Coronavirus Updates: Sept 22 2023

From Sept 22, 2023

Dear Spring Family,

We recognize that a recent uptick in COVID cases may be causing incremental stress and concern for patients who are actively trying to conceive, or who are pregnant, postpartum, or breastfeeding. We remain committed to sharing the latest data available to help you and your family make informed decisions about your health.

Spring Fertility aligns with the CDC and recommends that all individuals get 1 updated 2023-2024 COVID-19 vaccine, at least two months after getting the last dose of any COVID-19 vaccine. The updated COVID-19 vaccines target the XBB lineage of the Omicron variant and could restore protection against severe COVID-19 that may have decreased over time. The updated vaccines will target circulating variants, and will help to keep you, your family, and our community healthy and safe.

Safety and Effectiveness of COVID-19 Vaccination during Pregnancy:

As outlined by the CDC, evidence continues to build showing that COVID-19 vaccination before and during pregnancy is safe, effective, and beneficial to both the pregnant person and the baby. This data has now been collected from hundreds of thousands of pregnant people around the world and show that the benefits of receiving a COVID-19 vaccine outweigh any potential risks of vaccination. Below is a brief summary of evidence:

• COVID-19 vaccines do not cause COVID-19, including in people who are pregnant or their babies.
• Data on the safety of receiving an mRNA COVID-19 vaccine (Moderna or Pfizer-BioNTech), before and during pregnancy are reassuring:
  • Scientists have not found an increased risk for miscarriage among pregnant people who received an mRNA COVID-19 vaccine.
  • Additionally, a study has shown that vaccination of pregnant people with a COVID-19 vaccine prior to and during the first trimester was not associated with an increased risk of birth defects detectable on prenatal ultrasound.
• Data show that receiving an mRNA COVID-19 vaccine during pregnancy reduces the risk of severe illness and other health effects from COVID-19 for people who are pregnant.
• Vaccination during pregnancy builds antibodies that can help protect the baby.

Receiving the Vaccine During Fertility Treatment:

For patients who are planning an upcoming treatment cycle (egg retrieval or embryo transfer), we recommend not scheduling your vaccine within three days of your procedure.

This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days.

How to Get Vaccinated:

To schedule your vaccine appointment for you and your family members, you can visit MyTurn.ca.gov if you are in California and COVID19Vaccine.Health.ny.gov if you are in New York.  

We’re here for you. As always, please reach out to your Care Team with any questions.

Warmly,

Your Spring Fertility Team

 

 

From Mar 7, 2022

Dear Spring Family,

Typically, the start of March is a time filled with the promise of new beginnings and hope. This year however, our hearts are heavy as we bear witness to the humanitarian crisis occurring in Eastern Europe. Our love and compassion are with the people living in Ukraine and Russia experiencing unprecedented uncertainty and violence, as well as with our patients and team members who have been directly affected by the atrocities.

Amidst the devastation beyond our borders, we have reason to be optimistic that we are entering into the endemic phase of COVID-19. We recognize that the last two years have been incredibly challenging and everyone has made sacrifices for the sake of the greater good – we’ve sheltered in place, worn masks, limited our in-person interactions, and achieved widespread immunity through vaccination and prior infection. We’re in a much stronger place today as a country with more tools to protect ourselves and our communities.

The latest CDC guidelines released on February 25^th outline new metrics for assessing community risk that weigh hospitalizations for COVID-19 and the proportion of beds occupied by COVID-19 patients in local hospitals more heavily than rates of new infections alone. This updated approach focuses on directing our prevention efforts towards protecting people at high risk for severe illness and preventing hospitals and healthcare systems from being overwhelmed. The CDC has also significantly relaxed masking and social distancing recommendations in those communities determined to be low risk.

Spring’s COVID Committee and Medical Directors are aligned with the latest CDC, State, and Local recommendations. As of Monday, March 7^th, we will be implementing the below changes across our clinics:

• Partners will be welcomed at all appointment types, including being present in exam rooms
• No social distancing enforced in waiting rooms
• COVID tests are no longer required for patients undergoing anesthesia in California (we are awaiting changes to state regulations in New York)

*Please note that while the indoor masking requirement has been eliminated in many settings, masks are still required in healthcare settings. We will also continue our mandatory vaccination and booster policy among employees.

We recognize that as with any period of change, these new guidelines may feel scary and uncertain. We’re here for you. Please reach out to your care team with any questions or concerns.

With love and support,
Your Team at Spring

 

From Nov 1, 2021

Dear Spring Family,

It’s been nearly a full year since the first dose of the COVID-19 vaccine was administered in the United States. Since then, almost 78% of the population over age 12 has received at least one dose, and we continue to be encouraged about BOTH the safety and the efficacy of the vaccine in protecting against the virus caused by COVID-19, including the delta variant.

A recent study published in the New England Journal of Medicine reported increasing rates of Covid coinciding with declining levels of antibodies among vaccinated people in Israel.  The study suggested that the vaccine has waning immunity against the delta variant of SARS-CoV-2 across age groups by 6 months after receipt of the second dose of the vaccine.

Spring Fertility now recommends, in accordance with the CDC’s recommendations,  that all individuals receive a booster shot when they are eligible. This recommendation extends to individuals who are actively trying to conceive. As an organization, we are also requiring that our staff receive the booster shot in order to ensure the continued safety and health of our team, patients, and families.

We recognize that you may have some additional questions around the booster vaccine, and we’ve outlined a few FAQs below. As always, please don’t hesitate to reach out to your care team or to your primary care provider with any specific questions or considerations.

We’re here for you always as your partners in health.

Warmly,
Your Spring Team

 

What exactly is a booster?

A booster is an extra dose of vaccine designed to give you additional protection against a disease; in this case, COVID-19.

