Reopening

Dear medical teams,

Although the data is limited, we got the permission to start up ART treatments based on these facts:

• The risk for vertical contamination in pregnancy is small. • Probably no cross contamination in the embryology lab when handling gametes and embryos. • The pregnancies we initiate will first be delivered 9 month after the corona pandemic. • A pregnant woman does not seem to be more vulnerably during the corona crises than other young individuals. • The recognition, that delaying fertility treatment might cause irreversible damages to the patient in treatment due to loss of fecundity during the waiting time. • The major concern is the cross infection between patients and staff.

As the cross infection is the main concern during the opening of activities in society the following precautions have been deemed acceptable for opening the fertility clinics in a safe way:

In the clinic:

The staff do not shake hands with patients or have any unnecessary physical contact.

Waiting rooms have been re-designed only to have few patients with 2 m distance, most patients entering the clinic will be send to the treatment room immediately. That means the number of patients per hour in the clinic has to be adjusted appropriately. We have removed all magazines, papers, toys etc. in the waiting room and put up hand sanitizer. On the door to the clinic a poster explaining safe behavior has been put up along with a note telling patients not to enter if they have symptoms, but contact the clinic by phone.

All surfaces which the patient has contact with should be cleaned in-between the visits. Doors and other handles in mains arrears should be cleaned regularly. A specific designated person is in charge of this.

A thorough handwash is performed between all patients.

Alcohol for cleaning should be available at all working stations and telephones, computers etc. should be cleaned when a person leaves it.

All tools for protections such as mask etc. should be in place for both patients and staff if necessary.

For the patients:

As many consultations ad possible are conducted via Skype, facetime etc. For consultations in the clinic only the patient/couple are allowed. No family members or others.

We only accept payment by card or bank transfer.

The day before the patients is allowed to visit the clinic they are prescreened by a text message or phone call to ensure they do not have any signs of Corona infection. If in doubt they should talk to one of the doctors before coming. No patients (or staff) with signs of infection should be visiting the clinic. A 48 hours symptom free period is requested.

When the patients enter the clinic they are asked for signs of infection and advised immediately to clean their hands. At the entrance of the clinic and all toilets alcohol are placed.

All patients should be handled by the usual protections such as mask and gloves If a patient during the stay in the clinic shows signs of corona virus they are immediately brought to a designated room for this and taken care of. As soon as possible they have to leave the clinic for proper care and the room cleaned thoroughly.

All patients has to be counseled and informed, that although we do not know the full consequences of the Corona virus and on the basis of the little data we have, we have started the fertility treatment again, as we find it safe. However all patients will have the choice to wait. In this case they are informed that the normal age limits for treatments are postponed until July 2020. So they can wait for embryo donation and frozen embryo transfers.

Staff.

Staff has to be trained in the above mentioned procedures, and no staff should enter the clinic if they have signs of Corona infection. Firs after 48 hours of no symptoms are the again allowed in the clinic.

Documentations and procedures:

In the medical records for the patient documentation for prescreening the day before, screening at the day they are entering the clinic should be noted in the medical record including time and who has been doing this.

An informed consent should be in the medical record stating the little we know about the risk, and the age limits changed during the crises.

All of this has been described in a Standard Operation Procedure including all procedures. This procedure has to be read and trained by all staff members. This training has to be documented and proved valid by inspection from the Health Authorities.