Objective
To significantly reduce the number of in person visits during an IVF cycle without compromising cycle outcomes, patient safety, or patient satisfaction.
Materials and Methods
This was a multi-modal QI initiative at an academic fertility centre. After the temporary closure of many fertility services across IVF clinics in North America in March 2020, we identified that new policies and procedures were necessary in order to safely resume patient care during a pandemic. The primary intervention of this study was a change in our IVF monitoring protocol. Our default settings in our electronic medical record order sets were changed, and education sessions were held for clinic staff. Baseline data was collected from 2019 for comparison. A patient satisfaction survey using a 5-point likert scale was created and sent to every patient undergoing IVF on the day of their oocyte retrieval.
The number of in person visits during an IVF cycle were counted for each patient undergoing treatment from June 2020 to August 2020. This was compared to the number of in person visits during the same time frame in 2019. Balancing measures included patient satisfaction, pregnancy rates, risk and incidence of ovarian hyperstimulation syndrome (OHSS), incidence of cycle cancellation, and number of eggs retrieved per cycle. Pre- and post- intervention data was compared using univariate and multivariate poisson models to control for patient characteristics such as age, AMH, and BMI.
Results
A significant reduction in the number of in person visits (8 vs 4, p<0.001) during an IVF treatment cycle was observed post-intervention compared with the previous year. There was no significant difference in pregnancy rates, risk or incidence of OHSS, cycle cancellation, or number of eggs retrieved per cycle. Patient surveys were reassuring that the intervention did not change patient experience or satisfaction.
Conclusions
IVF Monitoring Protocol changes aimed at reducing the number of in person visits allowed our team to continue to provide ongoing care for patients during the Covid-19 pandemic without compromising IVF outcomes or patient satisfaction.
Impact Statement
This study allows for safer and socially distanced care for patients undergoing IVF cycles during a pandemic, and will also shape our future practise of cycle monitoring during IVF stimulation as we have shown that a reduction in bloodwork and ultrasound does not negatively impact patient outcomes.
References
Kwan I, et al. Monitoring of stimulated cycles in assited reproduction (IVF and ICSI). Cochrane Database Syst Rev. 2014 Aug 24;(8):CD005289
Hurst BS, et al. A minimally monitored assisted reproduction stimulation protocol reduces cost without compromising success. Fertility and Sterility. 2002 Jan;77(1):98-100.
P-139 6:30 AM Tuesday, October 19, 2021