 

Who is considered eligible for the COVID-19 booster shot (as of November 1, 2021)?

• Pfizer: COVID-19 Vaccine booster shots are available for the following Pfizer vaccine recipients who completed their initial series at least 6 months ago and are: 65 years and older; Age 18+ who live in long-term care settings; Age 18+ who have underlying medical conditions; Age 18+ who work in high-risk settings; Age 18+ who live in high-risk settings
• Moderna: CDC advisory committee recommends boosters of the Moderna Covid-19 vaccine; the agency’s Advisory Committee on Immunization Practices meeting recommended the Moderna booster for elderly people and at-risk adults six months after they complete their primary series of shots
• Johnson & Johnson: CDC advisory committee recommends boosters of the Johnson & Johnson’s Covid-19 vaccines; it also endorsed J&J boosters for everyone 18 and older who received the initial shot at least two months ago.

 

Can I mix and match vaccines for the booster?

The CDC has approved a “mix and match” strategy (i.e. if you received the Pfizer vaccine for your first two doses, you can receive any of the three boosters for your third dose). That said, we still advise you to consult your primary care physician to help inform this decision.  

 

What are the side effects of the booster relative to the initial doses of the COVID-19 vaccine?

As of right now, the CDC says you may experience similar side effects, like arm soreness, mild flu symptoms, body aches, and other symptoms. Everyone responds differently and pain around the injection and fatigue are the most commonly reported. Most side effects have been mild to moderate. Any severe side effects have been very rare, but can occur.

 

How can I receive the shot if I qualify for a booster?

Your primary care provider may be giving vaccines. Many larger pharmacy chains (like Walgreens or CVS) are also currently offering vaccine boosters by appointment. Please call your pharmacy of choice to inquire. They should be able to give you information on what vaccines are available and the process to book an appointment.

 

If I am immunocompromised, how long after my second dose am I able to receive the third?

If you are moderately to severely immunocompromised and have received two doses of either the Pfizer or Moderna vaccine, both the FDA and CDC recommend a third dose of the same vaccine 28 days or more after the second dose. As always, if you have any specific medical conditions or concerns, please contact your primary car physician for additional guidance here.

 

Is this going to be an annual booster, similar to the flu vaccine?
The CDC has said that they don’t know yet. We think it’s likely that this could be an annual part of our health maintenance like flu vaccines. Vaccine boosters help to increase your antibody levels to a very high level and future versions could be updated to cover new variants of the virus.

 

 

 

From July 26, 2021

Dear Spring Family,
We hope that everyone is having a wonderful summer and has enjoyed the opportunity to reunite with loved ones across the country. Our number one priority is always the health and safety of our patients, our team, and our families. Out of an abundance of caution, and due to the latest increase in Covid cases in the Bay Area, beginning on Wednesday, July 28^th, we will once again require that all patients and staff, regardless of vaccination status, wear masks inside all Spring clinics. It is important to note that the latest increase in Covid cases is predominantly impacting our unvaccinated population and that data on the vaccines’ effectiveness remain strong. We are hopeful that this latest surge will be brief and that we will be able to see everyone’s smiling faces again soon!
 
We want to acknowledge that this is hard.
We’ve all done so much over the last 16+ months to stay safe and take care of our communities. Just as we were finally starting to return to a more “normal” life, it may feel a bit like we’re taking steps back. We understand that’s frustrating, and we are right there with you. However, this decision is intended to make everyone feel safe and comfortable continuing to come into the clinic for treatment as we move through this time.
 
We are still very confident in the vaccine and the safety of our vaccinated patients.
Data on the vaccine’s effectiveness remain strong, and we encourage all our Spring families to get vaccinated (including individuals who are pregnant or actively trying to become pregnant). While the latest studies show that 5% of vaccinated individuals will get infected with Covid, most do not have any symptoms.  A vast majority of people who are still getting seriously ill from the virus are not vaccinated, and when we look at Los Angeles specifically, we know that all hospitalizations are among unvaccinated individuals. Reassuringly, San Francisco’s overall vaccination rate is 69% relative to LA’s ~50%, and even higher among those ages 25-44.
 
We will continue to welcome patients and partners at all appointments.
We are happy to share that partners and/or support persons continue to be welcome at all appointments even under this re-instated mask policy. As a reminder, due to the sensitive nature of our work, we ask that you avoid bringing children into the clinic. Thank you so much for understanding.
 
Telehealth appointments are still available. We are still providing the opportunity for patients to complete their initial consults virtually.
 
And finally, we want to thank you sincerely for your ongoing dedication to protecting yourself and our community. We continue to be so impressed by this community and grateful for your commitment and trust. On our end, we know our patients are resilient and we are keenly focused on the warm smiles and tight hugs on the other side of this.
 
As always, we are available for whatever questions you have. Your Spring provider and your care team are happy to discuss any specific questions regarding the vaccine and the timing as it relates to your treatment. Please don’t hesitate to ask. Thank you so much for being a part of the Spring Family.Warmly,

Your Spring Team

 

From June 19, 2021

 

Dear Spring Family,

Thank you, thank you, thank you. We recognize the massive collective effort that it took for us to reach this day. Pursuant to the new public health order effective June 15^th in California, we are happy to share that we are discontinuing many restrictions in our clinics:

Masks No Longer Required for Vaccinated Individuals

For all vaccinated individuals (both patients as well as Spring employees), we are no longer requiring masks be worn inside Spring clinics. If you are not fully vaccinated, we ask that you continue to wear a mask indoors to protect yourself and others. Additionally, anyone who prefers may continue wearing a mask if that remains your preference.

