I never anticipated that we would be having the conversations that we are having now about the implications of a worldwide pandemic on infertility and fertility treatment. I often wonder what the world will look like in the (hopefully) not so distant future once we get past this pandemic; locally, nationally and globally.
What I have noted in these past few weeks is that humanity can be beautiful when we come together. Community empowers us to set aside our own fears and anxiety in support of one another and those on the front line. To support the mental health of other infertility warriors on hold with kindness and simply checking in, to feed hungry children who relied on getting a meal each day at a school which is now closed, to protect and nourish our healthcare workers with personal protective equipment (which is is dire shortage) and feed them healthy food to fuel their immunity during extensive shifts so that they can continue to save lives.
What you may not know is that in certain places around the country including NYC, our fertility doctors are also being asked to volunteer to be on the front line to fight against Covid-19. The same doctors that you know help create life are now being asked to sustain it. I had the opportunity to catch up recently with Dr. Anate Brauer, one of our healthcare heroes who is ready to the answer the call if it comes.
I cannot wait for a nation no longer on pause, to see Dr. Brauer live and thank her for her empathy as well as lending her support and expertise to both infertility and in relation to a cause that none of us saw coming.
Dr. Brauer, what does your work day look like now versus two weeks ago?
AB: Wow. Where to begin. Two-three weeks ago my office was bustling with patients excited to embark on their journeys to parenthood. My day was filled with in-person consults, retrievals, embryo transfers and other procedures aimed at achieving the ultimate goal, PREGNANCY. Over the past couple of weeks, following state local and national guidelines, we have quickly shifted to remote practice of medicine. SGF (Shady Grove Fertility), as an organization, quickly developed and adopted an efficient telemedicine protocol which has been absolutely crucial in our continued delivery of care. Currently, my days are spent mostly on video consults as well as many calls and emails surrounding specifics of Coronavirus as it relates to fertility and pregnancy. As IVF Director of the New York region, I am also on SGF’s Coronavirus task force, which meets almost daily as situations change.
What has changed about patient protocol and office visits since ASRM released its view on treatments?
AB: Shady Grove Fertility - New York is now fully operational as a remote practice. It has been pretty incredible to see how quickly we made this happen. A patient calls to schedule a new patient or follow up visit, is registered into our secure portal where he or she will receive instructions on how to set up a link to a video consult. That link is then placed in to my daily schedule. We both simply click on the link and we are connected on a HIPPA compliant platform on our phone, tablet or computer. The patient can also upload our patient questionnaire and any records into the portal with help of our patient coordinators so that I am able to review prior to our consult. We are not currently doing any non-urgent testing or treatment, however are working on abilities for remote testing. We are continuing necessary in person care of our medical fertility preservation (for cancer) patients and our pregnant patients, and have very specific screening and social distancing protocols in the office.
Is testing included in your screening for patients that may have been exposed to Covid-19?
AB: We are not currently offering coronavirus testing in our office. If patients have been exposed, they are directed to contact their primary care physician.
What is SGF's view on pregnancy right now? How long does the medical community anticipate that it will take to understand any potential implications of pregnancy?
AB: The first reported cases of Coronavirus came out of China in November of 2019. Since this is a novel virus, there is little data about its effects on pregnancy. Data existing about other Coronavirus is reassuring, however. This is why the American College of Obstetrics and Gynecology and the Society for Maternal Fetal Medicine have NOT come out with statements that women should avoid pregnancy.
Does a pregnant patient have the potential to become more ill from the virus and could it affect a developing a fetus?
AB: We do not have any reason to believe that a pregnant patient will become more ill from the virus. We also have no data to suggest that the virus can affect a developing fetus. It is important to note that any virus that causes high fevers, such as the flu for example, can cause pregnancy complications. Coronavirus is no different.
Is SGF still planning to continue with new egg freezing, retrievals and transfers?
AB: SGF - NY is no longer initiating new, non-urgent fertility treatments. We are, however, very committed to taking care of our patients who require time sensitive fertility preservation, and therefore, will remain fully operational for those specific cases.
