Fertility Treatment in the COVID-19 Era

with DR. THOMAS MOLINARO
Hello, I am your host Dr. Andres Reig. Welcome to episode 2 of FertiliPod, the podcast where we discuss current topics and the latest research in the field of reproduction with some of the world's leading experts.

In today's episode, we are exploring what it is like to operate a fertility center in the COVID-19 era. For that we have invited Dr. Thomas Molinaro. Dr. Molinaro is an assistant professor for the Department of Obstetrics, Gynecology and Reproductive Science at Rutgers Robert Wood Johnson Medical School, and has a master's in clinical epidemiology from the University of Pennsylvania. He is also the clinical director of RMA of New Jersey's basking Ridge office.
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Podcast Transcript

Andres Reig:
Hello, I’m Dr. Andres Reig. Welcome back to FertiliPod, the podcast where we discuss current topics and the latest research in the field of reproduction with some of the world’s leading experts. Let’s get started. In today’s episode, we’re exploring what it’s like to operate a fertility center in the COVID-19 era. For that we’ve invited Dr. Thomas Molinaro. Dr. Molinaro is an assistant professor for the Department of Obstetrics, Gynecology and Reproductive Science at Rutgers Robert Wood Johnson Medical School, and has a master’s in clinical epidemiology from the University of Pennsylvania. He is also the clinical director of RMA of New Jersey’s basking Ridge office. Dr. Molinaro. Thank you so much for joining us today.

Dr. Thomas Molinaro:
Thank you, Andres. It’s a pleasure to join you today.

Andres Reig:
The COVID-19 pandemic has had an enormous impact on the world, obviously with the tens of millions of cases so far, and now close to a million dead. Beyond people who’ve actually contracted the virus, the resulting effect of the pandemic on day-to-day life has been very significant for everybody. In our field it has definitely affected how we do things both from the patient’s perspective, as well as from the professional’s point of view. And we wanted to dedicate an episode to this because the pandemic is probably far from over, and we are likely going to be dealing with its aftermath for many more months or longer. Let’s jump right in. What do you think the overall impact of the pandemic has been on patients who need assisted reproduction and how has their situation been unique?

Dr. Thomas Molinaro:
I think the COVID 19 pandemic has been challenging for everybody. In particular for fertility patients, there’s so much that is time-related and without an ability to reschedule very easily. So I think for the most part they’ve been particularly stressed. The infertility journey is one that takes months, hopefully not too many months, but it’s definitely one that builds momentum. And I think that COVID-19 has presented some particular challenges with respect to delays and what that means in terms of their progress to the pregnancy, to success, basically. So at RMA of New Jersey, we have been fortunate in that we’ve had very few delays, we’ve managed to stay open throughout the pandemic, taking the right precautions and making sure that we keep our patients and our staff as safe as possible while preventing the majority of delays that I think many infertility patients suffered through, particularly in spring and early summer.

Andres Reig:
You mentioned from spring to early summer. How would you say the usual care has changed since this all started in March and how has that evolved a little bit until today?

Dr. Thomas Molinaro:
Well, I think the management of infertility patients in the COVID era has been particularly challenging given the frequency of visits and the time constraints involved. We’ve tried our best to maintain the CDC protocols and keep abreast of all the latest developments. We’ve managed to stay open throughout the pandemic by encouraging social distancing. We were very early to implement universal masking for patients and staff alike. I think that was a very big part of being able to stay open, particularly in March and April. We were fortunate enough that we had access to the right PPE and our patients were very cooperative in terms of spacing out morning monitoring. We actually doubled our morning monitoring hours. So in order to have more time and spread people out, we went to an alphabet based scheduling system where half of the alphabet came early and half of the alphabet came later.

