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Saturday, 16 May 2020 06:03

Fertility decreases monthly as IVF access is limited

Following the cessation of all fertility services (except fertility preservation for cancer patients) on 23 March 2020, fertility patients have been waiting to learn when they will be permitted to recommence treatment.

For many, this has been a time of anxiety and frustration. One IVF consultant reports having had to make mental health referrals during the lockdown for patients who are suffering mentally and emotionally as a consequence of their treatment being postponed.

This anxiety is particularly acute for those whose treatment outcomes are time-sensitive: for some patients, the delay might be the difference between success and failure.

The government's decision to allow an additional two years storage of gametes and embryos for patients having fertility treatment during the pandemic will help some, but for many will not redress the impact of halting treatment on their outcomes.

Dr Marco Gaudoin, medical director at Glasgow's GCRM clinic, explained to the BBC: 'Statistically from the age of 34 onwards, for every month that passes your chances drop by around 0.3 percent. So after six months it's about two percent... If you are only starting at a level of 14 percent chance of it working and six months later you are down to 12 percent.'

As we begin to see the tide turning, we must now consider when, how and for whom, treatment will begin again.

The Human Fertilisation and Embryology Authority (HFEA) confirmed on 1 May that fertility clinics will be able to apply to reopen in the week beginning 11 May 2020.

Sally Cheshire, HFEA chair, acknowledged the distress cessation had caused, and emphasised that the HFEA's 'priority throughout the pandemic has been to consider how treatment could resume quickly and safely for as many patients as possible' and their 'clear plan sets out how clinics can treat and care for patients safely during the continuing COVID-19 pandemic.'

The HFEA is issuing revised directions which will require centres to develop a written COVID-19 strategy before resuming treatment provision. This should detail how COVID-19 risk will be managed, including compliance with current guidance on safe and effective treatment and how treatment will be delivered in a manner that mitigates risk for both staff and patients.

The resumption of fertility services raises numerous ethical questions that will need to be addressed. The most fundamental is whether, in the face of the risk to life and health posed by the pandemic, IVF treatment is sufficiently important for it to recommence if doing so might undermine response efforts. Given that the UK continues to endure the economic, emotional, physical and social burdens of lockdown to reduce the impact of COVID-19 – central to which is social distancing – restarting IVF services will necessarily entail contact of some kind. Even with protective measures in place, this creates risk for staff and patients, and potentially contributes to the ongoing spread of the virus. We need to engage with whether this is a risk worth taking, for staff, the wider community, and for the sake of patients wanting to have children.

Staff will need access to adequate protective equipment and supplies, such as hand sanitiser and disinfectants. When there is considerable pressure on supply of such equipment, there are hard questions to be asked about where they are best deployed and whether it is right to use scarce supplies for IVF if it undermines availability in other contexts.

Bringing centre staff back into work may place them at risk of contracting COVID-19 from patients. At present, furloughed staff's salaries are protected, but if centres re-open too quickly, there will likely be an expectation (or requirement) that staff return to work. For some – especially those from households including people at high-risk – this will create a stark choice between being exposed to risk or refusing to work and losing their employment.

However, against each of these issues, there is much to be balanced. Centres are currently facing substantial economic pressure, and recommencing operations will enable them to maintain their business and keep workers employed. On the use of scarce resources, it may be that supplies improve, or that centres can operate effectively without substantial use of such equipment.

And of course, the importance to patients of pursuing their reproductive goals must be considered. It is demonstrably clear that having children is highly important to many people, and this is particularly true of those who pursue fertility treatment. To prevent them accessing that treatment is potentially harmful, but for most a few months delay will not be fatal to their chances of having children. It depends very much of the age, condition and situation of the patient.

It is welcome that the HFEA is developing clear guidance on what centres must do to address safety concerns. It is also welcome that centres will not be permitted to open without meeting these requirements, and that an auditing tool for ensuring compliance will be used.

However, we might wonder how likely it is that staff will have access to adequate personal protective equipment (PPE) (which the Department of Health and Social Care (DHSC) has said will be made available), given the track record so far on the adequacy of supply of PPE. In order to protect both staff and patients it is vital that the government does provide the PPE needed to support the strategies for safe provision of services that centres put in place.

It is unlikely that centres will be able to open at the same capacity as previously, given the constraints that social distancing and availability of PPE will place on them, particularly NHS clinics.

'The procurement of PPE required at increased levels and the supply of some medications and consumables may also have an impact on centres' abilities to resume work as well as their capacity when they do,' the British Fertility Society pointed out. 'The work undertaken in centres, their local facilities and capacity and their NHS status and commitments are very varied, the timing of opening for each is likely to be quite different.'

Some patients, particularly at private clinics, will see their treatment resume before others. The DHSC has recognised that private clinics will be better able to adapt quickly, and has pledged to work on ensuring there is no inequity in access. However without proactive steps, NHS patients will be likely to receive treatment less quickly than those in private care. The DHSC should consider ways to support NHS clinics to adapt as rapidly as possible.

Regardless of adaptation speed, it is unlikely centres will return to full capacity. How, then, ought they to prioritise patients? Who should be treated first?

Older patients face much greater time pressures, but such patients may well also have lower chances of success, and if access to services is now more limited, these factors must be balanced. If older patients are given priority on the assumption that their chances are decreasing faster, other patients pushed further down the waiting list will be exposed to the same time pressure risks.

Clinics will need to strike a delicate balance based on need and evidence about the impact of waiting to determine who to treat first. Ideally, those who can bear a delay should have their treatment postponed, enabling those who cannot to be treated first. Prioritisation decisions should be evidence-based and applied equally across patients, although discretion will clearly be needed to deal with individual cases and space should be left for clinical judgments to be made by each centre.

