For women hoping to become pregnant, the prospect of putting off infertility treatments during the pandemic is excruciating, and — some doctors say — could potentially make it more difficult for them to ultimately have a child.
But continuing services could be unsafe for clinic staff, according to some employees who question whether infertility treatments should truly be considered essential.
Since mid-March, this debate has unfolded against a backdrop of complex and contradictory regulations that have allowed some doctors’ offices and surgical centers to continue seeing patients while others have had to close their doors.
On March 15, the Massachusetts Department of Public Health mandated the shutdown of “nonessential, elective invasive procedures” at hospitals and surgical centers to allow health care personnel to focus on the coronavirus outbreak and conserve protective equipment. But some infertility treatments can be performed in procedure rooms, or in surgical centers not licensed by the state, putting them outside the ban.
The order also leaves it up to health care providers to decide on a case-by-case basis what must be done to preserve a patient’s health.
Amid the uncertainty and unease, some workers and fertility doctors say all treatments should be postponed. If hip replacements and colonoscopies are being delayed, they say, so should treatments to help women get pregnant.
“I do feel bad for these patients, but it’s not a matter of life and death,” said a nurse who requested anonymity at Boston IVF, a Waltham clinic that has provided some services throughout the pandemic and resumed others last month. “These people will survive if they don’t get pregnant in the next couple months.”
Boston IVF, which temporarily closed almost all of its 28 sites around the country, never stopped offering diagnostic testing such as blood work and sperm freezing at its Waltham site. In early April, it relaunched several services that had been put on hold, including frozen embryo transfers and intrauterine insemination, which are performed in doctors’ offices. And it has petitioned the state to reopen its surgical center and resume in vitro fertilization, a process in which eggs are combined with sperm outside the body.
Fertility Centers of New England, which has offices around the region, including in Boston and Braintree, has continued to offer a full array of treatments, providers and fertility advocates said. The company did not respond to requests for comment.
CCRM Fertility, a nationwide facility with several Boston-area clinics, initially stopped many of its treatments, but began resuming them as the infection rate declined and the American Society for Reproductive Medicine eased its guidance, said Dr. Aaron Styer, founding partner of CCRM Fertility Boston. The surgical center is licensed by the American Association for Accreditation of Ambulatory Surgery Facilities, not the state health department, and is therefore not directly governed by the state, Styer said.
Heather Grey started an IVF cycle a year ago and produced “one little miracle embryo,” but she had it frozen after being hospitalized with a blood clot. Grey, of Falmouth, who is about to turn 43, had been planning to start the transfer process at Boston IVF in March, but was stopped by the shutdown. Grey can now proceed, but she doesn’t feel safe getting a baby sitter for her older children while she and her husband are in Waltham. She’s also worried about getting sick, or getting the staff sick.
This single embryo is their only shot. Grey’s medical condition means she can’t do another IVF cycle, and her husband’s recent cancer treatment rendered him sterile. “My infertility is a huge stress because here comes my birthday,” she said. “Time is my biggest enemy right now.”
With infertility treatments on hold at Massachusetts General Hospital and Brigham and Women’s Hospital, the resumption of certain treatments at Boston IVF generated “huge” interest from patients, according to employees who spoke on condition of anonymity.
While many employees have been furloughed, those still on the job, including office staff, are required to work on-site most days, despite the remote system in place. They must use the same bathrooms, share the same kitchen, and interact with patients in some cases. Doctors, on the other hand, have largely been doing telehealth consultations from home and coming in to perform procedures.
Boston IVF “has their heads in their wallets,” another employee said.
Boston IVF chief executive David Stern denied that money is a factor and said workers who handle sensitive medical information cannot work from home because of privacy rules. Hands-on activities like sorting through faxed lab results and scanning documents also requires workers to be in the office, Stern said, and there’s a great need for real-time interdepartmental communication, which is easier when everyone’s together.
Stern declined to comment on an employee’s assertion that two co-workers have tested positive for COVID-19 and that staff have never been officially informed. The Department of Public Health told the company that employees don’t need to be made aware of positive test results, he said, provided they didn’t have prolonged, direct contact with the infected person.
After resuming procedures performed in doctors’ offices in April with new safeguards — temperature checks, screening questions, limits on patient numbers, social distancing in waiting rooms, mandatory masks — the clinic was “inundated” with calls, Stern said.
“We felt that the office procedures offered little risk for transmission while providing patients with the medically necessary treatment," said Stern, noting that waiting even a few months could mean the difference between a woman becoming pregnant or not.
“We make all of our decisions based on the medical needs of the patients, not on the business needs,” he said. “We don’t feel that infertility is an elective condition. The biological clock doesn’t stop for COVID.”
MGH and Brigham and Women’s, on the other hand, are only conducting infertility treatments on cancer patients who may not be able to conceive after their treatment. MGH even arranged for at-home blood tests and curbside semen dropoff.
Elizabeth Ginsburg, medical director of assisted reproductive technologies at Brigham and Women’s, acknowledged that infertility treatments are in a “hazy gray zone."
“Could you wait a month to do treatment?” she said. “Sure. You’re not putting your life in jeopardy. . . . But you may be jeopardizing your ability to have a biological child.
"I kind of get why programs would be tempted to stay open, but I don't think it's the right thing to do from a public health standpoint."
Reproductive health advocates have been actively pushing states to resume procedures. A letter sent to Governor Charlie Baker from Newton-based Fertility Within Reach and other groups said infertility is a disease that may not be overcome if not treated in a timely manner. A petition on change.org said women whose ovaries don’t function properly “should have the same opportunities to conceive that any other person would have."
On April 7, the New York health department issued an advisory clarifying that reproductive services, ranging from fertility treatments to abortions, can proceed. Several states have tried to ban abortions as part of orders forbidding elective, nonessential procedures. In Massachusetts, abortions are considered essential.
Angela, 32, was scheduled to start her fourth cycle of IVF in April and is relieved that her clinic, CCRM in Newton, has started ramping up IVF again. Angela, who didn’t want her last name used, doesn’t produce enough eggs, a condition that can deteriorate over time, and this is her last shot at IVF. So last week, she donned a face mask and went to the clinic.
“I could possibly be at risk," she said, “but for me right now, I don’t have any choice.”