Dr. Thomas Molinaro:
And I have to say that patients were very cooperative in that way. And ultimately we’ve managed to leverage tele-health for a lot of our consultations. So while in-person visits are unavoidable for things like blood work and ultrasounds and procedures, for consultations, we use tele-health quite effectively, particularly early on when there was so much that was unknown. And that enabled us to prepare patients for their visits. They were able to get in and out of the office quicker because they had their questions answered in advance. We set a whole timetable for an evaluation at a tele-health patient where. Basically, we would do the consultation and then have them come in for one visit that allowed them to get their blood work, their ultrasound, sometimes even a saline ultrasound or an HSG in that one visit. So with that one visit, they were able to have the majority of their evaluation completed. And we were able to do it with appropriate social distancing, spacing out patients and all the right PPE to keep everyone safe.

Dr. Thomas Molinaro:
And we’ve had a very low rate of positive patients. Since early April, we started universal testing at the beginning of all treatment cycles. So every patient undergoing a treatment cycle, whether it’s a Clomid cycle or an IVF cycle or a frozen transfer cycle has a viral RNA test by a nasal swab at the beginning of the cycle. And then if they’re having anesthesia… in New Jersey, if you’re going to have anesthesia, you have to have a COVID test within six days. So patients undergoing hysteroscopies or egg retrievals have another COVID test at that point. And we’ve had very, very few positives relatively speaking to the number of tests that we’ve done. And we’ve been very fortunate, I think, that we’ve taken all the right precautionary measures. Our nurses call most patients the day before to find out if they’ve had any symptoms, to see if they’ve had any significant exposures.

Dr. Thomas Molinaro:
And we’ve tried to keep people out of the office if they’re sick or if they’ve had a significant exposure that warrants quarantining. Now, granted, those protocols have changed over time as we’ve understood more about what constitutes a high risk exposure, and also with the idea of universal masking. So if people are having interactions with COVID positive persons but both parties are masked, it’s no longer considered a high risk event in most scenarios. So we’ve been very, very fortunate. Our patients have been extremely cooperative and everybody understands that these are precautions that are unavoidable and they need to be implemented universally in order to make sure that the clinic can stay open and that everybody can make progress in achieving their dreams. We just looked recently, probably about three weeks ago I looked… and we discharged about 1500 pregnant patients since March. So between March and the beginning of August, we discharged 1500 pregnant patients, which I think is amazing in any time, let alone a time where there’s a viral pandemic that has affected so many people in so many ways.

Andres Reig:
So people are still getting pregnant even if there’s COVID.

Dr. Thomas Molinaro:
That’s right. That’s right. That’s right.

Andres Reig:
You were mentioning a little bit about how everything you’re offering to make patients safe and to make patients feel safe. There’s also a lot we’re obviously asking of patients and you keep saying this is a collaborative effort and we’re kind of in this together. And everybody has that idea that, like you said, it’s unavoidable and the sooner we get it over with the better. When you mentioned about testing and you require patients to be tested, you mentioned about the need for six days, within six days of anesthesia. How frequently do you test patients? If they’re negative today and they have to keep coming for the next week or two, do you retest them at some point? Do you ever reconsider testing them? How does that work?

Dr. Thomas Molinaro:
I think for most patients, one test at the beginning of the cycle has been enough for us. We test people from month to month and we haven’t had patients pop up positive in between. And you would think if we’re seeing somebody for a cycle start every four weeks, that we’d catch some positives in between. And we’ve had very few. I think that’s also because we’ve done a lot of symptom-based and exposure based management. So if somebody has symptoms, we require them to go get tested at an urgent care or with their primary physician so that we can find out what’s happening. We have canceled cycles, no doubt about it, for patients who develop symptoms or who test positive. Early on when there was a lack of testing availability, we had to basically cancel based on symptoms in a lot of cases.

Dr. Thomas Molinaro:
But now that we have more testing and other things that allow us to monitor things closer, we’re fortunate. I think that patients are also just smarter about their exposures. I think early on there was a lot of uncertainty, people weren’t quite sure how you could catch COVID. Now we understand so much more. That it’s a respiratory illness. That is one that’s mostly transmitted through the air. And so, if everybody wears their mask, then there’s a lot less risk for transmission. And our patients have proven to us that they can be responsible and they’ve reported the right exposure. And we’ve been very, very lucky.

