A la Une - COVID-19

Clinicians and embryologists recommendations during the Coronavirus (COVID-19) pandemic (Version 05- 20201019)

Dear Colleagues,

We are now facing a second wave of COVID 19 pandemic, affecting all age groups including more specifically the young population at reproductive age. Almost 7000 positive tests per day have been diagnosed during the last week. Although the majority remains asymptomatic, this second wave is accompanied by a dramatic increase in hospitalisation (>200patients/days). The Rt is now 1,516, meaning that the pandemic is still progressing. With a 14-day cumulative number of positive COVID-19 par 100000 reaching 637 (https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea), Belgium is considered in a critical situation based on the recent ESHRE guidance (14/10/2020).

A new BSRM statement was therefore mandatory to take position regarding the local impact and to provide updated recommendations:

• All the hospitals in Belgium are switching to phase 1B with 50% of the intensive care devoted to COVID-19 patients. However, most of them continue to provide regular elective and semi-elective care as reproductive healthcare is considered essential. Therefore, we consider that ART activities should not be suspended, unless local institutions or regional/federal regulation impose specific measures that directly or indirectly impact fertility centers. All fertility centres are advised to adhere to the policy imposed by their local health authority and hospital.
• The fertility centers should adapt their activities taking into account the impact which COVID-19 may have on staff availability (resulting from illness or quarantine) and on healthcare supplies.
• If necessary, centers should adapt their activities in order to enhance the sanitary measures. The access to IVF centers should be limited to treated patients (no accompanied person).
• Triage questionnaires are still relevant but systematic PCR testing is advised in all patients before OPU.
• Recommendations are still valid for cycle cancellation in case of illness, positive testing or a positive questionnaire and after medical review. The freeze-all strategy should be systematically applied if the cycle cannot be cancelled.
• IUI and embryo transfer can be considered if the patient is tested negative for SARS-CoV-2 and/or report a negative triage questionnaire. However, patients should be informed that there is still uncertainty about the effect of SARS-CoV-2 infection during pregnancy. If necessary, the COVID-19 Informed Consent Form (ICF) should be adapted and counselling should be reinforced.
• As previously recommended, ART treatment in the population with chronic or acute diseases (diabetes, hypertension, cardiac or renal disorders…) should be postponed.
• Fertility centers are encouraged to have a COVID-19 registry system and to participate to research projects in the field (ESHRE registry and/or BSRM collaborative project and/or others local initiatives).

On behalf the BSRM board

Isabelle Demeestere, President

 

 

 

Belgian Society for Reproductive Medicine (BSRM)

Belgian Society for Reproductive Medicine (BSRM)

Patient management and clinical recommendations during the Coronavirus (COVID-19) pandemic (Version 02- 20200504)

Dear colleagues, Starting on May 4, the hospital activities slowly began to resume including the activities of the IVF centers. Since this date, several recommendations and measures will be implemented in the hospitals regarding mainly: The maintaining of the hospital capacity to manage a possible “second wave“ of the COVID-19 pandemic The gradual increase in access to non-urgent healthcare and consultations for non-COVID-19 patients The implementation of additional organizational, structural and testing measures for ensuring non-COVID patient’s safety and avoid viral dissemination. A «surge capacity COVID-19 plan» will be applied in all regional and university hospitals and is detailed in the updated Covid19- Hospital & transport surge capacity (HTSC) letter on April, 30th 2020 (www.vbs-gbs.org). The plan describes different degrees of urgent and necessary cares for each speciality. Among gynaecological procedures that are detailed on the website (http://www.gbs-vbs.org/fileadmin/user_upload/Unions/OG/CORONA_LISTES/GYNAECOLOGIE_Nl_.pdf), ART including follicular punction, IUI and embryo transfer are considered as « Elective A+ » care meaning conditions that, if not treated, can lead to health damage <3 months. This classification supports our previous recommendations regarding a progressive restarting of fertility center activities. All the conditions of this restarting process described in our previous recommendation have still to be applied (see BSRM and Colleges recommendation, version 20200420) but the BSRM board has updated some general recommendations for clinicians and embryologists.

