Fertility Treatment Innovations Address Care Amid COVID-19

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During the COVID-19 pandemic, like many clinics around the country, the Massachusetts General Hospital Fertility Center was forced to restrict in-office services like uterine cavity evaluations and ultrasound procedures and more invasive procedures such as egg retrievals. But the team found innovative new practices, including expanding telemedicine offerings, to still offer patients compassionate and innovative care.

"For many of our patients, every week is crucial. The decision to pause certain procedures, while made through the collective wisdom of medical and political leaders, was extremely disheartening for them," says John Petrozza, MD, chief, reproductive medicine at the Fertility Center in the Department of Obstetrics and Gynecology. "We immediately contacted patients and began developing modifications to mitigate COVID-19 delays."

Now as stay-home orders have become less restricted, the clinic is following public health guidelines to develop a "new normal" that builds on practice modifications that were rapidly developed to maintain continuity of care and patient engagement during the pandemic.

Providing a Consistent Level of Care

Mass General's Fertility Center offers services not available in stand-alone clinics, including reproductive surgery and care for high-risk patients with complex medical conditions. Patients benefit from the clinic's ready access to renowned clinicians in disciplines such as anesthesia, embryology and high-risk obstetrics.

"Our patients, female and male, look to us for top-notch care throughout their reproductive life. We treat the most complex fertility cases with phenomenal results. Our goal within the COVID framework became the safe continuation of care wherever possible," says Dr. Petrozza.

Surge Coverage

Like many hospitals, Mass General responded to the surge of COVID-19 patients while managing personnel and equipment shortages. The hospital quickly coalesced around the needs of these patients and supporting its service providers, according to Dr. Petrozza, uniting services that rarely interacted prior to the crisis.

"From the beginning, decisions were made with a mindset of being in this together," he says. "We shut down our practice to make sure our colleagues had coverage. Some of our staff assisted in caring for patients on COVID floors—and we moved quickly to minimize the impact on our own patients."

In March 2020, the issuance of the Massachusetts Department of Public Health directed hospitals to cancel non-essential elective services and the American Society for Reproductive Medicine (ASRM) issued guidance calling for the suspension of new treatment cycles, including:

• Ovulation induction
• Intrauterine inseminations (IUIs)
• In vitro fertilization (IVF) including retrievals and frozen embryo transfers
• Non-urgent gamete cryopreservation
• Cancellation of all embryo transfers and non-urgent diagnostic procedures

Using these parameters, Dr. Petrozza and his team dove into the logistics of juggling support for their clinic's patients and their hospital colleagues.

Expanding Telemedicine

"Two years ago, our clinic was one of the first programs to integrate telemedicine into our processes. Many of our doctors have been utilizing this modality extensively," says Dr. Petrozza. "During this crisis, telemedicine has become the norm, a way to connect with patients that's now second nature to us."

After the onset of stay-at-home orders, the clinic staff conducted an intensive patient outreach campaign, substantially increasing patient and partner participation in telemedicine visits. And as medical translators have shifted to telemedicine, wait times for their services have dropped, increasing efficiency and accessibility.

Modifying Patient Testing

The Fertility Center team developed modified procedures for ongoing testing regimens that can be done in the home, including:

• Semen analysis: Clinic-based sample collection has been replaced with mailed home collection kits. The man collects his specimen at home, the andrologist meets the patient outside the clinic, conducts an identification check and intakes the sample. Initially, the patient never left their car, but now the patient will drop off their specimen at a secure location just outside the clinic attended by one of the andrologists
• Hormone, ovarian function, genetic and prolactin tests: Some of these hospital-based assays have shifted to home collection. A company that previously provided private home testing developed a fingerstick kit that is mailed to patients. Cheek swabs can be used for carrier genetic screening. These samples are then returned by mail to the outside laboratory for analysis

Necessity Motivated More Patients to Engage in Online Activities

The Fertility Center also updated existing technology to support patient communications and education. The Patient Gateway tool, already structured to support and chart HIPAA-compliant email and text communications, was loaded with newly created documents and workflows for staff to follow.

Nurses successfully employed outreach calls to encourage patients to register and use the system. Daily patient orders, medication changes and most treatment communications are almost entirely done through Patient Gateway. Patients actually see a shorter communication cycle, which Dr. Petrozza's team expects will translate into increased patient satisfaction.

The Fertility Center team has also created educational webinars to help provide guidance. Topics include patient- and provider-focused information such as:

• IVF 101
• Preimplantation genetic testing
• Semen analysis
• Surgeries
• Male fertility
• Enhancing natural conceptions

"Our interactive sessions have been well attended," says Dr. Petrozza. "We're able to answer questions and provide detailed information that patients can review and absorb in their own time, contact-free.

Data-driven Resuming of Procedures

As data surrounding COVID-19 risk in pregnancy and childbirth becomes available, the medical community is becoming comfortable with restarting procedures that will result in pregnancy, Dr. Petrozza says. He notes that in counseling patients eager to resume treatment cycles, it's important to explain the limitations of the data when it comes to pregnancy.

As Dr. Petrozza looks to the future, he finds positives in the center's response to COVID-19. The crisis reinvigorated innovations in care provision, helping the practice and patients further adopt 21st-century care delivery.

"The changes we made in response to COVID-19 will allow us to provide world-renowned, responsive care to an even greater number of patients," Dr. Petrozza says. "Telemedicine, home testing and other pipeline innovations will support provisions of care in Boston and even internationally."

Learn more about fertility care at Mass General

Refer a patient to the Mass General Fertility Center