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 1st or 2nd 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!
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.
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.
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 1st.
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.
Your Team at Spring
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 23rd IUI, IVF and Egg Freezing starts began for patients 38 and older, unique situations considered
- May 11th All IUI, IVF and Egg Freezing cycle starts resume
- June 1st Frozen Embryo Transfers cycle starts resume
- June 1st 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 4th.
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.
- 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:
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