Clinical practice

The BSRM board encourages all A and B centres in Belgium to follow a strict plan locally adapted according to the hospital directives and to adhere to the following general recommendations: To organize a gradual and adaptative restart of the provision of ART procedures and consultation in line with the hospital involvement in the COVID-19 pandemic. Distant consultation remains recommended when it is possible. To inform and provide inform consent to all patients before starting any treatments, explaining the acknowledge regarding the potential risk of COVID-19 infection during pregnancy. The patients should adhere to the local safety policy during and after treatment including the possibility to cancel/postpone the cycle at any time in case of confirmed infection, suspected symptoms, or changes in the hospital directives. To postpone ART treatment in the population with chronic or acute diseases (diabetes, hypertension, cardiac or renal disorders…). To perform a triage questionnaire by preference by phone (symptoms and recent contacts) with all patients and partners 2 weeks before starting treatment (example of questionnaire can be found on the ESHRE website). The questionnaire should be approved by the local institution and should be repeated the day of starting. Any positive answers should be considered as a contraindication for starting ART treatment. To refer all patients suspected of infections for testing according the local instructions. Any patients who had a previous confirmed COVID-19 infection should provide evidence of recent assessment and medical report. To implement safety procedures to protect all staff members and patients according to the local directives (appropriate distancing in the waiting room and working places, masks, gloves, timetables for appointment, restriction of access, procedures for hands, room and materials disinfection). All the staff members have to be trained for these COVID-19 procedures. To cancel cycles of confirmed symptomatic patients during treatment. To perform a RT-PCR COVID-19 testing 2 days before the oocytes collection (day of trigger). For the other procedures such as embryo transfer or IUI, the triage questionnaire should be repeated the day before the procedure.

Laboratory activities

Until now, insufficient data is available to conclude for the presence of coronavirus COVID-19 in semen and follicular fluid, or whether the virus receptors are present in the different cells of the genital tract To reduce the contamination and cross-contamination between biological material, patients, and staff, the BSRM proposes a set of general recommendations, to be adapted to the specific context of each laboratory. The ABEF and VVKE contributed and subscribed to this document. Good laboratory practice instructions should always coincide with extra attention to physical distancing, sanitizing surfaces, and frequent handwashing outlined below. Interaction between personnel/staff/patient Lab staff should be minimized to reduce the number of personnel in the area. Only necessary personnel should be present in the lab. Contact and sharing of materials (e.g. pencils) with external personnel (clinicians, nurses, etc.) should be avoided. Contact and sharing of materials with patients should be avoided; if not possible, wear surgical masks and keep the necessary distance (min 1.5m). Laboratory procedures Outer packaging (cardboard boxes) of material and media entering the IVF unit from an outside source should be handled with gloves. Gloves are advisable for oocyte collection, sperm preparation, and transfer. Gloves should be changed between each patient and not touched on the outside when taking it off. Safe and immediate disposal of fluids in individual closed one-used containers is advised. Sharing equipment (pipettes, strippers, etc.) should be avoided or should be cleaned/disinfected between different users. The use of shared devices (fix phones, PC…) should be avoided and use of a washable keyboard be promoted. Regular cleaning/disinfection is recommended. Thoroughly clean the surfaces, microscopes, micromanipulators (joystick), instruments and any point of touched equipment and tools after each patient using a disinfectant that works against coronavirus COVID-19. Semen If possible, sperm collection should be performed at home. Clean properly the semen recipient with disinfectant and avoid direct touching of the recipient. Use a tissue or plastic bag to transfer to the lab. New gloves should be used for each sperm preparation in the lab. Oocyte retrieval Consider changing to new gloves before placing the dishes into the incubators. Cryopreservation Wash your hands properly before the manipulation of cryogenic straws and before using the cryogenic gloves. Consider using standard plastic gloves inside the cryogenic gloves. Protective equipment (eye protection glasses and others) should not be shared or should be washed between each user with the proper disinfectant. High-security straws should be preferably used. In the case of open system, vapour phase storage is recommended. According to your laboratory procedure, straws should be disinfected before warming, taking care not to destroy the biological material. Embryo transfer The number of staff members in the transfer room should be limited. Access of the partner into the transfer room should be avoided. Coronavirus COVID-19 positive patients If the treatment cannot be postponed for medical reasons, the laboratory procedures should be performed as for the cases with positive serology for blood transmitted viruses (Hep B, Hep C, HIV). Please take into account that these recommendations are based on current knowledge and regulations and therefore may be subject to change. On behalf the BSRM board Prof. Isabelle Demeestere, President –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Chers membres ABEF,

Nous sommes tous confrontés actuellement à une situation incertaine et à de nombreuses questions quant à notre activité. Nous avons peu de réponses actuellement, mais chaque société dans notre domaine s'attelle à rassembler autant d'information que possible et tenter de mettre en place des guidelines. L'ESHRE, l'ASRM ou l'IFFS par exemple ont une page dédiée au COVID sur leurs sites respectifs :

https://www.eshre.eu/Home/COVID19WG

https://www.asrm.org/news-and-publications/covid-19/

https://www.iffsreproduction.org/page/COVID-19

La BSRM a également travaillé conjointement avec le collège des médecins pour émettre des recommandations, qui ont été communiquées ce matin aux différents centres.