Will there be any impact to the embryo if mom tests positive during the cycle?
AB: Not that we know of.
Will SGF- NY proceed with treatment situations that require immunosuppressants?
AB: We do not generally use immunosuppressants as part of our protocols as they are not evidence based, and in the current environment, likely cause more harm than good.
What happens if someone had to cancel a treatment mid-cycle? Can their financial investment be recouped?
AB: There are clinical protocols in place of what to do medically if you must stop in mid cycle. These protocols revolve around decreasing risks of OHSS in the setting of no retrieval.
Financial investment is a whole different issue. Just as in the case of cancelled cycles for other reasons most clinics will only charge for what had been done thus far and therefore patients should be able to recoup the bulk of the cost that comes from the retrieval itself. Another option is crediting part of their current cancelled cycle to their resumed cycle after the virus is under control.
Anything else you would like the (in)fertility community to know?
AB: This is a very difficult time. As IVF director of a large center in the heart of NYC, I am faced with new challenges daily during these unprecedented times. Remember, we, as an IVF community have to not only protect our current patients, but protect our precious eggs and embryos in our freezers during a time of crisis and possible shut downs. We know and understand that infertility in and of itself is an extremely anxiety provoking state which makes the current situation even more unfathomable.
We are right there with you. We are a team that now more than ever needs to (and are) working together to find the safest and most practical solution(s).
This. Will. End. You will build your family. And when you do, you will cherish it in a way the world has never experienced. That’s what crisis does. It makes you stronger and opens your eyes to new appreciations for everything around you.
Dr. Anate Aelion Brauer A. Brauer, M.D., FACOG, is a board-certified reproductive endocrinologist with extensive experience in treating all medical and surgical aspects of infertility. She serves as Shady Grove Fertility - New York’s IVF Director. Learn more about Shady Grove Fertility - New York here, and Dr. Brauer on IG: @dranatebrauer
*Note: Clinics may be operating slightly differently based on ASRM guidelines and where they are located in conjunction with the epicenter (NYC) and other US hot zones.
More About Dr. Brauer. Dr. Brauer earned her medical degree from the George Washington University School of Medicine, where she was elected to the prestigious Alpha Omega Alpha medical honor society. She completed her residency in Obstetrics and Gynecology at New York Presbyterian Hospital-Weill Cornell Medical Center. Dr. Brauer subsequently completed her fellowship training in Reproductive Endocrinology and Infertility at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine and Infertility-Weill Cornell Medical College. Prior to joining Shady Grove Fertility, Dr. Brauer was an Assistant Clinical Professor at NYU School of Medicine.
Dr. Brauer has expertise in ovulation induction, in vitro fertilization (IVF), egg freezing, pre-implantation genetic testing and third-party reproduction including donor egg, donor sperm, donor embryo, and gestational surrogacy. She applies the latest clinical data, state-of-the-art technology, and extensive clinical experience to optimize pregnancy rates while minimizing patient stress with her supportive approach to care.
Dr. Brauer has published and presented at numerous national meetings on the topics of optimizing fertility treatments in patients with diminished ovarian reserve, polycystic ovarian syndrome (PCOS), or those using a gestational surrogate; fertility preservation; and complementary therapies in infertility. She is especially passionate about helping young patients with cancer build families, which has led her to serve on the Advisory Board of the Young Survivors Coalition. Dr. Brauer is a regular contributor on a variety of women’s health topics to local and national media such as Parents, Reader’s Digest, Refinery 29, Woman’s Health Magazine, Byrdie and Shape, to name a few. For Shape, she serves on their expert Brain Trust.
She is a fellow of the American Congress of Obstetrics and Gynecology and an active member of the American Society for Reproductive Medicine and the Fertility Preservation Special Interest Group.
Dr. Brauer enjoys spending time with her husband and their three children. She also enjoys cooking and running or spinning for exercise in her free time.
Dr. Brauer, who is also fluent in Hebrew, joined SGF in 2019, and sees patients at SGF's New York office, located in the heart of Manhattan.