Welcoming Partners at all Appointments

We are also happy to share that partners and/or support persons are now welcome to join all appointments. As a reminder, due to the sensitive nature of our work, we ask that you avoid bringing children into the clinic.

Discontinuing Temperature Checks

We will also be discontinuing temperature checks for patients as well as employees. If you do have symptoms, we ask that you inform your care team.

Social Distancing

We will no longer be operating at a reduced capacity or enforcing social distancing in our waiting areas.

Telehealth

We will still provide the opportunity for patients to complete their initial consults virtually.

 

Again, from the bottom of our hearts – thank you. We wouldn’t be here today without your conscientiousness and trust. We’re looking forward to our country’s re-opening, to continued falling transmission rates, and to seeing the smiling faces of so many of our community members. We know that the past 15+ months have not been easy, and we are so proud of the resilience and love that we witnessed in our clinics every single day.

 

Warmly,

Your Spring Team

 

 

 

From Apr 29, 2021

 

Dear Spring Family,

Although we continue to see the devastating impact of the COVID crisis globally, we are pleased to share some positive news: a new report published in the New England Journal of Medicine regarding the safety of COVID-19 mRNA vaccines (such as Moderna or Pfizer) during pregnancy.

The CDC has created the v-safe program, a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after vaccinations, and specifically a v-safe pregnancy registry to gather information on the health of pregnant people who have received the vaccine.

As of the beginning of March, 35,691 women who received the vaccine identified as pregnant. The V-Safe Pregnancy Registry successfully obtained information on pregnancy outcomes after vaccination from 3,950 women.  Among this group, there were no increased risks in adverse pregnancy or neonatal outcomes compared to women who did not receive the vaccine.

Given the known risks and severity of COVID-19 disease during pregnancy, we continue to support vaccination of individuals who are pregnant or actively trying to become pregnant. This recent study further supports this recommendation.

We are encouraged by the continued decline in the number of new COVID-19 cases in the US, as well as the growing percentage of people who have been vaccinated. We hope you, your family and community are healthy and well.  As always, we appreciate the trust you place in us.  We will continue to share more data and update you with any new studies that may influence decisions that you need to make for yourself and your family.

 

Warmly,

Your Partners at Spring Fertility

 

From Mar 13, 2021

Dear Spring Family,

Over 380,000 vaccine doses have been administered in San Francisco county, and we remain encouraged by the continued decreasing trend in Covid infections.

Given the known risks and severity of COVID-19 disease during pregnancy, we continue to support vaccination of those individuals who are pregnant or actively trying to become pregnant. This support is in accordance with recommendations by the World Health Organization (WHO), the American College of Obstetricians and Gynecologists (ACOG), the American Society for Reproductive Medicine (ASRM), and the Society for Maternal-Fetal Medicine (SMFM).

As vaccines become more widely available, we have updated our published guidance with respect to timing around vaccine administration and certain fertility treatments and procedures. We support the latest recommendations by ASRM published on February 22, 2021:

Patients scheduled for elective surgery or outpatient procedures, including oocyte retrieval, embryo transfer, and intrauterine insemination, avoid COVID-19 vaccination at least three days prior and three days after their procedure.

This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination, especially after the second dose, include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days. Anesthesia impairs normal thermoregulatory control and may be impacted by pre-existing fever. Additionally, these side effects would make it difficult to determine if a post-procedure fever is related to the vaccine or to a developing infection related to the procedure. Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has COVID-like symptoms, including those that are possible side-effects of the vaccine, even if their COVID-19 test is negative.

Please speak with your Spring provider and your care team if you have any questions regarding timing of receiving the vaccine as it relates to your planned treatment. We’re here for you!

Warmly,

Your Spring Team

 

 

From Feb 24, 2021

Dear Spring Family,

We remain optimistic and hopeful as more of our population receives the Covid-19 vaccine and cases continue to trend downward. We also reaffirm our position and encourage everyone to get vaccinated as soon as they have access to do so.

While data are still limited regarding pregnant women who have received one of the COVID-19 vaccines.  Here is the latest:

• The initial data from animal developmental and reproductive toxicity studies is reassuring. No safety concerns were demonstrated in rats that received Moderna COVID-19 vaccine before or during pregnancy; studies of the Pfizer-BioNTech vaccine are ongoing. 
   
• Based on how mRNA vaccines work, they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and their fetus are unknown because these vaccines have not been studied in pregnant women. 
   
• Researchers have studies planned in people who are pregnant. 
   
• Both vaccine manufacturers are monitoring people in the clinical trials who became pregnant. 
   
• Pregnant people are at increased risk for severe illness from COVID-19.

 
Spring strongly supports the Maternal Immunization Task Force in urging that the Covid-19 vaccine be made available to pregnant individuals. We recognize that getting vaccinated is a personal decision, and we encourage you to speak with your healthcare provider to discuss any specific questions or concerns.
 
Additionally, we’d like to share a recently published letter and small study in the New England Journal of Medicine regarding the efficacy of the Covid-19 vaccines against the new strains that have emerged of the virus. The good news is that the vaccines are still effective against most of the new strains. There is concern that the antibodies may be less effective against the new South African strain (B.1.351), however the immune response is not limited to antibodies, and we continue to recommend receiving the vaccine as soon as it’s made available.
 
As always, we appreciate the trust you place in us. We are proud to share that 94% of our front line staff have now been fully vaccinated, and we remain committed to minimizing any risk of exposure among our patients, providers, and team. We will share more data as they become available and will update you with any new studies that may influence decisions that you need to make for yourself and your family.

 

 

From Dec 11, 2020

Dear Spring Family,

For the first time in many months, we now have some positive news around the pandemic, as we anticipate approval of two vaccines for use in the United States. While this news is reassuring, it has prompted many questions from our patients regarding the efficacy and safety of these vaccinations if they are trying to conceive or are currently pregnant.

