Although there have been no public advisories for women not to get pregnant during the pandemic, there may be potential risks. Patients are required to sign an informed consent in order to receive treatment at this time. Potential risks include:
- The possibility patients may contract COVID-19 at any public place, including at RCC, despite utilization of risk mitigation strategies.
- The potential for treatment cancellation due to COVID-19 exposure, infection or other issues such as unavailability of Personal Protective Equipment (PPE) or changes in regulations.
- There may be increased risk for pregnant women who contract COVID-19.
- There may be increased risk for pregnancies or children conceived during the pandemic or whose mothers have COVID-19.
American Society for Reproductive Medicine (ASRM) Task Force Recommendations:
- All mitigation measures as outlined in the Task Force’s Update #3 should remain firmly in place while vaccination efforts get underway, as: 1) it is not yet known whether a vaccinated individual can spread the virus if they become infected with SARS-COV-2; 2) protective immunity against COVID-19 takes time to develop; and 3) although a two-dose regimen of the Pfizer-BioNTech vaccine is 95% effective against the development of COVID-19, it does not confer 100% immunity.
- The Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating. These recommendations are in line with those of the Advisory Committee for Immunization Practices (ACIP) of the U.S. Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM).
- Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.
- A shared decision-making model between patients and providers should be used when considering vaccination and should take into consideration the ethical principles of autonomy, beneficence, and non-maleficence. Consideration of local COVID-19 transmission and risk of acquisition, personal risk of contracting COVID-19, risks of COVID-19 to the patient and potential risks to a fetus, efficacy of the vaccine and known side effects, and the lack of data about the vaccine during pregnancy should all be taken into consideration as patients make decisions regarding vaccination. Some individuals may elect to defer conception attempts until both doses of vaccine have been administered.
- Recent studies have suggested that pregnancy is a risk factor for severe COVID-19 disease. Furthermore, many women who are pregnant or contemplating pregnancy have additional risk factors such as obesity, hypertension or diabetes which may further increase the chance of severe disease from COVID-19 infection. These considerations should be included in decisions regarding vaccination.
- Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies. It should be noted that pregnant and lactating women were excluded from the initial phase III trials of these two vaccines, so specific safety data in these populations are not yet available and further studies are planned. However, the mechanism of action of mRNA vaccines and existing safety data provide reassurance regarding the safety of COVID-19 mRNA vaccines during pregnancy. The FDA EUA letter permits the vaccination of pregnant and breastfeeding individuals with a requirement that the company engage in post-authorization observational studies in pregnancy.
- While COVID-19 vaccination can cause fever in some patients (up to 16% of those vaccinated and mostly after the second dose), this risk should not be a concern when deciding whether to vaccinate a pregnant individual or a patient desiring pregnancy. While fever in pregnancy (particularly the 1st trimester) has been associated with an increased risk of neural tube defects, a recent study demonstrated the association no longer remained significant if the patient is taking >400 mcg of folic acid daily. Another large Danish cohort study did not demonstrate any increased risk of congenital anomalies of those who reported fever in the first trimester. Additionally, the most common symptom of COVID-19 infection itself is fever (83-99% of affected patients). Patients who experience fever following vaccination should take an antipyretic medication, like acetaminophen.
- Patients who conceive in the window between the first and second dose of the vaccine should be offered the second dose of the vaccine at the appropriate interval.
- Physicians should promote vaccination to patients, their communities, and to the public. Preliminary data suggests that those populations at greatest risk of severe disease from COVID-19 may also be the most hesitant to be vaccinated, and specific efforts to increase vaccine uptake in these communities should be undertaken.
Risk Mitigation Plan:
- Telemed/Phones will be used for all consultations with the physicians, nurse practitioner and nurses and for any discussions with billing our scheduling staff.
- Limited patient volumes will allow for appropriate social distancing.
- RCC physicians and teams will be physically separated to reduce exposure risk
- Spouse/Partner, children, and additional family or friends will not be allowed in clinic. No exceptions.
- All patients and employees in clinic will be required to wear a mask. Patients should bring their own masks.
- All patients and staff spending time in clinic must download and use the Healthy Together app provided by the state to help monitor patient/staff health and to determine if COVID-19 testing is needed. Patients and staff are required to answer the following screening questions honestly on the Healthy Together Utah app just prior to entering the clinic:
- Who are you taking this for?
- Do you have any of these symptoms? (fever, cough, congestion or runny nose, new or increased shortness of breath, decreased sense of smell or taste, sore or scratchy throat, muscle aches and pains, none of the above)
- Have you been in close contact with someone who tested positive for COVID-19 in the last two weeks? Close contact means you were within 6 feet (2 meters within 6 feet (2 meters) for at last 15 minutes in a 24 hour period. If yes, you will need to reschedule.
- Have you been tested for COVID-19 in the last 2 weeks?
- See healthytogetherutah.com for more information about this program. Please contact us if there are any concerns about this requirement. Results from successful check in then need to be emailed to [email protected]. If unable to email, have the app ready to show staff when your temperature is taken outside of the clinic.
- Employees who show symptoms of illness or who have been in contact with anyone who is sick or who has traveled to a high-risk area are required to stay home. Staff able to work remotely to limit contact with co-workers and patients will continue to do so.
- All RCC employees have been strongly encouraged to receive both doses of the COVID-19 vaccine.
- RCC staff will continue strict clinic protocols for cleanliness and hand washing.
- Patients stay in their car and check in via cell phone by calling: Sandy 801-878-8888 or Clearfield 801-784-5484
- When an exam room is available, our staff will call to invite the patient to meet at the front door of the clinic with their mask. A touch free thermometer will be used to confirm all who enter are fever free. Hand sanitizer will be used and then the patient will be escorted directly to an exam room. We ask patients to refrain from touching anything in the office as much as possible. Ideally, rest room facilities would be used at home prior to coming to the office.
- Payment will be collected over the phone or via patient portal to avoid contact.
- Upon check out, patients return to their car without stopping at the front desk. Future appointments will be scheduled by phone.
- In order to gain greater knowledge of COVID-19, RCC is participating in a research project headed by doctors at UC San Francisco. Patients are invited, but not required, to participate in this study which will help healthcare providers manage this virus efficiently and safely in the future.
Our Pleasant Grove and Idaho Falls patients are continuing care via telemed with in-clinic visits at our Sandy or Clearfield locations. Our Pleasant Grove and Idaho Falls clinics will remain closed until further notice due to COVID-19 staffing measures to reduce risk.
We appreciate your understanding while we continue to comply with ASRM, federal, state and local mandates and recommendations due to COVID-19. Click here for further information regarding ASRM recommendations: