29 May 2020
Anna Veiga – ESHRE / Spain
Luca Gianaroli – ESHRE /Italy
Steve Ory – IFFS /USA
Marcos Horton – IFFS / Argentina
Eve Feinberg – ASRM/USA
Alan Penzias – ASRM/USA
Declaration of principle
Reproduction is an essential human right that transcends race, gender, sexual orientation, or country of origin. Infertility is the impairment of reproductive capacity; it is a serious disease that affects 8-12% of couples of reproductive age and harms physical and mental well-being. Infertility is time-sensitive, and prognosis worsens with age. While there is no cure for most causes, the disease is most often treatable, and the majority of patients who seek treatment can ultimately become parents.
Defining the problem
The COVID-19 pandemic presents a unique global challenge on a scale not previously seen. The infectivity and mortality rates are higher than previous pandemics and the disease is present in almost every country. The propagation and containment have varied widely by location and, at present, the timeline to complete resolution is unknown. In the earliest stages of the pandemic, the American Society for Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE), independently recommended discontinuation of reproductive care except for the most urgent cases. More recently, with successful mitigation strategies in some areas and emergence of additional data, the societies have sanctioned gradual and judicious resumption of delivery of full reproductive care. In this document, ASRM, ESHRE and the International Federation of Fertility Societies (IFFS) have come together to jointly affirm the importance for continued reproductive care during the COVID-19 pandemic.
Reproductive medicine is essential
Reproductive care is essential for the well-being of society and for sustaining birth rates at a time that many nations are experiencing declines. During the pandemic, reproductive medicine professionals should continue to:
In addition to helping patients, reproductive medicine practices are uniquely positioned to gather data and help to further COVID-19 research.
Reproductive care is essential and reproductive medicine professionals are in a unique position to promote health and wellbeing. In addition, ASRM, ESHRE and IFFS are collaborating to advocate for patients and to gather data and resources to enhance the understanding of COVID-19 as it pertains to reproduction, pregnancy, and the impact on the fetus and neonate. The lessons learned from these experiences will be useful as humanity deals with future pandemics.
13 May 2020
Karl-Gösta Nygren, known to his colleagues in Sweden as 'KG', died peacefully on 12 May following a brief period in hospital with coronavirus infection. ESHRE is now honoured to record the enormous contribution Karl made to the Society over many years and to express deep sadness at his death.
Oscars for the EIM pioneers: from left, Anders Nyboe Andersen, Luca Gianaroli, Karl-Gösta Nygren, Jacques de Mouzon, Anna Pia Ferraretti.
For ESHRE the inspiration of Karl and Anders Nyboe Andersen has now become one of its most powerful and influential activities, with all now agreed that monitoring such systems as ART are mandatory for clinical science to progress. EIM reports continue to be some of the most highly cited papers in the ESHRE journals.
Karl-Gösta Nygren was Associate Professor of Obstetrics and Gynaecology at the Sophiahemmet clinic in Stockholm, which he established in 1984 as Sweden's first private IVF centre and where he would remain throughout his career. He served on many committees, notably ESHRE's advisory committee of national representatives and later as coordinator of the SIG Safety and Quality in ART. He was elected chairman of the International Committee Monitoring ART (ICMART) at its first board meeting in 2003 to coordinate its world surveillance programme, and was president of the Swedish Society for Obstetricians and Gynaecologists between 1992 and 1994.
In 2007, in a report highlighting a 5% twin rate in IVF in Sweden, he predicted that single embryo transfer 'will become the norm' in the treatment of infertility, and throughout his career he continued to support SET as a necessary requirement of IVF safety. It was Karl, whose personal rallying cry was 'Safety first', who came up with the 'one child at a time' slogan, which many would take up in campaigns to reduce their multiple pregnancy rate. And applying the data generated by Sweden's registry systems, he was the author of many cross-linkage studies assessing the long-term safety of IVF. Multiplicity was invariably associated with adverse outcomes in these studies.
Karl was a member of ESHRE's executive committee from 1997 to 2001 and was an ever cheerful fixture at annual meetings and Campus events, where he continued to enjoy the company of members and colleagues. He was made an honorary member of ESHRE in 2005. His contribution to the Society in the foundation and running of the EIM consortium has been monumental and ESHRE is honoured to express its gratitude for his work and its condolences to his wife Margareta and family.
