Fertility Care at Anova
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- If you have a family physician, OBGyn, or other physician, request a referral by giving them this form. Since you physician will be involved in follow up care in later pregnancy, we like to involve them at the start of the process.
- If you do not have a physician, please email us so that we can discuss the options for you to see an Anova fertility specialist
- If you are currently receiving care at another clinic, you can request a chart transfer or a second opinion. Please email us to learn more.
- Ensure that you have submitted the patient intake form, and that you have browed the available resources at Anovafertility.com and anovalife.com
- For virtual appointments:
- check to ensure you have the correct equipment. This includes an audio/video component to your computer, tablet or smart phone, as well as a strong connection to the internet
- Sit in a private, quiet and comfortable place
- If there is an issue with the call quality, please know that the physician will call you via telephone. It will appear as an unknown caller.
- Even virtually, physician schedules can run behind. Please be patient, and allocate some extra wiggle room for your appointment in case it starts late.
- Assessment of the woman’s uterine cavity (Sonohysterogram)
- Chromosome/Karyotype testing
- Thrombophilia testing
- Endometrial biopsy
- Hormone Profile
- Product of conception testing
- Infrequent, prolonged menstrual periods
- weight gain
- acne
- excess male hormone (androgen) levels
- excessive hair growth
- numerous ovarian cysts, failure to ovulate
Covid-19
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- Overall, you do want to ensure you are maintaining a healthy weight
- Eat a well-balanced diet; find time for regular daily physical activity. The silver lining is that you have more time now to do both
- Take prenatal vitamins (Vitamin D, CoQ10 and Folic Acid), and remember that a different mix of prenatal vitamins for men might be improve sperm quality as well
- As always, quit smoking and avoid alcohol
- An important one right now is your mental health as well; do try to manage your anxiety and stress levels during this challenging time. The Anova Wellness team is doing virtual consultations
- Get all the routine testing up to date so that it is ready when we reopen
- Ensure the paperwork is complete (mainly consent forms)
- Get in contact to learn about the different financial options that exist, such as payment plans and financing options.
We are currently trying to get in contact with women who had been notified of a funded cycle, as well as any patient who was prepared to pay privately for their IVF treatment. If you haven’t heard from us yet, please email us.
In addition, prescribing ovulation induction drugs to a patient without the appropriate monitoring is NOT safe. Patients can hyper-stimulate on ovary stimulation drugs. They can get ten follicles on each one of these drugs, and without proper monitoring, there is no way to know how many follicles were created. Conceiving naturally, with this many follicles, significantly increases the risk for multiple pregnancies, which is considered to be higher risk pregnancy and can be dangerous for both mom and babies.
Even if we can’t see you at the clinic right now (though we are still seeing patients virtually!), we are still responsible for your health, and responsible for every prescription we prescribe. Therefore, Anova fertility will NOT prescribe these medications or refills during this time.
- In the early weeks of pregnancy and throughout the first trimester is when a patient will have their most interactions with the healthcare system. Right now, our healthcare system is trying to adjust, to be able to handle the COVID-19 pandemic. By not creating new pregnancies we are helping to decrease the overall burden on the system and support our healthcare workers.
- As mentioned, the scientific community has not had time to do extensive, robust studies on the impacts of the COVID-19 virus on moms, dads, eggs, sperms, embryos, and babies.
- All pregnant women are, to some extent, considered immunocompromised. Since we know that COVID-19 is more dangerous to certain people, including those that are immunocompromised – we want to avoid getting anyone pregnant and having them be more at risk of severe complications if they develop COVID-19.
Currently, the data is reassuring and suggests that pregnant women are not at a higher risk of infection, nor at a greater risk of infection, nor a higher risk of severe morbidity (other health concerns) compared to non-pregnant women of the same age.
Moreover, the vast majority of infants born to pregnant women infected with COVID-19 have been healthy at birth, with near-term prematurity (preterm birth) being the most commonly reported adverse pregnancy outcome. However, adverse pregnancy outcomes are thought to be proportional to the degree of maternal respiratory illness.
You might also want to read this resource from the Centre for Disease Control.
Now is a good time to learn more about the potential reasons you are facing fertility challenges, and to come up with a care plan moving forwards.
Birth control medication (OCPs) allows us to essentially take control of your menstrual cycle. While this may seem counterintuitive, it means that we will be better able to time the start of the IVF treatment once we are allowed to do so.
If you are not comfortable taking birth control, that is a personal decision. If you choose to go this route, we are asking for you to call in on the first day of your period to have an update conversation with the nursing team.
For this reason, it is important that pregnant women will practice vigilance and self-isolate as much as possible.
- Practise physical distancing. Keep a safe distance of 2 meters away from other people.
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth
- Avoid contact with others. No visitors unless essential (such as care providers), stay away from elderly persons, and people with chronic medical conditions.
- Stay home, and avoid all non-essential trips. Do not go to work, the corner store, or other public places.
- Practice good cough and sneeze etiquette. Cover your mouth and nose every time you cough or sneeze. If you don’t have a tissue, sneeze or cough into your sleeve or arm.
- Clean and disinfect frequently touched objects and surfaces. Think doorknobs, railings, sinks, etc.
- Practise physical distancing. Keep a safe distance of 2 meters away from other people.
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth
- Avoid contact with others. No visitors unless essential (such as care providers), stay away from elderly persons, and people with chronic medical conditions.
- Stay home, and avoid all non-essential trips. Do not go to work, the corner store, or other public places.
- Practice good cough and sneeze etiquette. Cover your mouth and nose every time you cough or sneeze. If you don’t have a tissue, sneeze or cough into your sleeve or arm.
- Clean and disinfect frequently touched objects and surfaces. Think doorknobs, railings, sinks, etc.
On the day of your appointment, you will be asked to bring a face mask and to wait in your car until it is time for the appointment. In the lobby you will be greeted by a member of the Anova team. You will need to update your declaration of COVID-19 risk factors, sanitize your hands, wear a sticker, and will be brought to the elevator.
At the clinic, the door will be propped open and you will check in with reception before being brought to a clinic room. While we have adjusted the wait room to allow for social distancing, we will be treating it more as a ‘through room’ at this time.
After your appointment, you will need to check-out at reception, and leave the building promptly.
To decrease exposure risk, we are minimizing the amount of people in the clinic. This includes the restriction that at this time, family, visitors and support people will not be allowed inside the clinic. See more detailed response below.
We will do our best to accommodate ‘virtual visitors’ for OPU and FET procedures.
Post-procedure, patients who required sedation will be escorted by an Anova team member to the lobby, where they will be met by their support person
Omicron variant
References:
1. Kozlov, M. (2022, January 6). Omicron’s feeble attack on the lungs could make it less dangerous. Nature. https://www.nature.com/articles/d41586-022-00007-8
2. Edelman, A., Boniface, E., Benhar, E. et al. (2022). Association between menstrual cycle length and coronavirus disease 2019 (COVID-19) vaccination. Obstetrics & Gynecology. Volume – Issue – 10.1097/AOG.0000000000004695 doi: 10.1097/AOG.0000000000004695
3. Narayanaswamy, V., Pentecost, B., Schoen, C. et al. (2022). Breastfeeding infants receive neutralizing antibodies and cytokines from mothers immunized with a COVID-19 mRNA vaccine. MedRxiv. Doi: https://doi.org/10.1101/2021.10.12.21264890
4. Kugelman N, Nahshon C, Shaked-Mishan P, et al. (2021). Maternal and Neonatal SARS-CoV-2 Immunoglobulin G Antibody Levels at Delivery After Receipt of the BNT162b2 Messenger RNA COVID-19 Vaccine During the Second Trimester of Pregnancy. JAMA Pediatr. doi:10.1001/jamapediatrics.2021.5683.
5. Yang, Y., Murphy, E., Singh, S. et al. (2021). Association of Gestational Age at Coronavirus Disease 2019 (COVID-19) Vaccination, History of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection, and a Vaccine Booster Dose with Maternal and Umbilical Cord Antibody Levels at Delivery. Obstetrics & Gynecology.
Both the Pfizer and Moderna vaccines are based on a novel mRNA technology.
The COVID-19 mRNA vaccines provide our bodies with the template for our cells to make a harmless piece of a protein found on the coronavirus surface called the “spike protein.” When the mRNA template gets injected, cells in our body will generate the coronavirus spike protein, which will later be displayed on their cell surface. This will activate the immune system to create specialized antibodies that will identify and destroy the spike protein (and thus, any viruses that have these proteins on them).
The mRNA vaccines are considered safe because they do not contain any live, and they do not use any adjuvant, which may cause adverse reactions in people with a severe allergy. These vaccines do not enter the nucleus and do not alter human DNA in vaccine recipients.
While mRNA vaccines are considered to be safe, most study participants for both the Pfizer-BioNtech and Moderna vaccines experienced mild side effects similar to influenza-like illness symptoms following vaccination (see table below, Source ACOG)
We have summarized the main features of each vaccine in the table below.
While mRNA vaccines are not considered live virus vaccines, they are not hypothesized to be a risk to pregnant or breastfeeding women. However, it is important to note both pregnant and breastfeeding women were excluded from the COVID-19 vaccine trials. Therefore, there is not enough data to suggest or deny efficacy or safety during pregnancy or breastfeeding.
According to an SOGC: “While there have been no red flags or hypothesized mechanisms for potential harm associated with administration of an mRNA vaccine during pregnancy until more data is available, the potential risks of vaccination to a pregnant individual and fetus remain unknown.”
While most pregnant women who become infected with SARS-CoV-2 will have mild-to-moderate symptoms, and many can be asymptomatic, some pregnant women are at high mobility risk. Risk factors for severe morbidity from COVID-19 include maternal age over 35 years old, asthma, obesity, pre-existing diabetes, pre-existing hypertension, and heart disease. For individuals at high risk of infection and/or morbidity from COVID-19, the SOGC states that the documented risk of not getting the COVID-19 vaccine outweighs the theorized and undescribed risk of being vaccinated during pregnancy or while breastfeeding, and therefore, vaccination should be offered to them.
In any case, pregnant and breastfeeding people should consult their prenatal care provider, who could weigh in their individual risk factors versus benefits and help them make an informed decision that is right for unique circumstances.