Andres Reig:
You also said the number there was about 1500 patients that have been discharged since March, pregnant. That obviously goes with the whole uncertainty of what that means in the time of COVID. There were, in the very beginning, a lot of studies on whether the viral particles were found on different fluids, on different parts of the body, including the ovaries, sperm, so forth. What is currently known about the effects of COVID on reproduction? Not necessarily on fertility itself, but on outcomes after that. And how is that uncertainty that obviously all these patients must have, like we do. How is that conveyed to patients in a way that it doesn’t alarm everybody?

Dr. Thomas Molinaro:
Well, I mean, I think first and foremost, patients are inundated with information on a daily basis, whether it’s television or the internet, patients come in with a lot of information already. So they’re pretty well educated about a lot of these things. And every time I have a conversation with a patient, they seem to already know what I’m going to say. But for the most part, the evidence has been reassuring that patients who get pregnant are not at a higher risk of contracting COVID. The data regarding this particular coronavirus is still relatively sparse, but in general, coronaviruses have been around for a long time and they don’t seem to increase the risk of birth defects in utero, right? We know things like cytomegalovirus, rubella, these are things that can cause birth defects, but coronaviruses traditionally have not been found to be teratogenic. And I think that there’s now some data to suggest that pregnant patients who contract COVID may have slightly more respiratory complications, but in general, still do okay as long as they’re managed appropriately and as long as they take the right precautions.

Dr. Thomas Molinaro:
So the take home advice for patients is that, number one, we feel our office is safe. We’re screening everybody, we’re taking the right precautions. They’re probably more likely to catch COVID at the grocery store than they are in our office. But that being said, if they do get pregnant, if they do become pregnant, then we recommend that they follow all the universal precautions, they limit their exposures, they wear a mask whenever they’re in public or especially in closed areas inside, and that they have discussions with their OB-GYN, particularly in the second and third trimesters where pregnant patients seem to be a little more susceptible about things they can do to mitigate their risks. But I think the medical community has become a little more comfortable with managing COVID patients in general and managing pregnant patients as well.

Dr. Thomas Molinaro:
And we’ve seen that the majority of pregnant women who contracted COVID are actually asymptomatic, right? There’s a few studies now that just look at the rates of COVID positive patients showing up in areas of high prevalence and the majority of them were asymptomatic, I think over 80% were symptomatic in the studies that I recall. So most pregnant patients are going to do okay. That being said, they should do everything possible to limit their exposures.

Andres Reig:
Obviously, there’s going to have to be some tough calls every now and then and some things that must have been a little more challenging, I can imagine some. But what would you say have been one or two examples of things that have been a little complicated or maybe –

Dr. Thomas Molinaro:
I think we’ve been pretty fortunate in that the majority of cycles that we’ve had to cancel, we canceled early in the cycle before patients had gotten too far along, right? The advantage of doing the COVID swab at the start of medications is that we get results back typically within 36 to 48 hours, and at that point, they haven’t spent a lot of time or effort in the cycle. So when we do get positives there, canceling them early is easy and patients are very understanding of that. And they’re obviously concerned that they tested positive anyway and they want to make sure that they’re healthy before they go through it. We have had a couple of cases, particularly early on where people developed symptoms later in the cycle and we had to treat them as presumed positives. And there’s not too much you can do with somebody who’s already been triggered, who has a high estrogen and a lot of follicles. You can’t exactly cancel them the day of their egg retrieval when they wake up with a fever.

Dr. Thomas Molinaro:
So we’ve had a couple of cases like that and we just managed to isolate them, protect the staff involved with all the right PPE. We have N95 masks. We have the right set up for a COVID positive patient to be retrieved, and then the room turned over in the right way so that you sterilize it and the next patient can come in safely. So we’ve been fortunate in those cases, but it’s not to say that we didn’t sweat it out at the time when you have somebody walk in with a fever on the morning of their egg retrieval and you don’t really have a choice, but to proceed. I think employees are nervous, patients are nervous. We’ve been very fortunate. Our employees, our physicians, our nurses, our medical assistants, they’ve all done an incredible job showing up every day for work with so much uncertainty, especially not knowing whether they’re putting themselves at risk to contract the virus, but they’ve shown up and they’ve been an outstanding asset for us. And we’ve managed to not just stay open, but stay busy. And we’ve been very fortunate throughout this entire pandemic.