Such an approach is most likely to ensure the best overall outcomes for the greatest number.

Even with clinics taking steps toward reopening, many patients will need to wait longer for treatment, and for some, this will reduce their chances of having the baby they hope for. This will be deeply distressing, and centres must do what they can to give the most people the best chance of achieving their reproductive goals.

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We have been very satisfied, I have been comfortable at the clinic and with my doctor. I was heard. I could ask any questions. I like you have hu-mor, despite the circumstances. Great clinic. Your service has been very good. You have been a huge support and very spacious. You have been available 24 hours a day. You have the answer to all the questions we have been asked. You have accommodated our nervousness, you have rejoiced with us, you have been there throughout. I could not have wished ...
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The communication with surrogate is easy and better than what we expected. The updates are provided as scheduled with occasional surprises
S
The support was great. It was easy on us that the coordination was done by the delivering dreams team while being completely transparent with us on the progress. The communication with the delivering dreams team was always fast, responsive, and easy.
E and K
Thank you kate. You have been great today and all the other days ❤ you are a great team. We are very satisfied and happy for your help.
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We were confident before in our choice, but this experience has confirmed beyond any doubt that we choose the best agency.
Doyles
I loved working with Susan and her team and highly recommend them to anyone considering her services. She's is great at every aspect of a process and knows how to handle delicate matters.
Diana Lyakhovetska
Susan truly understands the needs of parents using surrogacy, and offers comprehensive emotional support to parents as they experience the journey!
Christine Hughes Pontier
The team at Delivering Dreams is amazing! Their attention to detail and ability to put your mind at ease while growing your family is like none other. They handled everything for us, and I never once doubted they would help us accomplish our dreams.
Margaret Jones
I’ve known Susan for several years now, and I’ve always been impressed by her attention to her clients’ needs. I’ve known her to work ardently and diligently to solve whatever challenges, no matter how unique, that prevent her clients from completing their families. She is a problem-solver, and she earnestly believes in providing the best options and in making surrogacy opportunities realities: this is not merely a business for Susan. She will help customize the process for your needs and to ...
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Mary Woods
Susan has a keen sense of business and goes to the max to solve her clients’ problems. She is super knowledgeable on business, laws and how things work in surrogacy in general, and specifically on Ukrainian surrogacy. She is an advocate for transparency in a market that’s often opaque and full of hidden risks. I really enjoyed working with Susan. She really pays attention to detail and was always looking out for my best interest above all. Highly recommend!
Laurie Tham
Delivering Dreams goes above and beyond what other surrogacy agencies offer. After speaking with Susan, I see how they anticipate every part of the process, down to details that I had never even considered. I didn’t know what I didn’t know! Surrogacy can be really complicated and confusing. What an amazing sense of relief to have a company so dedicated to managing the WHOLE process and taking away as much of the stress as possible.
Kate Varness
I have gotten to know Susan through a group where we are members. I have found her to be a genuine and caring person. Her consideration for others and love of her work with Ukrainian surrogates and parents-to-be are evident in all her decision making. She is passionate about being a force for the greater good and helping where she can. I have been amazed at the way she is able to smoothly navigate the complicated maze of requirements in the surrogacy process. I am happy to give her my highest...
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Rose Anne Barbour Huck
Susan Kibler is kind.  She clearly loves those she works with and loves what she does.  Susan listens deeply and compassionately and can make you laugh all in the space of one conversation.  She is wonderful!  If you are feeling worried, she'll hear you.  If you have questions, she will find answers for you. If you need help, she does her very best to support you.  I feel so fortunate to have found her and imagine you will too.
Frances Russell
Susan has the ability to really connect on a personal level quickly.  I have found her easy to talk to and have been so grateful for her guidance.  She is one of those people who offers so much to her clients.  She sees the big picture and has a heart for the most intimate concerns.  She is highly skilled and able to manage what can certainly be challenging and uncomfortable experiences, making them feel easier.  She will take charge at the perfect times and guide you when you really need her...
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Susan Seare
The international surrogacy world is complicated. Susan Kibler knows its ins-and-outs. She knows the people and outfits you can trust and the ones to avoid. She insists on the best for her clients and handles the details so they don't have to worry about them. If you want to take the international surrogacy journey, you can trust Delivering Dreams International Surrogacy Agency to guide you on that path.
Nancy Linnerooth
My friend and I had a positive experience working with Susan. Susan is always super responsive and caring. She is very professional, helpful and reliable. My friend has soo much troubles trying having a baby for many years. My friend and her husband were about to give up their dream of having a baby. Susan Kersch Kibler found the way to help. She has unlimited energy, attentive to detail and super efficient. Great to work with!
Polina Clend
Susan is passionate about helping people become families. She is a trustworthy confidant to have on your side.
Kristen Ancker
Our experience with Delivering Dreams has been overwhelmingly positive. The team seems to be genuinely dedicated to helping us to realize our dream of having a child. The constant communication leading up to the trip and the numerous touch points made us feel comforted in what has been a very challenging and uncomfortable situation. We always had streamlined communication through the group chat and was frequently checked on during our stay.
Marilyn

Under Ukrainian law, surrogacy is a legal affordable option for traditionally married couples to have children using their own embryos, or with either an egg or sperm donor. There must be a medical reason you can’t carry a child. You are also able to participate if you have had 4 unsuccessful IVF attempts.

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Under Ukrainian law, surrogacy is a legal affordable option for traditionally married couples to have children using their own embryos, or with either an egg or sperm donor. There must be a medical reason you can’t carry a child. You are also able to participate if you have had 4 unsuccessful IVF attempts.