Former ESHRE chair Kersti Lundin remembers Karl as 'a very important person for ART in Sweden and in the world'. 'I first met him when I was a young embryologist in Gothenburg,' she recalls, 'and was fascinated by his determination and stamina in fighting for patient rights to best treatment and for the health of the children. He was a very kind and generous man, with a great sense of humour, but he would rarely give way in any discussion on matters close to his heart. He was a good friend and part of my upbringing in ART, and I, like many others, will remember him with great fondness.'
23 April 2020
As the COVID-19 pandemic is stabilising, the return to normal daily life will also see the need to restart the provison of ART treatments. Infertility is a disease and once the risk of SARS-CoV-2/COVID-19 infection is decreasing, all ART treatments can be restarted for any clinical indication, in line with local regulations.
However, vigilance and measured steps must be taken for safe practice and to minimise the risks related to SARS-CoV-2/COVID-19-positive patients or staff during treatment.
The ESHRE COVID-19 working group has prepared the “ESHRE Guidance on recommencing ART treatments”, a set of recommendations for centres planning to restart ART treatments.
Read the full Guidance here
2 April 2020 (last revision 17 April)
In view of the continuing prevalence of infection from the coronavirus SARS-CoV-2 (i.e. the virus causing COVID-19) and widespread initiatives to limit its spread, ESHRE reaffirms its recommendation to follow local and national government advice, particularly national daily updates.
The available evidence
To date, there is no clear evidence of any negative effect of SARS-CoV-2 infection on pregnancy, as indicated by the latest updates from the Centers for Disease Control and Prevention (CDC) in the USA and others in Europe.[1, 2] Even so, we should be mindful that viral infections can be more problematic for pregnant women and acknowledge that some of the medications used in virus-infected patients may not be recommended during pregnancy.
Recent updates on pregnancy outcomes in infected mothers report healthy infants born free of the disease. However, there are small case series reporting adverse outcomes, such as premature rupture of membranes and preterm delivery. Neonatal SARS-CoV-2 infection (five cases) [5-7] and the presence of IgM (and IgG) antibodies against the virus in newborns (three cases) [8, 9] have also been reported. It is unclear whether these data are indicative of vertical transmission of SARS-CoV-2.
An up-to-date overview of data extracted from all published reports on pregnancy and neonatal outcomes in women with confirmed COVID-19 is available from the Cochrane Gynaecology and Fertility Group (https://cgf.cochrane.org/news/covid-19-coronavirus-disease-fertility-and-pregnancy). In general, the data on pregnancy outcomes, although reassuring, only report small numbers and must be interpreted with caution. Furthermore, as reports mainly refer to infection in the third trimester, there is no information on the possible effect of SARS-CoV-2 infection on pregnancies in their initial stages.
In view of the above considerations and outcomes reported in cases of other coronavirus infections (such as SARS and MERS) [11, 12], ESHRE continues to recommend a precautionary approach to assisted reproduction, which is consistent with the position of other scientific societies in reproductive medicine. During the pandemic, all medical professionals have a duty to avoid contributing additional stress to a healthcare system that in many locations is already overloaded.
ESHRE advises that assisted reproduction treatments should not be started at present for the following reasons:
- To avoid complications from assisted reproduction treatment and pregnancy
- To avoid potential SARS-CoV-2 related complications during pregnancy
- To mitigate the unknown risk of vertical transmission in SARS-CoV-2 positive patients
- To support the necessary reallocation of healthcare resources
- To observe the current recommendations of social distancing.
In cases of urgent fertility preservation in oncology patients, the cryopreservation of gametes, embryos or tissue should still be considered.
For those patients having started assisted reproduction treatment at the present time, elective oocyte or embryo freezing for later embryo transfer (freeze-all) is recommended.
Any risk of viral contamination to gametes and embryos in the IVF laboratory, either from infected patients or professionals, is likely to be minimal (if at all) because the repeated washing steps required for the culture and freezing protocols will result in a high dilution of any possible contaminants.Even with no specific data available, it is assumed that sperm, oocytes and embryos are unlikely to be infected. Furthermore, the zona pellucida represents a high level of protection for oocytes and embryos. Regardless of the biological details, it is prudent to defer all elective fertility-promoting medical procedures, primarily to maintain social distancing and protect any and all medical resources.