Andres Reig:
You were mentioning kind of the feeling of the employees and how everybody is stressed about this, not just the patients, and obviously, nobody wants to get the disease. From a management perspective, making sure everybody feels safe, speaking about your employees now, what specific measures do you take and when do you implement them? Obviously, this has been a very changing things since it all started. How do you choose what to implement and what or what you have reasonable knowledge that it works?

Dr. Thomas Molinaro:
Well, I mean, I think we’ve looked to the CDC for the majority of our guidance. Their website has some pretty clear documentation of how to manage exposure in healthcare workers, along with ways to mitigate that exposure by implementing cleaning protocols, spacing out of patients, the correct PPE. And so we’ve done a great job, I think, on that front. Mostly it’s been about trying to limit the potential patients who might be COVID positive to try to prevent them from coming into the office to begin with. We’re fortunate in that we’re not an urgent center, we’re not an ER, we don’t need to see COVID positive patients. And so if we practice the correct social distancing, if we are keeping patients out of the office who’ve had exposures or symptoms, then we just limit the prevalence of the disease in her office, and that makes sense.

Dr. Thomas Molinaro:
The other thing that we have done is we’ve done antibody testing on our employees now a few times, and we’ve had right around 10% of employees test positive, which is about what I think we’ve seen in the New York, New Jersey area for all individuals. So it’s not that our employees are at a higher risk. Going through the people who tested positive, almost all of them had exposures outside of work that we noted, whether it was a family member or a spouse, somebody in their household, or some other exposure. And we had very few that we couldn’t trace. I actually don’t know if there’s one that we couldn’t trace the exposure back to somewhere outside of the office. So we do feel that employees are safe in our offices and that they can keep each other safe by practicing the right social distancing and using masks and et cetera.

Dr. Thomas Molinaro:
And they’ve been very, very agreeable and everybody has been on the same page with respect to keeping the office safe because we want to keep the office open and we want to keep the availability for patients and to be able to continue treating patients and help them along their infertility journey.

Andres Reig:
That’s right. One of the things that I think is challenging, and I was a resident not very long ago, and we had the situation where a couple people came positive with COVID at the same time and that affected at that time quarantining a lot of the people they were working with. And that kind of takes out a significant part of the team at the same time. Do you have any contingency plans or anything of that nature? What happens if there is an outbreak, so to speak, and it is traced to within, or what happens if a big part of the team needs to be quarantined for two weeks at the same time?

Dr. Thomas Molinaro:
Right. Well, I mean, I think that’s something that we were very afraid of, particularly at the beginning, that we’d have an outbreak in an office and we’d have to shut down an office. And I think that that was basically our plan, was that if we had an outbreak in one of our satellite offices, one of our monitoring offices, then we may be forced to close that office for two weeks while it gets cleaned and while the staff recover. I think that, again, the CDC guidance here has changed dramatically. And so at the beginning, what constituted a high risk exposure was different from what it is now. And so if we have a COVID positive employee in an office, as long as they’ve had their mask on, then the other employees in the office should be fine and they’re still considered relatively low risk exposures.

Dr. Thomas Molinaro:
We’ve also tried to allow employees who can work from home to work from home. That has the advantage of spacing out who’s in the office, so there’s more effective social distancing for employees. It also means that there’s more people who are out of the office if there is an exposure, right? So if half of your staff is working from home, only half of them is going to get exposed on that day when a COVID positive employee or patient comes in and exposes a bunch of people. So I think that that has been one of our strategies as well, is to split people up and keep them apart because it’s smart for a variety of reasons, not just to avoid the spread, but also to keep at least some of your staff intact and hopefully free from that exposure.