In summary, we encourage everyone who has access to get the vaccine if they have a negative pregnancy test. While we believe that the mRNA vaccine is likely safe for pregnant women, we do not currently have data to support that. Therefore, until more data become available, we do not recommend getting the vaccine while you are pregnant if you are at low risk for severe COVID infection.

• If you are pregnant and at a higher risk of severe diseases, women with diabetes or pre-existing lung diseases, we recommend receiving the vaccine even while pregnant.
• We also support the recommendation that front line healthcare workers who are pregnant should consider getting vaccinated due to their higher risk of exposure.
• Patients who are trying to conceive should be vaccinated if they are not currently pregnant.
• For patients undergoing active fertility treatments: Since we do not know the effect of the vaccine on treatment, we would not recommend the vaccine within 1 week of when an embryo is implanting.  This means holding off on the vaccine AFTER we trigger ovulation for IUI or a cycle with a projected embryo transfer.  If you have any questions and you are in treatment, your care team can clarify.

For additional context on our recommendations, we’ve included more information on what we know about the vaccine below. As always, we’re committed to sharing our perspectives and information and as data become available. We greatly value the trust that you place in us as your partners in your fertility care.

—

What is an mRNA vaccine?

Unlike many vaccines that we are familiar with such as the flu shot and chicken pox, an mRNA vaccine does not use the virus itself or any parts of it. Instead, it transfers mRNA that allow cells in our body to produce a critical protein that the virus needs to infect our cells. This allows our immune system to learn how to attack the virus by making antibodies to this protein. These antibodies protect us from future infection, without ever having been infected.

Think of mRNA as a set of instructions for the cells in our body to use. The mRNA provides a set of instructions to the machinery in our cells that make proteins, so that they will make a specific protein that is found on the surface or capsule of the SARS-Cov-2 virus.  Once our cells make that protein, they break down the instructions (mRNA) and the cell is not infected with the virus.  Our cells will then begin to display this protein piece on their cell surface so that it can be recognized by our immune system as foreign, causing our body to produce antibodies to the protein. This is similar to what would happen during a natural infection with COVID-19.

Do the vaccine trials look promising at preventing COVID-19?

So far initial data looked great. There are currently two vaccine manufacturers seeking emergency use authorization for COVID 19 vaccine distribution in the US, the Moderna mRNA vaccine and the Pfizer and BioNTech mRNA vaccine.

Interim results from the Phase III Moderna vaccine trial included over 30,000 participants across the United States randomized to receive either a two-dose COVID 19 vaccination or a two-dose placebo. The interim results noted 95 cases of COVID 19. 90 cases occurred in the group that received the placebo and 5 cases occurred in the group who received the vaccine. There were 11 severe cases of COVID 19 and all were from the group that received the placebo. Their interim trial results give the vaccine an efficacy rate of approximately 94.5% after 2 doses of the vaccine.

The Pfizer and BioNTech vaccine phase III trial enrolled over 43,000 participants globally to receive either a two-dose COVID 19 vaccination or a two-dose placebo. At the time of their report, over 41,000 participants had received two COVID 19 vaccine doses and their vaccine has a reported 95% efficacy rate. According to their data, they had 170 confirmed cases of COVID 19 with 162 observed in the placebo group. The most common side effects reported in the Pfizer trial were fatigue and headache, each occurring in less 4% of participants.

How do we know if it is safe?

The mRNA vaccine, unlike other vaccines, does not contain a weakened or inactivated virus so there is no risk of developing COVID-19 disease. Additionally, data from the two leading vaccine makers have shown no serious safety concerns.

Who will initially be eligible to receive the vaccine?

According to the CDC, the initial release of the vaccination will likely be focused on high risk groups including healthcare workers, workers in essential industries, people in long term care facilities, people at high risk for severe COVID-19 disease due to underlying medical conditions and people 65 years and older.

Were pregnant women included in the vaccine trials?

No. As a general rule, pregnant women and children are considered a “protected class” for medical research and are therefore excluded from participating in most initial vaccine and medical trials.  Thus, pregnant patients were excluded from participation in the COVID-19 early vaccine trials. Both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine (SMFM) are strongly advocating that the vaccine be tested in pregnant women in order to accumulate efficacy and safety data in pregnant women. 

Is the vaccine harmful or potentially harmful to a pregnant woman or fetus?

Unfortunately, since pregnant women were not included in the studies, we can’t say for sure. We do know that current studies have shown a very favorable safety profile and there does not seem to be significant risk in taking the vaccine for you.  It stands to reason that it is safe during pregnancy, but unfortunately, we do not have data to support. 

Given the molecular makeup of the virus, the risk of fetal harm is low (no case of fetal harm has ever been reported, despite using a similar vaccine for ebola in pregnant women). Although new, our best science suggests that the vaccine is safe for pregnant women and their fetuses.

Should I get the vaccine if I am CURRENTLY pregnant?

While we believe that the mRNA vaccine is likely safe for pregnant women, we do not currently have data to support that. Therefore, until more data become available, we do not recommend getting the vaccine while you are pregnant if you are at low risk for severe COVID infection.

Spring Fertility joins our colleagues at ACOG and SMFM in advocating that pregnant women with underlying conditions should be encouraged to obtain the COVID vaccine.  First responders or healthcare workers who are pregnant and breastfeeding should consider getting the vaccine as well. In general, we believe that pregnant women should be eligible to receive it based on shared and informed decision making with the patient and their obstetrician.

While pregnancy can increase the risk of more severe disease when infected with COVID-19, overall mortality risk remains low in young women, including pregnant women.  Most severe cases of COVID in pregnant women have been limited to women with co-existing conditions, like diabetes or respiratory disease.

I heard the vaccine is dangerous or can cause infertility, is that true?

No.  Sadly, there is a campaign of misinformation circulating on the internet, including claims that the vaccine will cause infertility.  This is absolutely not true.  Many of these malicious rumors use pseudoscientific terms and physician names to try to give the appearance of credibility.  Please be careful about where your get information and help family members and friends find trusted sources of information like the CDC website.

Should I get the vaccine if I am trying to become pregnant (but not pregnant now)?

Yes, we encourage everyone who has access to get the vaccine if they have a negative pregnancy test.  We would not recommend the vaccine within 1 week of embryo implantation if you are going through treatment.

More to come…

As always, we appreciate the trust you place in us.  We will continue to stay current as more data emerge and will update you with any new studies that may influence decisions that you need to make for yourself and your family.

We’re wishing you a safe and happy holiday season. We acknowledge what a stressful year 2020 has been for everyone as we have now been dealing with the COVID 19 pandemic for over 9 months. We understand that COVID fatigue and the desire to gather with family and friends is particularly strong right now, especially given the holiday season. However, we encourage everyone to continue to follow the CDC guidelines regarding holiday gatherings to keep themselves and their loved ones safe.

Warmly,

Your partners at Spring Fertility

 

 

From Dec 9, 2020

Dear Spring Family,

We’ve received inquiries from many of you over the last several days regarding whether we would remain open under the new stay-at-home orders. Please rest assured that fertility care is essential care, and we remain committed to helping you achieve your goals, especially in these challenging times.  Please also note that our recommendations about receiving the vaccine prior to and during pregnancy is forthcoming, and we will continue to update our recommendations and interpretation of new data as they become available.

Responding to this pandemic has been a priority and presented us with numerous additional challenges.  We could not be prouder of our team – from our front desk to patient navigators and medical assistants who have all stepped up and put in extra effort, demonstrated terrific flexibility and resilience to help you safely achieve your goals on your timeline.

Since March, we’ve made numerous changes to our operating procedures to prioritize patient safety and to mitigate any risk of exposure to coronavirus. As a reminder, these measures include:

Telehealth: We made the decision to revert all initial consults back to video consults three weeks prior to the most recent shelter in place order to prioritize the health of our patients and staff. We will continue to rely on video and teleconferencing to complete initial consultations as well as any appointments that do not require an ultrasound, bloodwork, or a surgical procedure.

Staffing: Our team continues to operate in distinct pods to minimize and contain risk of spread if there were a coronavirus exposure. When you come into the office for an appointment, you may see a physician other than your primary Spring provider for treatment. Please rest assured that your Spring doctor, nurse, and patient navigator are still your care team; they are dedicated to your cycle and will be available to answer any questions or address any concerns that you may have.

Personal Protective Equipment: We are still asking our patients to please bring your own mask to all appointments. Masks help protect you and those around you. For the safety of our patients and our team, we’re requiring all Spring patients and team members to wear masks in all care settings, at all times. Following the Thanksgiving holiday, we required all Spring team members to wear N95 masks until everyone was tested and reported negative results.

COVID Screening: All patients are being screened for symptoms prior to scheduling their initial or baseline ultrasounds by a Spring patient navigator or nurse. Additionally, all patients must re-submit an updated COVID screening questionnaire by 5pm the evening before an in-person appointment via the Portal. If we do not receive a completed questionnaire, we will have to reschedule the appointment. In accord with the San Francisco Public Health mandate, all patients that are undergoing anesthesia (for an egg retrieval or hysteroscopy) must have been tested within 7 days of their surgery or the start of their IVF cycle.

Temperature Check: If you are scheduled to come into any of our clinic locations for an appointment, we ask that you take your temperature before you arrive. If you have a fever >100.0⁰F, please let your care team know and do not come into the office. We are also checking our employees’ temperatures at the beginning and end of their shifts. Anyone with an elevated temperature will be sent home.

Social Distancing:  We are continuing to minimize the number of people present in our offices in order to provide sufficient social distancing guidelines. We have extended appointment times to minimize any unnecessary in-person interaction between patients and are actively limiting the number of patients in the waiting areas at any given time to accommodate the recommended six feet of physical distancing. Additionally, we are asking for all patients to avoid bringing guests (including partners) to monitoring visits.

The health and well-being of our patients and team continues to be our top priority. We also recognize that health and well-being goes beyond the physical body, and we are happy to share our list of recommended mental health professionals if you are looking for additional support during this challenging time. We will all get through this together!

Warmly,

Your Family at Spring

 

From Nov 3, 2020

Dear Spring Family,

First, we’d like to acknowledge the immense stress currently being experienced collectively over our nation’s future:  today is the last day to vote. Over the last few weeks, Americans have been turning out to vote in record numbers. This level of engagement shows how passionate our country is about the challenges we’re facing and the movement is inspiring. We believe that every voice matters and that our country is stronger when we all participate in the democratic process. Thank you to everyone who has exercised their right to vote this electoral season. We are greeting this moment with hope for a bright future.

Secondly, we’d like to share our thoughts on findings recently published in a CDC Report as well as a New York Times article regarding pregnant women’s increased risks from COVID-19 infection. It is important to note that absolute risk for severe outcomes for women of child-bearing age, infected with COVID-19 remains low overall. This data reinforces an earlier CDC report showing a higher rate of hospitalization and ventilation among pregnant women with COVID.  Fortunately, mortality among younger pregnant women remains low and there was not a significant increase among pregnant women. Additionally, a separate study demonstrated an increase in risk of preterm birth among pregnant women who were infected with SARS-CoV-2.  The increase in absolute risk was 2.7% higher among women who tested positive for SARS-CoV-2 (12.9% compared to 10.2%).
 
Do pregnant women have more severe COVID-19 associated illnesses than non-pregnant women?

Among all women, cough, headache, muscle aches, and fever were the most frequently reported signs and symptoms. After adjusting for age, race/ethnicity, and underlying medical conditions, pregnant women were significantly more likely than were nonpregnant women to be:

• Admitted to an intensive care unit (ICU) – Pregnant (10.5%) vs. Nonpregnant (3.9%)
• 2.9x more likely to receive ventilation
• 2.4x more likely to receive extracorporeal membrane oxygenation (ECMO), although this is still extremely rare

These data reflects a group of 23,434 symptomatic pregnant women compared to 386,028 symptomatic non-pregnant women, ages 15-44. Notably, this sample size of pregnant women is 5x larger than the previous CDC report. 

Unlike the last report, in this study the CDC limited the data to women with symptoms in order to minimize confounding from some pregnancy related conditions that were unrelated to COVID.
 
Are pregnant women of color more at risk for severe COVID-19 associated illnesses than pregnant white women?

Unfortunately, it seems the answer is yes. While African American women made up 14.1% of women included in this analysis, they represented 176 (36.6%) deaths overall, including nine of 34 (26.5%) deaths among pregnant women and 167 of 447 (37.4%) deaths among nonpregnant women. This indicates a need to understand and better care for women of color who may be at higher risk for complications.  The higher proportion of Hispanic women who tested positive for the virus and had symptoms further highlights racial and ethnic disparities in both risk for infection and disease severity among pregnant women.
 
Does infection of COVID-19 while pregnant lead to a higher likelihood of preterm birth?

The data suggest that rates of preterm birth may be higher in pregnant women who become infected with SARS-CoV-2. This report included 4,442 infected women with known pregnancy outcomes, of whom 80% were in the third trimester of their pregnancy. Their average age was 29 years old and 45% had at least one pre-pregnancy condition. In this population, the absolute increase in risk of preterm birth for women testing positive for SARS-CoV-2 was 2.7% (12.9% vs. 10.2%). 

Data remain limited for women who are infected during their 1^st or 2^nd trimester. Additionally, this data set does not account for risk factors that can increase the rate of preterm birth, such as history of preterm birth.
 
What is the risk of a pregnant woman transmitting COVID-19 infection to their newborn?
The risk of transmitting infection to a newborn remains low.  Fewer than 3% of infected women had infants who tested positive.  This risk was mostly confined to women who tested positive within 1 week of giving birth.
 
What does this mean for me?

At this time, we are not making any recommendations to defer pregnancy. We will however take this opportunity to remind all of our patients to protect themselves from COVID wherever possible 

We encourage everyone to follow recommended infection prevention measures, including wearing a mask, social distancing, and frequent handwashing when going out or interacting with others. In addition, pregnant women or those who are actively trying to become pregnant should continue measures to ensure their general health, including staying up to date with flu vaccines and continuing prenatal care appointments.

As we enter flu season and case numbers continue to climb in some areas of the country, we remain dedicated to the precautionary measures we have taken to reduce transmission at Spring, dividing staff into distinct teams with regular testing, leveraging remote counseling and implementing effective social distancing. Please know that our greatest commitment is to the health and safety of our patients and our community. Our Providers are following developments closely, and we continue to develop and implement processes to keep our patients and staff safe.  We will continue to send meaningful updates as we learn more or if situations change.

We are tremendously grateful for the trust that you’ve placed in us as your partners in care. We’re here for you always!

Warmly,

Your Spring Team

 

 

 

From July 6, 2020

 

Dear Spring Family,

It has been wonderful to see so many patients back in our clinics over the last several weeks. The opportunity to partner with you to help you achieve your goals is our greatest joy, and now more than ever, we’re finding hope in helping to build families and look towards the future.

As more of life begins to re-open, we remind everyone to remain diligent in practicing good hand hygiene, following social distancing guidelines, and wearing protective face coverings. We’ve seen the efficacy of these safety measures in reducing transmission in the Bay Area and around the world, and we affirm that by working together, we can continue to keep ourselves and our loved ones healthy and safe.

You may have seen recent news articles describing a CDC report showing a higher rate of COVID hospitalization and intubation among pregnant women. Many of our patients have called with questions and so it feels important to share our understanding of recent findings with our whole community.

While a lot is still unknown, this data showed a higher hospitalization and ventilation rate among pregnant women, without a higher mortality rate from COVID-19 infection. At this time, we are not making any recommendations to defer pregnancy, and we are still moving forward with embryo transfer cycles, but what does this mean? 

Do pregnant women with COVID get sicker than nonpregnant women?

Unfortunately, the data sources were unable to determine if hospitalization, ICU admission or intubation are due to COVID or other pregnancy related complications.  While hospitalization is understandably more common among pregnant than non-pregnant women, the findings of higher rates of ICU admission and ventilation are concerning.  These could suggest that pregnant women with the SARS CoV-2 virus are more likely to require more intensive treatments, but it remains to be seen whether this is because the disease is more severe, or because pregnant women are being treated more aggressively in order to maintain healthy oxygenation. An increased need for respiratory support among pregnant women makes biological sense and is not cause for alarm. Pregnant women need higher oxygen levels to facilitate fetal-placental oxygenation, and so have a lower tolerance to respiratory issues.

Is there an increased risk of severe illness for pregnant women infected with COVID?

Fortunately, the report did NOT find a higher risk of severe illness among pregnant women with COVID than among non-pregnant women with COVID.  While this appears reassuring and seems to indicate that pregnant women do not have a higher risk of mortality than non-pregnant women, a higher rate of routine asymptomatic testing among pregnant women may account for this.   Both groups of women reported similar rates of cough, but 8% fewer pregnant women who tested positive reported a fever as well. There is a lot that is still unknown.  We are reassured by the fact that the rate of severe illness was not higher for pregnant women and at this time, we are not making any recommendations to defer pregnancy due to the ongoing pandemic, and we are still completing embryo transfer cycles.

Moving forward.

As case numbers surge across the country, we are confident in the measures we have taken to reduce transmission at Spring, dividing staff into 3 teams and lab staff into two teams, leveraging remote counseling and implementing effective social distancing. Please know that our greatest commitment is to the health and safety of our patients and our community. Our Providers are following developments closely, and we continue to develop and implement processes to keep our patients and staff safe.  We will continue to send meaningful updates as we learn more or if situations change. 

As always, we are tremendously grateful for the trust that you’ve placed in us as your partners in care. We know that the current environment remains challenging and may feel scary.  You are not alone if you feel anxious. Please know that we are here for you and remained committed to our Spring community.

Warmly,

Your Spring Team

 

 

 

From May 28, 2020

Dear Spring Family,

First, let us say that we are so happy to be seeing patients again and remain thoroughly committed to helping you achieve your reproductive goals, on your timeline. We are beginning egg retrieval cycles as soon as our patients are ready and are looking forward to re-initiating baseline visits for frozen embryo transfer cycles on June 1^st.

In adherence with a recent Directive from the San Francisco Department of Public Health, we will be implementing SARS-Cov2 (coronavirus) testing in advance of scheduled surgeries, including egg retrievals, hysteroscopies, and other procedures as advised by your care team. Please note, this does not include frozen embryo transfers.

All patients undergoing an egg retrieval will need to be tested for active COVID-19 infection via nasal swab prior to your baseline ultrasound.  We anticipate that some patients may test positive even if they do not have symptoms.  In this case we will need to delay your treatment until a repeat test is negative.  For patients undergoing other surgical procedures requiring anesthesia, we will screen within 7 days of your procedure.  Spring will provide a testing kit, complete with an order requisition and insurance / billing information. It is each patient’s responsibility to complete the nasal swab test and drop it off at either Labcorp or Spring the same day as administered. If the test is not completed, we will not be able to proceed with your egg retrieval or surgery.

We recognize that this testing may cause additional stress. Please know that we are doing everything possible to minimize any undue burden on our patients. By adhering to the new health mandate and taking every necessary precaution to prevent the transmission of COVID-19, we are protecting our community and preserving your ability to continue to access fertility treatments through the duration of the ongoing pandemic.

In anticipation of questions, we’ve outlined more details below. Please reach out to your care team if you have additional questions or would like to discuss your treatment plan in more detail. As always, we’re here for you and we are enormously grateful to be your partners in health.

Warmly,

Your Team at Spring

FAQ:

How much does a COVID-19 nasal swab test cost?

Labcorp will bill to your insurance, and they have informed us that your insurance should cover the full cost of the test.  The self-pay cost for the nasal swab test is $119.

What happens if my COVID-19 test comes back positive?

If you have a positive COVID-19 diagnosis, we will work with you to reschedule your surgery.

Who is financially responsible if my egg retrieval is cancelled due to a positive diagnosis?

We ask that the tests are completed 4-7 days prior to your baseline so that we have results and can minimize the risk of interruption or financial loss from a cancellation after a patient has started stimulation. If your egg retrieval surgery is cancelled due to a positive COVID-19 diagnosis prior to your baseline ultrasound, Spring will apply all payments received to date towards a future cycle as a credit. We cannot reimburse you for the cost of your medications. 

If your tests results are still pending or you have a test scheduled within 7 days of your baseline ultrasound and you elect to move forward with your cycle without a confirmed diagnosis, Spring will not be able to assume any responsibility for costs incurred, nor provide a credit towards future cycles.

From May 5, 2020

Dear Spring Family,

We hope that you and your loved ones are healthy and safe. We know that for many of our patients, pausing fertility treatments has caused tremendous stress and pain. Please know that we are doing everything we can to re-start your journey as quickly and safely as possible.

As previously communicated, we will be gradually re-initiating cycle starts for all patients over the coming weeks at a cadence that will enable us to prioritize our most time-sensitive patients, as well as provide the highest level of care to accommodate social distancing guidelines.

We’ve included the earliest available appointments, by type, below. If you are interested in beginning treatment as soon as possible, we will do our best to accommodate you. Please contact your care team with the start of your next menses or a positive ovulation test and we will review next steps and develop a personalized treatment timeline for you.

• April 23^rd IUI, IVF and Egg Freezing starts began for patients 38 and older, unique situations considered
• May 11^th All IUI, IVF and Egg Freezing cycle starts resume
• June 1^st Frozen Embryo Transfers cycle starts resume
• June 1^st Third party (egg donor and gestational carrier) screening processes resume, only if Shelter in Place ordinance is lifted

Other diagnostic appointments including Saline Sonograms, HSGs, and Semen Analyses, as well as necessary Hysteroscopic surgical procedures, will resume May 4^th.

We will continue to leverage telehealth services to complete initial consults via video conference through June 1st.

Please know that we take our role as healthcare providers during this time (and always) with great responsibility. We have made modifications to our typical patient experience to ensure the continued health of our patients, providers, and staff, and we greatly appreciate your understanding.

This means that you may see a provider other than your primary Spring physician for your monitoring appointments during the month of May. Rest assured that your doctor will still be creating your treatment plan and will be available to answer any questions you may have.

Additionally, in accordance with county-wide ordinances, we are requiring patients to bring their own masks to appointments, as well as permitting partners or other guests to only attend limited appointments, including egg retrievals and pregnancy ultrasounds (and later, embryo transfers).