Since many uncertainties remain about the effects of SARS-CoV-2 infection on ART and pregnancy, and despite different approaches among treatment centres and countries, ESHRE currently considers any risk too high when similar treatments can be performed at a later date.
Healthcare professionals and clinics should remain available to provide supportive care , psychological support and clinical advice to their patients, preferably via online consultation.
As always, good clinical and laboratory practice is strongly recommended by ESHRE to guarantee safety for processed tissues and cells, professionals and patients. [13, 14]
ESHRE will continue to monitor the scientific literature and this statement will be regularly updated.
The ESHRE COVID-19 working group is presently preparing recommendations for clinics planning to restart ART services. These will consider patient selection, general and specific organisation of services and good laboratory and clinical practice, with an emphasis on both patient and professional safety and responsibilities.
3. Schwartz DA, An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med, 2020. https://doi.org/10.5858/arpa.2020-0901-SA
4. Liu Y, Chen H, Tang K, et al., Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect, 2020. https://doi.org/10.1016/j.jinf.2020.02.028
5. Yu N, Li W, Kang Q, et al., Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-centre, descriptive study. Lancet Infect Dis, 2020. https://doi.org/10.1016/S1473-3099(20)30176-6
6. Wang X, Zhou Z, Zhang J, et al., A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clin Infect Dis, 2020. https://doi.org/10.1093/cid/ciaa200
7. Zeng L, Xia S, Yuan W, et al., Neonatal Early-Onset Infection With SARS-CoV-2 in 33 Neonates Born to Mothers With COVID-19 in Wuhan, China. JAMA Pediatr, 2020. https://doi.org/10.1001/jamapediatrics.2020.0878
8. Dong L, Tian J, He S, et al., Possible Vertical Transmission of SARS-CoV-2 From an Infected Mother to Her Newborn. Jama, 2020. https://doi.org/10.1001/jama.2020.4621
9. Zeng H, Xu C, Fan J, et al., Antibodies in Infants Born to Mothers With COVID-19 Pneumonia. JAMA, 2020. https://doi.org/10.1001/jama.2020.4861
10. Liang H and Acharya G, Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? Acta Obstet Gynecol Scand, 2020. https://doi.org/10.1111/aogs.13836
11. Schwartz DA and Graham AL, Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses, 2020. 12 (2). https://doi.org/10.3390/v12020194
12. Rasmussen SA, Smulian JC, Lednicky JA, et al., Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. Am J Obstet Gynecol, 2020. https://doi.org/10.1016/j.ajog.2020.02.017
13. ESHRE Guideline Group on Good Practice in IVF Labs, De los Santos MJ, Apter S, et al., Revised guidelines for good practice in IVF laboratories (2015)†. Hum Reprod, 2016. 31: 685-686. https://doi.org/10.1093/humrep/dew016
14. European Directorate for the Quality of Medicines (EDQM), Guide to the quality and safety of tissues and cells for human application 2019: https://register.edqm.eu/freepub.
25 March 2020
In view of the rapidly growing number of reports and the impact of the COVID-19 coronavirus on public health, ESHRE has formed a specialist working group to keep track of bibliography and published scientific reports relevant to reproductive medicine, pregnancy and newborns.
This working group comprises
Anna Veiga (ES), Coordinator
Kersti Lundin (SE)
Juha Tapanainen (FI)
Luca Gianaroli (IT)
Edgar Mocanu (IRL)
Baris Ata (TR)
Satu Rautakallio-Hokkanen (Fertility Europe) (joined on 9 April 2020)
and will be supported by Nathalie Vermeulen, ESHRE Senior Research Specialist.
It is hoped that the data assembled will consolidate and lead ESHRE's response to the impact of COVID-19 on pregnancy and reproductive health.
'There are scientific reports on the coronavirus published every day,' said Coordinator Anna Veiga, 'and our group will screen them for developments in reproductive health and pregnancy. Our first aim will be to ensure ESHRE guidance is up-to-date and accurate, but we also hope this will become an ESHRE resource centre for everyone working in reproduction.'
The working group's aims are to:
A daily report will be prepared by ESHRE Central Office from the working group's monitoring activities.
23 March 2020 - It is with great regret that ESHRE today announces cancellation of its 2020 Annual Meeting planned for Copenhagen on 5-8 July. Many of you, ESHRE members and colleagues, will not be surprised: indeed, with long-term protection measures against the coronavirus now in place, restrictions on public gatherings, and flight schedules unlikely to be resumed soon, cancellation had rapidly become inevitable.
