Resuming assisted reproduction services during COVID-19 Pandemic: An Indian experience
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Abstract
Purpose
The pandemic of COVID-19 has affected many countries; and medical services including assisted reproductive treatment (ART) have been hampered. The purpose of the study was to assess the preparedness of ART clinics and staff to resume services; patients’ reasons to initiate treatment and key performance indicators (KPIs) of ART labs during pandemic.
Methods
Semi-descriptive report of two private in-vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. Time required for replenishing laboratory supplies, and staff preparedness to function under ‘new norms’ of pandemic was documented. Infection mitigation measures at workplace and triaging strategy were evaluated. KPIs of the clinics were evaluated.
Results
30% of the patients consulted through telemedicine accepted or were eligible to initiate treatment upon clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and only 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands could be achieved within a week, but supply of consumables was a major constraint. 52 cycles of IVF were performed including fresh cycles and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval was associated with reduced procedure time and no intervention for airway maintenance, compared to general anaesthesia. Self reported pain scores by patients ranged from nil to mild on a graphic rating scale.
Conclusion
This study provides a practical insight and will aid in forming guidelines for resumption of IVF services during pandemic.
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SciScore for 10.1101/2020.09.20.20198143: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Informed written consent was obtained from couples for planned treatment and for IVF during COVID-19 pandemic. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable All women received human Chorionic Gonadotropin (HCG) as trigger. Table 2: Resources
Software and Algorithms Sentences Resources The data was prospectively maintained in Microsoft excel. Microsoft excelsuggested: (Microsoft Excel, RRID:SCR_016137)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We …SciScore for 10.1101/2020.09.20.20198143: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Informed written consent was obtained from couples for planned treatment and for IVF during COVID-19 pandemic. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable All women received human Chorionic Gonadotropin (HCG) as trigger. Table 2: Resources
Software and Algorithms Sentences Resources The data was prospectively maintained in Microsoft excel. Microsoft excelsuggested: (Microsoft Excel, RRID:SCR_016137)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:As the time span of pandemic increases, understanding of utility, constraints and limitations of different tests for SARS-CoV-2 is increasing [35,36]. Failure to appreciate the lacunae of various tests and undue reliance on them may prove to be detrimental for the ART program [33,35]. OPU is the only step in IVF during which considerable time is spent in close proximity to patients. Many different types of anesthesia or analgesia are equally effective in achieving patient comfort during OPU [37,38]. The findings of this study show that the procedure time is significantly less with CSA compared to GA for retrieval of similar number of oocytes. Reduced procedural time and no intervention for airway maintenance have important implications in this pandemic with a respiratory virus. Considering that the pain score was low and patient satisfaction was high, this is a useful strategy to mitigate the infection risk to health care professionals, in addition to use of appropriate PPE. Success of ART depends on the clinical and laboratory performance indicators, which benchmark the clinic’s performance. The additional challenges for IVF during this pandemic are the anxieties, added responsibilities and concerns faced by the IVF team adversely affecting the KPIs [20,28]. We evaluated these less often reported parameters and found that despite new and diverse responsibilities the stimulation and laboratory parameters were consistently above the competency level or approaching benchmark le...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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