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COVID 19 Update – January 15, 2021

I continue to follow ASRM guidelines and state and local authority directives.   Links to the American Society for Reproductive Medicine (ASRM) Patient management and clinical recommendations during the coronavirus (COVID 19) pandemic and the following updates are found at the bottom of this page.

COVID-19 Vaccinations are now available, what should I know?

On December 11th, 2020, the FDA issued the first EUA approval of a SARS-COV-2 vaccine in the U.S. for the Pfizer-BioNTech COVID-19 vaccine to be distributed in the U.S. for individuals age 16 and older. On December 17th, 2020 he FDA issued the second EUA approval of a SARS-COV-2 vaccine in the U.S. for the Moderna COVID-19 vaccine.

The Pfizer and Moderna vaccines are both mRNA vaccines that do not contain live virus. Both these vaccines require a two-injection series at 21-day (Pfizer-BioNTech) or 28-day (Moderna) intervals. The vaccines deliver mRNA into cells near the injection site. This mRNA instructs the body’s own cells to replicate the coronavirus’s spike (S) protein. This protein, in turn, is recognized by the body as foreign, generating protective antibodies. The mRNA itself is rapidly degraded and does not enter the cell’s nucleus. Rarely, some individuals could be allergic to a part of the lipid nanoparticle known as polyethylene glycol (PEG), a common component in other injectable medicines. Consequently, caution is advised when administering the vaccine to those individuals who have experienced severe allergic reactions to prior vaccines or injectable drugs. 

 

Should I get one of the COVID-19 vaccines?

The American Society for Reproductive Medicine (ASRM) Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating (1,2,3). Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered. Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies. It should be noted that pregnant and lactating women were excluded from the initial phase III trials of these two vaccines,so specific safety data in these populations are not yet available and further studies are planned. These recommendations are in line with those of the Advisory Committee for Immunization Practices (ACIP) of the U.S. Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM). 

 

After I get vaccinated do I still need to wear a mask?

 It is not yet known whether a vaccinated individual can spread the virus if they become infected with SARS-COV-2.   Protective immunity against COVID-19 takes time to develop, and although a two-dose regimen of the Pfizer-BioNTech vaccine is 95% effective against the development of COVID-19, it does not confer 100% immunity.  For this reason, the current mitigation strategies for controlling the pandemic – universal masking, physical distancing, limiting social interactions, and frequent sanitizing measures – continue to be necessary.

Dr.  Levrant received the Pfizer-BioNTech COVID-19 vaccine first dose on December 17, 2020 and second dose on January 7, 2021.  Most of the Partners in Reproductive Health staff have received at least their first dose of the Pfizer-BioNTech COVID-19  or Moderna vaccine in January 2021.

Infertility is a disease, not an elective procedure, and delay of treatment can have serious medical and mental health consequences.  COVID 19 will be with us for some time, even as the COVID-19 vaccinations are starting, and we can not delay treatments indefinitely.   There are big gaps in knowledge regarding the impact of COVID 19 on both patient response to fertility treatment and on early pregnancy, prospective research is critically needed, but retrospective reports are encouraging.  The risks in initiating fertility treatment during this pandemic are not yet well understood.  Women who are infected during pregnancy may experience increased risk of miscarriage, stillbirth, preterm birth or birth defects due to severe illness, the impact of COVID 19 on pregnancy is unknown.  Women with underlying medical conditions (e.g. hypertension, diabetes, obesity) may face an increased risk of complications if they become infected.

This IVF center stopped ALL new treatments, diagnostic testing, and IVF cycles from March 20 through April 30th.  I did no IVF egg retrieval or embryo transfer during that time period, in an abundance of concern for our patient’s, and our staff’s safety.  I started doing telehealth office visits (new patient and established patient consultations) in April..  No patients were seen in either office in April 2020.

The IVF center in Tinley Park reopened May 1, 2020.  The Munster office reopen was May 29.  Fertility treatments resumed after May 2..  IVF procedures resumed the week of May 11 with a reduced schedule.    Outpatient surgeries (laparoscopy, operative hysteroscopy) primarily done at the Tinley Woods Surgery Center, resumed after May 11, 2020.  Office consultations were telehealth only April and May 2020.  In office consultations resumed in June 2020.