'It's an extremely disappointing decision to take,' said ESHRE Chair Cristina Magli, 'but we are all aware of the devastating effects of COVID-19. Prevention and protection must be our priorities. We did consider postponement, but this is an annual event attended by more than 10,000 people from all over the world. Postponement and re-arrangement were impossible. ESHRE remains a strong and well supported Society and it is our hope that the energy and scientific advances made by our supporters this year will continue to drive our next meeting in Paris in 2021.'
ESHRE is now exploring the possibility of developing a virtual platform for the availability of intended 2020 presentations online. This would hopefully be a simple process, and all speakers will now be contacted about their willingness to participate - but this project is still in the planning stages. Thus, the abstracts review process and programme planning will continue, and all those submitting an abstract will be informed in due course if it was selected for presentation.
All those who have already registered for Copenhagen 2020 will also be contacted about refunding their payments.
Cancellation of this year's meeting has implications for many related activities, for which ESHRE cannot yet provide detailed information. Precongress courses and certification exams scheduled for Copenhagen must now be cancelled and rearranged; once clarified, details, including refund of fees, will be distributed. Also cancelled or postponed are all Campus meetings scheduled for May.
Despite the loss of this year's annual meeting, please be assured that ESHRE, its online activities and website will remain as active as ever during the next difficult weeks. We are determined that ESHRE’s opportunities for education and leadership are not suppressed by these most unfortunate circumstances. And we hope we can rely on your continued support and understanding at this unprecedented time.
19 March 2020
In view of the increasing incidence of infection from the coronavirus Covid-19 and widespread initiatives to limit its spread, ESHRE reaffirms its recommendation that Society members follow local and national government advice, particularly national daily advice updates, with compliance encouraged where feasible.
Pregnancy and conception
There is no strong evidence of any negative effects of Covid-19 infection on pregnancies, especially those at early stages, as indicated by the latest updates from the Centers for Disease Control and Prevention (CDC) in the USA and others in Europe.(1,2)
There are a few reported cases of women positive for Covid-19 who delivered healthy infants free of the disease.(3) There have been reports of adverse neonatal outcomes (premature rupture of membranes, preterm delivery) in infants born to mothers positive for Covid-19 during their pregnancy, but the reports were based on limited data.(4,5) Similarly, one case report has been published of an infected infant, but again there was no strong evidence that this was the result of vertical transmission.(6)
These data, although encouraging, only report small numbers and must be interpreted with caution. They refer to pregnancies in their final stages, but we have no information on the possible effect of Covid-19 infection on pregnancies in their initial stages.(7)
However, in view of the above considerations and the maternal and neonatal outcomes reported in cases of other coronavirus infections (such as SARS), ESHRE continues to recommend a precautionary approach.(8) It is also important to note that some of medical treatment given to severely infected patients may indicate the use of drugs which are contraindicated in pregnant women.
As a precautionary measure - and in line with the position of other scientific societies in reproductive medicine - we advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid becoming pregnant at this time. For those patients already having treatment, we suggest considering deferred pregnancy with oocyte or embryo freezing for later embryo transfer.
ESHRE further advises that patients who are pregnant or those (men and women) planning or undergoing fertility treatment should avoid travel to known areas of infection and contact with potentially infected individuals.
ESHRE will continue to monitor the scientific literature, especially in relation to ART and pregnancy. And reaffirms the view that all medical professionals have a duty to avoid additional stress to a healthcare system that in many locations is already overloaded.
