SBV Journal of Basic, Clinical and Applied Health Science
Volume 3 | Issue 2 | Year 2020

Management of Infertility—Recommendations in the COVID-19 Era

Sendhil C Arumugam1, Jayasree Manivasakan2, Syed Habeebullah3

1,3Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India
2Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Corresponding Author: Sendhil C Arumugam, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry, India, Phone: +91 9485475508, e-mail:

How to cite this article Arumugam SC, Manivasakan J, Habeebullah S. Management of Infertility—Recommendations in the COVID-19 Era. J Basic Clin Appl Health Sci 2020;3(2):53–55.

Source of support: Nil

Conflict of interest: None


Worldwide, the incidence of infertility is 15%. In India, the incidence of infertility varies between states ranging between 3.9% and 16.8%. India has 22–23 million infertile couples, and the total fertility rate has declined from 3.9 in 1990s to 2.3 in 2019. At present, the estimated number of in vitro fertilization cycles countrywide are around 100,000, and it was expected to reach 250,000 by the end of 2020. But with the COVID-19 pandemic, all these treatments have been brought to a sudden halt. Decision to stop all treatment is because SARS CoV2 is a global health pandemic and infertility treatments are usually electively done. Also we need more studies to show that COVID-19 has no effect on newer pregnancies.

Keywords: COVID, Cross-training, Freeze-all, Infertility..


The World Health Organization (WHO) states that one in every four couples in developing nations is affected by infertility. India has 22–23 million infertile couples, and the total fertility rate has declined from 3.9 in 1990s to 2.3 in 2019. At present, the estimated number of in vitro fertilization cycles countrywide is around 100,000, and it was expected to reach 250,000 by the end of 2020.1 As the world faces a pandemic with enormous casualties and an uncertain future for most people, the physicians in reproductive medicine and their patients are faced with newer challenges.

Patients should be informed that considering the rapid community transmission and the lack of symptoms among infected people, frequent visits to the hospital may endanger them and their families. Healthcare workers in fertility centers should understand that high virulence and the sustained surface viability of the virus may cause severe difficulty in keeping the lab surfaces sterile.

Keeping the healthcare workers and their patients a priority, most fertility societies have advised suspension of elective clinical activities. This is highly applicable to infertility workup and procedures. As we have very little information on the effect of COVID-19 on organogenesis (teratogenic ability) and also on perinatal outcome,2 it is better to withhold fertility procedures. But if women are in the middle of an intervention or a treatment cycle or for fertility preservation before oncology treatment, treatment cycles can be completed with the full counseling and understanding of the implications by the patients.


The following guideline will help decrease the chance of acquiring the infection and help conserve essential resource of healthcare workers.3,4

Social Distancing

  • All persons entering clinical spaces, both patients and healthcare workers, should be carefully assessed for body temperature and health status.
  • Minimize the number of healthcare providers in the clinic.
  • Minimize number of patients in the reception and patient waiting area when they come in for urgent procedures.
  • Follow social distancing by shifting the OPD practice to the telehealth model either using telephone or computer-based face-to-face office-based consultations.


  • Advise patients to avoid travel to fertility clinics for the sole purpose on non-emergency procedures like egg donation, gestational surrogacy, etc.
  • Patients who have had babies delivered through gestational carriers from travel-restricted areas should make alternative care plans for the infants until the travel restrictions are withdrawn.
  • For geographically distant patients teleconsultations are recommended to ascertain the need for an appointment.





Once the pandemic stabilizes, we need to arrange the provision for restarting assisted reproductive treatments.5 These treatments have to be in line with local regulations. Teleconsultation and triage have an important role in restarting the fertility clinics. Patients, staff, and any other person attending the center need to be triage negative. Each center should adapt the triage questions. These triage questions should be used in the teleconsultation to screen and give appointments to patients. On arrival to the center, they again need to be screened before entering the clinic premises or spaces. If they screen positive to the triage questions either at teleconsultation or on entry, viral screening is recommended.

These guidelines are as on date. These may change as the understanding of COVID-19 is still evolving. Since our country is in lockdown when this article is being written, routine clinical care may start only after ICMR recommendations. So, we need to update our knowledge on a regular basis with national and international fertility societies to keep up with the changing guidelines.


1. Sabahat R, Omar SA. The huge burden of infertility in India - Are we crumbling underneath? Glob J Reprod Med 2018;5(3): 555670. DOI: 10.19080/GJORM.2018.05.555670.

2. Schwartz DA. An analysis of 38 pregnant women with COVID-19, their newborn infants, and maternal-fetal transmission of SARS-CoV-2: maternal coronavirus infections and pregnancy outcomes. Arch Pathol Lab Med 2020. DOI: 10.5858/arpa.2020-0901-SA.

3. ASRM.Patient Management and Clinical Recommendations during the Coronavirus(COVID-19) Pandemic (as of March 17, 2020).

4. ESHRE. Assisted reproduction and COVID-19. A statement from ESHRE for phase 1 - Guidance on fertility services during pandemic.Published on 2 April 2020 (last revision 17 April).

5. ESHRE. ESHRE guidance on recommencing ART treatments. Document prepared by the ESHRE COVID-19 Working Group Published on the ESHRE website.Date of publication: 23/04/2020 Last update: 05/05/2020 (addition clarification on triage and testing).


  • Have you been sick in the last 2 weeks?
  • Do you have fever (>37.5°C)?
  • Do you have you cough at present?
  • Do you have a sore throat?
  • Have you lost your sense of smell or taste?
  • Have you been in contact with somebody who had cough/fever or sore throat?
  • Have you recently traveled to a red zone or a containment zone?
  • Do you work in a hospital/nursing home or healthcare facility?
  • Have you been in contact with somebody who has COVID-19?
  • Have you been diagnosed with COVID-19?
  • Do you live in a household with somebody who has been diagnosed with COVID-19?
  • If you have been COVID-19 positive and recovered, do you have certified medical evidence of clearance?
  • Do you have a severe comorbid medical condition like diabetes, respiratory disease, chronic kidney disease, etc.?

Keywords: COVID, Cross-training, Freeze-all, Infertility..

Keywords: COVID, Cross-training, Freeze-all, Infertility..

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