Guidance on Fertility Treatment during Level 4 Lockdown | 4 May 2020

May 4, 2020

Dear SASREG Member

The President of South Africa has announced a staged reopening of the economy during the COVID-19 pandemic. From the 1st of May South Africa moves from level 5 to level 4 lockdown. The regulations were gazetted on the 29th of April. All medical and veterinary services are allowed during level 4 lockdown. Therefore, a progressive stepwise resuming of all fertility services is acceptable. The concerns regarding the reopening of fertility services are:

  1. Spreading of the SARS-CoV-2 virus must be prevented as much as possible.
  2. Infertility is a disease that leads to disability and is an essential service. Reproductive rights of patients must be respected.
  3. Safety of patients and staff must be optimized.

We are following the guidance from other Fertility Societies who are faced with similar challenges of reopening fertility services.

SASREG has made four guidelines on COVID-19 and ART and they are published on the SASREG website.

  1. The first guideline was published on the 19th of March. This was a general guideline to do IVF in a safe way. https://sasreg.co.za/guidance-on-fertility-care-and-surgery-during-covid-19-19-march-2020/
  2. The second guideline was published on the 24th of March. This was the day after the President of South Africa declared a national lockdown. This guideline recommended a suspension of all non-urgent fertility services. https://sasreg.co.za/guidance-on-fertility-care-and-surgery-during-covid-19-240220/
  3. On the 10th of April, we published a legal opinion that defines infertility as an essential service and that legally urgent ART can be performed during the national lockdown if the clinical director finds it indicated. https://sasreg.co.za/guidance-on-fertility-care-during-covid-19-10-april-2020/
  4. A detailed document was published on the 24th of April: https://sasreg.co.za/sasreg-covid-19-art-guidelines-update/

 

What is allowed during level 4 lockdown?

It is the opinion of SASREG that all fertility services, including IVF and egg donation, are allowed to proceed during level 4 lockdown. All protective measures for staff and patients that have been published in the SASREG update #4 are still valid and need to be followed. It is, however, still the responsibility of the reproductive specialist to assess each case on its merits and to discuss the treatment options with the patient. All Fertility Units, freestanding or as part of a hospital, needs to abide by regulations as stipulated by the Department of Health and the NICD. Fertility Clinics part of a hospital group needs to adhere to regulations stipulated by hospital management.

Directors of fertility units have the obligation to secure a safe environment for patients and staff and to implement risk reduction strategies during this COVID-19 pandemic. It is advised that all fertility units have a written procedure in place to describe their risk reduction strategies.  This protocol should include a section on staff safety. Additionally, a disclosure and consent document specific to staff, depicting the risks involved and responsibilities of both the employer and employee, is suggested.

 

Patient counselling

All patients must be carefully counselled of the risks and benefits of proceeding with fertility treatment. This counselling must include the potential pregnancy-related risks, the transmission of SARS-CoV-2 virus, cancellation of treatment and all other concerns. All patients should sign a specific COVID-19 consent form. Download the example of a Disclosure and Consent Form.

 

Testing of patients

All patients should be tested for COVID-19 before an ART procedure.  The recommendation on the guideline to read that all patients should be screened every time they visit the Unit/Hospital and be tested with a PCR for SARS-CoV-2, 3 or 4 days before oocyte aspiration (approx. D10-D11 of the cycle).

 

Screening and testing of staff

The DoH has made guidelines for symptom monitoring and management of essential workers for COVID-19 related infection and these must be strictly followed. Download a copy of the DoH “Guidelines for symptom monitoring and management of essential workers for COVID-19 related infection”. These guidelines are applicable to all essential services workers covered by regulation GN R.398 of Government Gazette 43148 under section 3 of the Disaster Management Act, 1957 (Act 57 of 2002) as amended on 25 March 2020.

This letter was prepared by the SASREG BOARD: Dr Jack Biko, Prof Igno Siebert, Dr Nomathamsaqa Matebese, Dr Sagie Naidu, Dr Victor Hulme, Dr Gerhard Hanekom, Dr Yusuf Dasoo, Dr Abri De Bruin, Dr Chris Venter, Mrs Gloria Raidani, Mr Gerhard Boshoff, Mrs Mandy Rodrigues and Dr Sulaiman Heylen.

 

Yours sincerely

Dr Sulaiman Heylen and Dr Jack Biko