As soon as the epidemiologic situation permits, we plan to resume our normal operations. Behind all of our Spring masks, we’re your same committed team. We are here for you and are dedicated to partnering with you to achieve your goals.

 

In health and fertility,
Your Spring Family

 

P.S. Below are some publicly available pandemic related resources that you may find helpful:

• The San Francisco Chronicle has done a great job of tracking cases in the Bay Area.
• Testing:
  • Wondering if you might be infected? Here are a list of sites and ways to get tested
  • Quest Diagnostics began offering direct to consumer Testing for coronavirus antibodies. A positive test may indicate you have some immunity to future re-infection.
• Looking for a way to give back to the community? Many members of our Spring Team have used this time to volunteer for those in need. If you are interested, here are some local opportunities:
  • https://www.handsonbayarea.org/covid19
  • https://www.sfchronicle.com/bayarea/article/Ways-to-help-Bay-Area-s-most-vulnerable-15141732.php

 

Previous Coronavirus Update: April 17, 2020

Dear Spring Family,

Thank you for all that you’re doing to help slow the spread of COVID-19 in our community. We recognize the immense personal sacrifices that everyone has made during this time to respond to the pandemic. We miss seeing our team in the office each day, we miss seeing you, and we miss the opportunity to share in the highs (and lows) of supporting your fertility journey. 

Fortunately, in the Bay Area it seems that we are winning in our goal to flatten the curve. We greatly appreciate the support we received from so many of you regarding our decision to pause beginning new fertility treatment cycles, and today, we are happy to share that we will be re-initiating egg retrieval cycle starts beginning on April 23rd. We plan to start slowly and will be prioritizing the most time sensitive cases first (egg retrievals for patients over age 38 or unique circumstances). Over the next few weeks, we will begin to re-initiate cycle starts for additional patients, even if the shelter in place ordinance is extended. This will include frozen embryo transfer (FET) cycles beginning in mid-May.

The entire team at Spring is passionate about providing the highest caliber of fertility care, and we look forward to continuing to advance our mission to partner with patients to achieve their goals, safely and responsibly.

How has the situation changed?

When we suspended the initiation of new treatment cycles, we did so because we felt it was our social responsibility to prevent any undue burden on our healthcare system, not because of data suggesting that it was unsafe to pursue treatment or conceive. Additionally, we faced tremendous uncertainty around how the rate of infection would progress in the Bay Area. Fortunately, early actions have proven effective at managing community transmission, and our hospitals and critical care centers are not under stress.

Fertility care is defined as essential by the state of California and as a standalone private practice (not part of a larger hospital), we can operate without diverting needed resources like personal protective equipment (PPE), ventilators, or skilled staff from the pandemic response at a larger hospital system.

So, is it safe to pursue treatment?

It is safe to conceive despite the pandemic, but there are important considerations for any person or couple considering pregnancy right now. At this time, still very little is known about the SARS-Cov2 virus, particularly related to its effect on pregnant women and infants, but there are currently no recommendations specific to pregnant women regarding the evaluation or management of COVID-19.

However, it is important to consider the overall healthcare system and recognize that prenatal care visits and overall access to health services will be more limited during this pandemic. 

For many of our patients, especially those women over the age of 38 or with diminished ovarian reserve, we recognize that every month counts. Therefore, we will be prioritizing restarting egg retrieval cycles for our patients in these categories. At this time, we will not yet be re-initiating embryo transfer cycles.

What does this mean for me?

We greatly appreciate your continued support and patience as we make every effort to resume clinic operations as safely and as seamlessly as possible. As the COVID-19 pandemic evolves, we are also updating our precautionary measures to help keep our patients, providers, and staff healthy and safe.

COVID Screening: All patients are being screened prior to scheduling their initial or baseline ultrasounds by a Spring patient navigator or nurse. Additionally, all patients must re-submit an updated COVID screening questionnaire by 5pm the evening before an in-person appointment via the Portal. If we do not receive an completed questionnaire, we will have to reschedule the appointment.

Temperature Check: If you are scheduled to come into any of our clinic locations for an appointment, we ask that you take your temperature before you arrive. If you have a fever >100.0⁰F, please let your care team know and do not come into the office. We are also checking our employees’ temperatures at the beginning and end of their shifts. Anyone with an elevated temperature will be sent home.

Personal Protective Equipment: Please bring your own mask to all appointments. Masks help protect you and are mandatory for treatment and workers at essential businesses.  For the safety of our patients and our team, we’re requiring all Spring team members to wear masks in all care settings, at all times.

Social Distancing:  As we resume operations, we will do so at a reduced capacity. We have extended appointment times to minimize any unnecessary in-person interaction between patients. We will limit the number of patients in the waiting areas at any given time to accommodate the recommended six feet of physical distancing, and we are asking for all patients to avoid bringing guests (including partners) to monitoring visits.

Staffing: We have implemented a “Doctor of the Week” staffing model through the duration of Shelter in Place. When you come into the office for an appointment, you may see a physician other than your primary Spring provider for treatment. Please rest assured that your Spring doctor, nurse, and patient navigator are still your care team and will be available to answer any questions or address any concerns that you may have. We have also taken the additional precaution of splitting our clinic staff into two teams to minimize and contain risk of spread if there were a coronavirus exposure.

Telehealth: We will continue to rely on video and teleconferencing to complete initial consultations as well as any appointments that do not require an ultrasound, bloodwork, or a surgical procedure.

We are doing everything in our power to keep both our patients and staff healthy, safe, and advancing towards their goals. Nothing that we do would be possible without the immense trust that you place in us, and we look forward to continuing to partner with you.

 

In health and fertility,

Your Spring Family