being overwhelmed. As such, our advice to patients would be that they stay at home if they can and that would include not attending fertility consultations or procedures.

While large government organizations cannot specifically address implementation of public health measures for fertility clinics, CFAS is providing interpretation as it applies to our members and professional behaviour mandates following the provincial government edict. We interpret this as requiring decisive actions by fertility clinics to drastically reduce in-person interactions by:

1. Conducting consultations by telemedicine or phone

2. Completing current IVF cycles but utilizing freeze-all only

3. Suspending all diagnostic and elective procedures and surgeries 

4. Postponing any new cycle starts (IUI, IVF, FET), aside from urgent cryopreservation for oncology, until further notice 

This guidance document will be revisited at least every two weeks, or as more information becomes available, given that the situation is evolving and changing. 

Thank you to each and every one of you for working hard under such challenging circumstances and for doing your part to play a meaningful role in protecting us all. 

Sincerely,

Eileen McMahon, President (2019-2020)

Goldi Gill, Executive Director

CFAS Board of Directors

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Updated March 17th, 2020

Dear Members:

As per the Government of Canada website, COVID-19 (Corona Virus Disease 2019) is a disease that caused an outbreak of respiratory illness, including pneumonia, in Wuhan, China, in late 2019 and early 2020. Since that time, cases have been reported in a number of other areas, including Canada.

There is very little known about the impact of COVID-19 on reproduction and pregnancy. However, pregnancy increases susceptibility to respiratory infections and severe respiratory infections in pregnancy can lead to preterm labour and delivery. As such, we recommend that non-essential travel to areas where an increasing number of COVID-19 cases are being reported should be avoided by patients and their partners.

We recognize that this is a fluid situation and recommend all members monitor public health agencies for official directives and outbreak information.

All those in contact with patients have a critical role to play in helping to identify, report and manage potential cases of COVID-19.  We encourage everyone to follow good hygiene practices, including washing hands often, covering your coughs and sneezes, and avoiding contact with others when unwell.

As further developments in the COVID-19 outbreak and the mitigation strategies to limit its spread emerge, fertility clinics are having to make difficult decisions about what services they will or will not provide, and some are even contemplating closure.

CFAS recommends that each region follow their respective Public Health authority and Government of Canada directives. However, in addition to infection prevention and control strategies such as washing hands often, covering your coughs and sneezes, and avoiding contact with others when unwell, there are other potential strategies you can employ to minimize risk to staff and patients.

These include:

  • Telemedicine for any visits not requiring physical examination including for example consults, reviews, injection teaching appointments

  • Remote options for consent signing

  • Delaying FET cycle starts indefinitely

  • Delaying ETs (implementing freeze-all) indefinitely

  • Reduction of non-essential monitoring visits

  • Telephone screening of patients prior to presenting for appointments

  • In-person screening of patients and visitors upon presentation at clinic

  • Limiting accompanied visitors (partner only if applicable for example) 

  • Staggering arrival times for monitoring appointments

  • Decisions around missed monitoring appointments or cycle cancellation if patient becomes unwell

  • Review of PPE for droplet and contact precautions with all staff

  • Developing emergency preparedness strategies and protocols to account for      

  1. staffing shortages

  2. supply shortages

  3. adherence to directives for closure

  • Identification of COVID-19 Team Leads

  • Increased cleaning of clinic common and consult/exam/procedure spaces 

  • Clinic messaging to patients regarding COVID-19 and impact on care (for example via email or webpage)

Adapted from Bortoletto & Hariton (2020)

With respect to travel, Canada’s Chief Public Health Officer Dr. Theresa Tam has advised that Canadians “postpone or cancel all non-essential travel outside of Canada.” 

With respect to COVID and the risk to the fetus during pregnancy, there is very little data but we support the American Society for Reproductive Medicine’s (ASRM) Bulletin: COVID-19: SUGGESTIONS ON MANAGING PATIENTS WHO ARE UNDERGOING INFERTILITY THERAPY OR DESIRING PREGNANCY. Link here

You may find the following resources helpful:

Government of Canada:

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals.html

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

The Society of Obstetricians and Gynaecologists of Canada (SOGC):

https://www.sogc.org/en/content/featured-news/sogc-statement-coronavirus.aspx

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Updated March 17th, 2020

The CFAS would like to thank the Executive Committee of its Counselling Special Interest Group for providing the following information about coping during these uncertain times.
 
If you are feeling unsettled over recent events regarding COVID-19, you are not alone. Dealing with uncertainty is never easy. And change can be hard for many to deal with at the best of times. In the case of COVID-19, we are experiencing rapid changes and unknown territory. We would like to take this opportunity to share some strategies for managing uncertainty during this challenging time. (See the Coping with Uncertainy page in the menu on the right.)
 

The CFAS cares about your physical health and safety, but also about your mental health and the well-being of your family as we adjust to this rapidly-evolving global pandemic. For this reason, we wanted to share the following important resources with you, which you can also share with patients expressing concern:

Government of Canada Resources for Canadian Businesses:
 
Canadian Federation of Independent Businesses: Information and Helpline (willing to help non-CFIB members) 
 
Managing Coronavirus Anxiety:
 
 
World Health Organization On Protecting Your Mental Health:
 
Free emergency childcare for healthcare workers in Quebec - Information on how to register:
 
Information regarding COVID-19 from the Canadian Psychology Association and resources for anxiety/stress:
 
Tips for those staying home with their children and practicing social distancing:
 
Links from the Canadian Cancer Society regarding cancer and COVID-19 as well as online peer support:
 
 
Mental Health Resources for Students:

We know a long road potentially lies ahead. We are here to support you and want to let you know we appreciate everything you do for your patients and society, not only in a public health crisis, but at all times.

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Updated February 25th, 2020

Dear Members:

As per the Government of Canada website, COVID-19 (Corona Virus Disease 2019) is a disease that caused an outbreak of respiratory illness, including pneumonia, in Wuhan, China, in late 2019 and early 2020. Since that time, cases have been reported in a number of other areas, including Canada.

There is very little known about the impact of COVID-19 on reproduction and pregnancy. However, pregnancy increases susceptibility to respiratory infections and severe respiratory infections in pregnancy can lead to preterm labour and delivery. As such, we recommend that non-essential travel to areas where an increasing number of COVID-19 cases are being reported should be avoided by patients and their partners.

We recognize that this is a fluid situation and recommend all members monitor public health agencies for official directives and outbreak information.

All those in contact with patients have a critical role to play in helping to identify, report and manage potential cases of COVID-19.  We encourage everyone to follow good hygiene practices, including washing hands often, covering your coughs and sneezes, and avoiding contact with others when unwell.

You may find the following resources helpful:

Government of Canada:

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals.html

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html

The Society of Obstetricians and Gynaecologists of Canada (SOGC):

https://www.sogc.org/en/content/featured-news/sogc-statement-coronavirus.aspx