An open letter to members of the British Fertility Society and the Association of Reproductive and Clinical Scientists and Persons Responsible for UK Licenced Fertility Services

Dear Members and Colleagues,

As the COVID 19 pandemic hit the UK there was increasing pressure for principled thinking around what this meant for fertility services. Jane Stewart and Raj Mathur (Chair and Chair Elect of the British Fertility Society) wrote an opinion piece for Bionews1 and the BFS with the Association of Reproductive and Clinical Scientists (ARCS) published a brief statement to their members2. Both encouraged Centres to look at their services and how they could adapt as public health advice changes and to ensure they had contingency plans in place – recognising that services would of necessity be pared down to a minimum level of activity e.g. maintenance of storage banks. We committed to a guidance paper to follow.

Although the European Society of Human Reproduction and Embryology (ESHRE) had already made recommendations to cease treatments in their published guidelines3 (14th March) BFS and ARCS, recognising that the UK National Strategy was deliberately less stringent, did not make firm recommendations to stop treatment. We believed there was yet time to begin to prepare for change. This statement was welcomed by the Human Fertilisation and Embryology Authority (HFEA) and the Royal College of Obstetricians and Gynaecologists (RCOG).

On the same day the Prime Minister announced a change in public policy – social distancing was introduced along with cancellation of mass gatherings in response to a significant increase in confirmed cases of COVID 19. London in particular was seen as a hot-spot, perhaps in advance of the rest of the country. Pregnant women were identified as a ‘vulnerable’ group and advised to reduce social contact.

On 17th March the American Society for Reproductive Medicine (ASRM) published guidelines advising cessation of all fertility treatments4.

BFS and ARCS Guidance was published on the evening of the 18th March reflecting the change in public policy and other nations’ guidance. We recommended cessation of all new treatments knowing that many centres were already enacting this and expecting that all would follow suit. Peter Thompson, Chief Executive of the HFEA wrote to all licenced centres confirming that the regulators expected BFS and ARCS guidance to be followed.

BFS and ARCS are aware that the limited evidence so far is that risk for pregnant women is probably no greater than if they had not been pregnant, and that there does not seem to be a particular risk to the fetus (although there appear to have been reports of peri-partum transmission to newborns). We have not advocated an immediate ban on treatment but an appropriate winding down to cessation in a managed way, which should be achievable within a three-week timeframe. Centres will work to their own policies on how to manage this, as well as minimisation or cessation of their outpatient and diagnostic activities. We have been most grateful for the positive response to our guidance from colleagues in both NHS and Private settings. We have been struck by how colleagues understand that these are extraordinary times for the nation, and how as health professionals we have a duty to help the national response to this crisis. Similar sentiments have been expressed by US colleagues5. Concern and anxiety in these conditions is to be expected; in some centres teams are being split up and redeployed to aid in the fight against the COVID-19 pandemic, whilst in others there are fears around job losses and business failure. The scale and speed of the UK Government response to the outbreak should demonstrate the severity and scale of the task ahead to all.

In recent days we have been presented with potential alternative ways of working in times of social distancing. Fertility and Sterility published an article written by reproductive medicine specialists in Italy describing changes in their practice in response to the COVID-19 outbreak6. This has been shared widely on social media. In addition, the Australian Fertility Society has produced guidance for ongoing fertility treatment7. We are aware that some colleagues are preferring to take a less restrictive approach and that is in part driven by patient wishes as well as business position.

Given the daily escalation of restrictions on public movement and the increasing pressure on NHS facilities particularly in London and North West England, coupled with predictions that the crisis will continue to intensify for at least the next twelve weeks, the BFS and ARCS stand by their recommendations that centres in the UK work to cease treatments. We are however committed to review our guidance as the situation progresses, with reference to national advice and new evidence as it emerges and hope to work with colleagues over coming weeks and months to consider how and when best to resume normal activities.

We will keep our guidance under review as the situation develops and will publish amendments as necessary in coming weeks and months. As always, we welcome views of colleagues in the specialty, whether members of the Societies or not.

Thank you for your ongoing support and collaboration,

Jane Stewart
Jason Kasraie