key: cord-0992302-sww2swsc
authors: Shaw, Jacquelyn; Tozour, Jessica; Blakemore, Jennifer K.; Grifo, James
title: Universal SARS-CoV-2 PCR screening and Assisted Reproductive Technology in a COVID-19 pandemic epicenter: Screening and cycle outcomes from a New York City Fertility Center
date: 2021-06-01
journal: Fertil Steril
DOI: 10.1016/j.fertnstert.2021.05.109
sha: 80ee5a3715fc01dd05a13ed07dd050ff8e435bb0
doc_id: 992302
cord_uid: sww2swsc

Objective(s) To evaluate the prevalence of COVID-19 and efficacy of a universal screening program in patients undergoing controlled ovarian stimulation (COS) Design Single center retrospective cohort study Setting Academic fertility center in New York City, the epicenter of the COVID-19 pandemic Patients All patients undergoing controlled ovarian stimulation from June 17, 2019 to February 28, 2021 Intervention Universal COVID-19 screening starting June 17, 2020 with SARS-CoV-2 PCR testing within five days of oocyte retrieval, patient-reported symptoms screen and temperature monitoring Main Outcomes Measure(s) The primary outcome was the number of positive COVID-19 cases in patients undergoing controlled ovarian stimulation cycles. The secondary outcomes were cycle outcomes compared to pre-COVID-19 COS cycles, adverse outcomes in COVID-canceled cycles, and the center-specific COVID-19 detection rates compared to New York City cases. Results From June 17, 2020 to February 28, 2021, 1,696 controlled ovarian stimulation cycles were initiated with only 7 positive COVID-19 cases for an overall positivity rate of 0.4%. When compared to pre-COVID cycles from June 17, 2019 to February 28, 2020, the volume of COS cycles was higher, while the overall cycle cancellation rate was lower during COVID-19. Cycle outcomes including oocyte yield and blast utilization rates were unchanged from pre-COVID cycles. Cases of COVID-19, while very low, occurred more frequently during surges in New York City rates. Conclusion(s) Assisted Reproductive Technology can be performed during the COVID-19 pandemic utilizing frequent universal screening and safe practices with low SARS-CoV-2 positivity, low cycle cancellation rates, and positive patient outcomes.

The first diagnosed COVID-19 case in the United States was reported on January 19, 2020, though 49 serologic reports suggest it was present earlier (1) . New York City (NYC) confirmed its first patient on 50 February 29, 2020 initiating a rapidly expanding epicenter of COVID-19 cases (2). In response, health Cuomo issued an executive order for statewide suspension of all elective surgeries and procedures (8). As 58 fertility care is time sensitive, secondary to age related decline, the delays in treatment provoked by the 59 pandemic heightened the inherent stress and anxiety that already exists in the setting of infertility 60 treatment with many patients rating infertility as their top stressor above COVID-19, employment and 61 finances during the early pandemic (9). Interestingly, a study by Romanski et al. (2020) found no 62 difference in live birth rates from Assisted Reproductive Technology with a three-month delay in 63 treatment (10), possibly alleviating some of these concerns. However, at the onset of the pandemic it was 64 unclear how long fertility treatments may need to be delayed. the infertility population, a small study in the early months of the NYC COVID-19 pandemic 75 demonstrated low incidence of COVID-19 rates and safe resumption of fertility treatments through 76 symptom screening and SARS-CoV-2 PCR testing prior to starting controlled ovarian stimulation (COS) 77 (13). As more time has elapsed and NYC has experienced a second surge in cases, more data is available 78 to better understand and evaluate Assisted Reproductive Technology (ART) practices during COVID in 79 terms of cycle cancellation and fertility office COVID-19 prevalence rates to provide patients with actual 80 outcomes, counseling on risks and expectations about ART treatment during a pandemic. initiated. Three cycles were excluded from analysis due to patient age less than 18 years old. The median 158 patient age was 37 years, with patients ranging from 21 to 48 years. The majority of patients in this study 159 identified as Caucasian with low representation from Hispanic and Black patient populations. Overall, 160 the patients were healthy with a median BMI of 23 kg/m 2 , though 25% of patients were overweight and 161 13% were obese with a BMI up to 56kg/m 2 (Table 1) .

Cycles were compared to COS cycles performed a year prior (June 17, 2019 -February 28, 2020) (Table   164 2). More cycles were started, and fewer cycles were canceled from June 17, 2020 onward, despite the 165 COVID-19 pandemic (p<0.02). Cycles were primarily in vitro fertilization (IVF), with similar 166 proportions of embryo banking and oocyte cryopreservation for elective and medical indications between 167 time periods (p=0.19). Cycles were mainly antagonist protocols, with similar total gonadotropin dosage 168 administered in each cohort. Starting follicle stimulating hormone and estradiol levels varied between 169 years due to a change in the platform used to perform the analysis but were overall as expected. More 170 importantly, cycle outcomes including number of oocytes and embryos cryopreserved, mature oocytes 171 and blast utilization rates were similar. As our center primarily employs a freeze-all approach to IVF, the 172 number of fresh embryo transfers were overall low, but similar between years.

For the primary study outcome, seven positive COVID-19 PCR tests were identified of the 1693 COS 175 cycles initiated for a positivity rate of 0.4%. Six patients tested positive prior to oocyte retrieval, and thus 176 had their cycle canceled. In general, cycle cancellations were primarily for low response to stimulation in 177 both time periods, with COVID-19 have little additional impact (table 2 ). The seventh patient tested 178 positive the day after the retrieval. This patient was an asymptomatic healthcare worker, underwent 179 elective testing prior to travel, and tested negative four days prior to oocyte retrieval. Table 3 

Serologic Testing of US Blood 273

Donations to Identify Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Reactive 274

US Department of Health and Human Services/Centers for Disease Control and and-apsf-statement-on-perioperative-testing-for-the-covid-19-virus

Screening of Asymptomatic Patients: A Model for Protecting Patients, Community and Staff During 319 Expansion of Surgical Care

Implementation and Impact 321 of Universal Preprocedure Testing of Patients for COVID-19 Before Endoscopy

Recommendations during the Coronavirus (COVID-19) Pandemic: Update #6. Updated

Risk of COVID-19 among front-328 line health-care workers and the general community: a prospective cohort study