Objective
On March 17th, ASRM published guidance for REI clinics regarding infertility treatment during the COVID-19 pandemic. The recommendations advised against initiation of new fertility treatment cycles outside of emergent fertility preservation. Our objective was to evaluate what SART-member fertility clinics communicated to the public and their patients via clinic websites during this time period.
Design
Cross-sectional study.
Materials and Methods
Between 4/20/20 and 4/24/20, SART-member fertility clinic websites were reviewed for REI-specific COVID-19 messages (REI-CM). The REI-CM was evaluated for: type of treatment offered, and to whom; adherence to updated ASRM guidance; and citation of ASRM (or other) guidance. Each website was evaluated by two reviewers and arbitrated by a third in the case of discrepancies. Practice size, type, and location were abstracted from SART. Clinics were classified by whether they were under a shelter in place (SIP) order and the duration of that order. Chi squared analyses were performed to determine associations between clinic demographics and patterns in messaging.
Results
381 SART-member clinics maintained active websites. Of those, 249 (65.3%) had REI-CM. The presence of REI-CM was more common in private than academic practices (73% vs 38%, p<0.001) and with increasing practice volume: 38% of clinics with <200 annual cycles vs 91% of clinics with >1000 cycles (p<0.001). There was a trend toward increased REI-CM use in states with a SIP order for ≥30 days (70% of 212, p=0.064).
ASRM guidance was cited in 61% (n=152) of REI-CM; however, only 33% (n=82) outlined treatment practices that reflected ASRM guidance published at the time of the data extraction. Adherence to ASRM guidelines was more common in academic than private practices (54% vs 31%, p=0.02) but was not correlated with size of practice or geographic region.
Conversely, 18% (n=44) of practices announced treating patients on a “case-by-case basis” with definitions ranging from specific (“women with AMH <0.7”) to vague (“as determined by our providers alongside our patients”). Additionally, 9% of REI-CM (n=23) announced continued treatment regardless of a patient’s clinical urgency. This messaging was more common in groups doing >1000 cycles a year (18%, p=0.009), with a trend toward practices in the northeast (16%, p=0.113) and in states with SIP orders lasting <30 days (14%, p=0.09). Clinics treating all-comers were less likely to cite ASRM than other clinics (41% vs 62%, p=0.045). However, 75% (n=14) cited COVID-19 guidance from WHO, CDC and state and local governments.
Conclusions
While public messaging may not reflect the actual practices of a clinic, this study reveals heterogeneity in how clinics incorporated ASRM recommendations and responded to the early stages of the COVID-19 pandemic. Academic practices were more likely to indicate their adherence to ASRM recommendations. High volume groups were more likely to communicate with their patients about what treatments they offered and to treat patients outside ASRM guidance. Lessons learned may inform optimal response in future waves of COVID-19.
References
American Society for Reproductive Medicine. Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic. Available at https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforceupdate2.pdf. Accessed on May 26, 2020
P-170 4:30 PM Saturday, October 17, 2020