A number of modifications, designed for patient and staff safety as well as compliance with medical society and state and local authorities guidelines were instituted and have evolved over time.  Our number one concern is the safety and well being of all the patients we care for and for all of our staff.  We have been fortunate, with no staff members infected with COVID-19, and no evidence of SARS-COV-2 infections linked to our fertility center. 

The following applies to the Tinley Park office and IVF center

  1. I ask all patients to call the office (708-532-7017) or text (via the OhMD app) when you arrive in the parking lot, before exiting your car.  Please remain in your call until you are contacted and instructed to enter the office.
  2. Upon entry into the offices of Seth Levrant MD dba Partners in Reproductive Health all staff members and  patients are screened for COVID 19 by aid of our COVID 19 Questionnaire (respiratory symptoms and travel) and a temperature check.  This was implemented March 23, 2020.
  3. All patients entering the offices are REQUIRED to wear a face mask or covering.  Any one without a facemask will be asked to leave.  Unfortunately we can not provide face masks or PPE to patients or other visitors.
  4. Only patients are currently allowed to enter the office.  Any accompanying person should remain in the car, unless given permission by our office to enter.
  5. Any person who presents symptoms of COVID 19 (an elevated temperature above 100.4 F and or respiratory symptoms such as  cough, shortness of breath) will be asked to leave.  Any such individual (patient or staff member) is instructed to seek follow up care with their primary care physician or COVID 19 testing location or urgent aid center.  SARS-CoV-2 testing, whether for viral RNA or serology for antibodies, is not a service provided in this clinic.
  6. Any person with recent travel outside of the country who has not self isolated for 14 days (and is not symptom free) will be asked to leave the office and reschedule.
  7. The ability of patients or staff to return to work or start/resume treatment within our offices are determined by CDC and state or local authorities guidelines and subject to change as more information is available.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/return-to-work.html

  1. All persons within the office, staff or patient, should follow social distancing guidelines at all times unless it is not possible due to medical treatment or procedure (e.g. blood draw, ultrasound, IVF procedure).
  2. We have removed all but four chairs from our reception room so all chairs are 6 feet from each other, doorways, and the reception desk.
  3. We have touchless payment options available to handle copays and other payments.
  4. After checking in with our front desk and handling any payments all patients are to WASH their hands, before sitting down or moving to an exam room.  By washing hands and wearing a facemask or covering, our goal is minimise contamination and transmission of  COVID 19 from any touched surfaces within our office.  This is a complement to our enhanced disinfection practices.
  5. We ask for your cooperation with your movement within the office and please wait for directions from staff.  This is to ensure your safety, the staff’s safety, and safety of all other patients.
  6. While we are resuming treatment with modifications to minimize risks as best we can, this is not intended to imply there is no risk of contracting COVID 19 disease traveling to or within our offices, or that there are no risks associated with COVID 19 disease and fertility treatments, pregnancy, or your or your future child’s well being.

The following applies to the Munster office.

  1. This is a shared office space and a smaller office space which limits our ability to implement some the changes done in the Tinley Park office.
  2. Appointments are scheduled further apart to reduce interactions between patients.  We ask everyone to practice social distancing within the reception area.
  3. Facemasks are MANDATORY for entry into our office, and should be worn at all times.  Please refrain from eating or drinking while in the office.
  4. We have touchless payment options available to handle copays and other payments.
  5. Only patients are currently allowed to enter the office.  Any accompanying person should remain in the car, unless given permission by our office to enter.
  6. Any person who presents symptoms of COVID 19 (an elevated temperature above 100.4 F and or respiratory symptoms such as  cough, shortness of breath) will be asked to leave.  Any such individual (patient or staff member) is instructed to seek follow up care with their primary care physician or COVID 19 testing location or urgent aid center.  SARS-CoV-2 testing, whether for viral RNA or serology for antibodies, is not a service provided in this clinic.
  7. After checking in with our front desk and handling any payments all patients are to WASH their hands, before sitting down or moving to an exam room.  By washing hands and wearing a facemask or covering, our goal is minimise contamination and transmission of  COVID 19 from any touched surfaces within our office.  This is a complement to our enhanced disinfection practices.

These are trying and difficult times for all of us. It is hard to imagine of anyone who has not been affected by COVID 19 in one way or another.  Stay safe, stay healthy, be smart about this disease, but don’t forget to live your life.  As our communities reopen, it is important to remain vigilant, maintain social distancing, and wear a mask or fascial covering when in close proximity to others. 

Best wishes to all. 

Seth Levrant MD

 

Partners in Reproductive Health