3. Schwartz DA. An Analysis of 38 Pregnant Women with COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Archives of pathology & laboratory medicine 2020. https://doi.org/10.5858/arpa.2020-0901-SA
4. Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infection 2020; doi.org/10.1016/j.jinf.2020.02.028
5. Liu D, Li L, Wu X, Zheng D, Wang J, Yang L, Zheng C. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. AJR American journal of roentgenology 2020: 1-6. https://www.ajronline.org/doi/10.2214/AJR.20.23072
6. Wang X, Zhou Z, Zhang J, et al. A case of 2019 Novel Coronavirus in a pregnant woman with preterm delivery. Clinical Infectious Diseases 2020; doi.org/10.1093/cid/ciaa200
7. Liang H, Acharya G. Novel corona virus disease (COVID-19) in pregnancy: What clinical recommendations to follow? AOGS 2020; doi.org/10.1111/aogs.13836
8. Schwartz DA, Graham AL. Potential and maternal infant outcomes from coronavirus 2019-nCoV (SARS-CV2) infecting pregnant women: Lessons from SARS, MERS, and other coronavirus infection. Viruses 2020; doi.org/10.3390/v12020194
12 March 2020
It was with great sadness that ESHRE learned of the death of Lynn Fraser, chair of ESHRE from 1999 to 2001 and the first female to lead the Society. Lynn, a biologist with a research interest in sperm function, had an extensive involvement with ESHRE, moving from the Advisory Committee in 1990 to become two years later co-ordinator of the newly founded Special Interest Group Andrology. She joined the Executive Committee the following year and in 1999 became the Society's first female chair, taking charge of ESHRE during the two most difficult years of its history.
Lynn Fraser grew up and was educated in the USA. She took her first degree in zoology at the University of Colorado and her doctorate at Yale, where she was awarded a Ford Foundation postdoctoral fellowship. In 1972 she moved to London to take up a scientific post for the Medical Research Council, where she remained for five years. In 1977 she became a lecturer at King's College, London, and in 1993 Professor of Reproductive Biology. From 1991 Lynn was also an inspector for the UK's Human Fertilisation and Embryology Authority.
The years of Lynn's chairmanship of ESHRE were noted for their divided views on the publication model of the ESHRE journals. Robert Edwards, who had edited Human Reproduction from its foundation in 1985 and in the meantime had introduced Molecular Human Reproduction and Update, favoured self-publication, while the Executive Committee preferred to rely on the proven support of a commercial publisher. It was Lynn's task to steer ESHRE's way through these divided opinions and to ensure through unanimity the continuing success of the journals.
After her academic retirement in 2003, Lynn retained her great interest in ESHRE and its progress, and was always to be seen at every annual meeting, enjoying the social gatherings and the company of her fellow past chairs. She had not been well for the past few months and ESHRE is honoured to express its gratitude for her work and its condolences to her husband Bill and family.
Hans Evers, who succeeded Lynn as ESHRE chairman in 2001, recalls how he learned 'to appreciate Lynn's wise governance and her gifts as a considerate moderator', adding: 'She always was at her best when strong opinions were in conflict, and when irreconcilable opponents needed an honourable escape. Otherwise, we will always remember Lynn and Bill (the first man in our annual meeting's spouses programme) for their congeniality, their great social skills and their delightful and entertaining dinner talks.'
12 March 2020 - last update 25 March 2020
It is with great regret that ESHRE is postponing its Campus meetings scheduled for March and April. ESHRE has been closely monitoring the spread and prevention of the coronavirus Covid-19 and has taken this decision in the light of present circumstances.
The following Campus meetings, originally planned for March and April 2020, have now been postponed:
The following Campus meetings have now been cancelled:
We have been monitoring the situation closely,' said ESHRE Chair Cristina Magli, ' but in the end, with increasing infection rates, travel restrictions and more international prevention measures in place, we considered postponement our best option given that avoiding personal contact is the only way to stop spread of the virus. We hope all ESHRE members and colleagues understand and support our decision.'
ESHRE will try to re-arrange these meetings at later dates with the SIG organisers and will inform all registrants individually about new arrangements. Meanwhile, answers to some of your questions may be found here.
ESHRE is closely monitoring developments in the spread and prevention of the novel coronavirus Covid-19 and wishes to reassure members and colleagues that its annual meeting, scheduled for Copenhagen on 5-8 July, is still on schedule to go ahead. We are monitoring infection updates and local travel and prevention requirements and at present have no plans to cancel or postpone the meeting. For frequent worldwide updates on the situation in Europe, we refer readers to the (official) coronavirus website (https://politi.dk/coronavirus-i-danmark/in-english/questions-and-answers), the website of the European Centre for Disease Prevention and Control (ECDC) (https://www.ecdc.europa.eu/en/novel-coronavirus-china) and the Q&As provided by the Danish Health Authority (https://www.sst.dk/da/Viden/Smitsomme-sygdomme/Smitsomme-sygdomme-A-AA/Coronavirus/Spoergsmaal-og-svar/Questions-and-answers).
ESHRE will continue to monitor these developments and provide further updates as necessary.
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