Actuellement, nous savons peu de choses sur le COVID en relation avec nos activités de PMA, et plus particulièrement en ce qui concerne le volet embryologie. Se tenir à jour dans le domaine n'est pas facile car il y a énormément d'articles, et il n'est pas simple de faire la part de ceux qui sont intéressants. Vendredi passé, une recherche sur PubMed avec le terme "COVID19" sortait 4300 résultats, mais très peu sur la biologie de la fertilité, et au final la plupart amenant plus de questions que de réponses.

Nous voudrions vous proposer de mettre à profit le confinement pour participer à accroître nos connaissances au sujet de cette pandémie, en nous communiquant par mail vos réflexions et/ou des articles qui ont attiré votre attention. Le tout sera "confiné"  sur le site web de l'ABEF.

Différents thèmes qui sont directement liés à notre profession méritent toutes nos attentions. Voici quelques exemples de réflexions que nous avons entamées :

· Sachant qu’en l’absence de vaccin, il faut considérer que le risque de transmission du COVID-19 est possible entre tous les acteurs entrant dans un programme de PMA (patients, secrétaires, infirmières, médecins et embryologistes), la question est de savoir comment gérer nos activités en général dans le centre de PMA et aussi plus spécifiquement au laboratoire pour minimiser les risques de transmissions entre personnes.

· Que savons-nous actuellement au sujet des interactions COVID 19 – embryologie ? Comme mentionné précédemment, pas grand-chose.Les récepteurs ACE2 (voie d'entrée du virus) sont-ils exprimés sur les membranes cytoplasmiques des ovocytes et embryons ?

· En ce qui concerne le sperme, le virus pourrait se fixer aux cellules primordiales et sur les  cellules de Leydig. Mais est-il présent dans le sperme éjaculé ? Cela affecte- il les spermes et la fertilité ? Quid de la cryopréservation des spermes ?

Si on regarde quelques articles plus anciens en relation avec le SARS en général, (pas le Sars Cov 2), apparemment le virus ne serait pas présent dans le fluide folliculaire et le plasma séminal. Un espoir donc.

· Devons-nous adapter nos procédures dans le traitement des gamètes et embryons ? Quid de la cryopréservation ?

Nous vous souhaitons un confinement le plus agréable possible.

Pour le CA

Déborah Desmet et Pierre Vanderzwalmen

PS: notre espace lecture est régulièrement mis à jour et un dossier spécial a été créé.



Un embryologiste à l’honneur pour la première fois à la BSRM …

Lors du 42^ième congrès de la BSRM (Belgian Society for Reproductive Meeting) qui s’est tenu à Anvers ces 22 et 23 novembre 2019, Pierre Vanderzwalmen a reçu le titre de membre d’honneur.

Chaque année, la BSRM met à l'honneur un de ses membres. Jusqu'à présent, seuls des médecins actifs dans le domaine de la PMA ont reçu ce titre, mais c'est pour la première fois cette année que cette distinction est accordée à un embryologiste, Pierre Vanderzwalmen. Ce titre lui a été décerné en reconnaissance pour sa contribution scientifique en PMA, qui a fait l’objet de nombreuses publications.

Dans son exposé intitulé : “Of animals and men: across species mammalian embryology for improving human IVF skills and knowledge”, Pierre Vanderzwalmen a évoqué son parcours professionnel atypique, qui lui a permis de contribuer grandement au développement des techniques modernes de PMA en s'inspirant de ses expériences de recherche en médecine vétérinaire. On peut citer par exemple le développement de la culture embryonnaire jusqu’au stade de blastocyste, la sélection morphologique des spermatozoïdes avant injection (IMSI), le traitement des spermes testiculaires ou encore la cryopréservation des embryons et des ovocytes par la technique de la vitrification, thème qui a suscité beaucoup de débats et d'intérêt dans le secteur de la reproduction. Après avoir développé la technique de vitrification et rapporté la première naissance chez l’humain, il a continué à s’investir dans ce domaine et a écrit près de 40 articles sur ce sujet.