Andres Reig:
Speaking of work from home, obviously it’s helpful, like you say, for many reasons and there’s a big reason for implementing it, but a lot of the day-to-day sort of work environment happens because we’re all working together in the same place. All this working from home creates a lot of isolation. What do you think is, if any, the impact of working from home on the dynamic of the team as a team?

Dr. Thomas Molinaro:
Right. Well, I mean, I think first and foremost, working from home has only been part of our solution, right? I mean, and we still all go to the office at least a few days a week. And as we’ve gotten to warmer weather and the prevalence has dropped, we’ve spent the majority of the time in the office in August at least, and we’ll see how the fall goes, if we can continue to spend time in the office together, or if we’re going to have to go back to more spacing out, more social distancing. But I think it’s challenging to a certain extent. We’ve always been an organization that has been connected electronically. Having 10 or 11 offices spread out around the state, we are not altogether in one place almost ever. The doctors do spend a day a month together, but that’s as part of-

Dr. Thomas Molinaro:
The doctors do spend a day a month together, but that’s as part of an administrative meeting, not taking care of patients. So we’re very much connected with email, and with phone calls, and with Zoom to begin with. Even before the pandemic, that was part of our day-to-day life. So we were already set up for that at the beginning, we were in a good position to move forward because we weren’t necessarily inventing something, we were just expanding something that already existed.

Dr. Thomas Molinaro:
In my particular office, we tried to do Zoom meetings once a month, or once every three weeks, where all the staff got on, whether they were in the office or working from home, and try to just talk about what was happening, give everybody the opportunity to express their concerns and their frustrations, and there were plenty of frustrations going through it, not knowing what was going to happen and with all the uncertainty, but we managed to get through it. And I think that our staff that’s come through with us on the other side, really we feel very, very close and we feel like going into the fall and the uncertainty that colder weather is going to bring, that it’s going to serve us well as we try to navigate the next few months.

Andres Reig:
In terms of the frustration you mentioned, it obviously arises when things are changing so much and there’s so much just is not in our control. From a, I guess, management perspective, how do you explain to everybody when you implement a change and a week later, or sometimes the next day, that changes, especially in the very beginning when it was March, April and things were changing almost daily, in terms of what your policies are?

Dr. Thomas Molinaro:
Well, I think number one first and foremost is just to be up front with them. So I think the most effective communication strategy is to be open and honest. And so telling people, «Listen, I don’t know what next week is going to bring, I don’t know where we’re going to be, but where we sit right now, these are the decisions that we have to make. And ultimately you may not like it, but it is what we have to do to get through the next week, and we’ll see in a week where things are and we’ll reevaluate and reassess.» That was a huge part of this was that we were constantly reassessing, not just every day, but every hour. And frequently we would say something in the morning and then by the afternoon, that would change.

Dr. Thomas Molinaro:
And so encouraging the employees to understand that this is such a dynamic environment, that this is something that has no precedent. It’s not like we have a playbook that we can turn back to the viral pandemic of five years ago. We’ve never had anything like this before in our careers. And so I was very upfront with people saying, «Listen, I don’t know what we’re going to do. I don’t know how we’re going to handle this, but I know that my goals are to keep the practice moving so that we can take care of patients, and to keep everybody safe.» And not necessarily in that order. So patient safety, employee safety, always had to come first. And I think that we really did prioritize keeping people safe despite what was happening, especially early on, and trying to understand what the risks were, what the options for reducing those risks are, and then just taking it one day at a time.

Dr. Thomas Molinaro:
I think the more that we communicated with our employees, the better off we were, because that communication let them understand that this was not an easy situation to be in. And I think our employees wanted to continue taking care of patients. They wanted to stay open as a practice. They didn’t want to be furloughed or shut down like a lot of other people were. And so to their credit, they worked extra hard and they covered extra shifts, and they sometimes went to locations that weren’t their primary location if we needed help, and the employees were phenomenal. We would not have made it through March, April, May, if our employees weren’t dedicated to taking care of patients and dedicated to the practice.

Andres Reig:
That was another thing I wanted to touch up on, the idea that you were saying people work more or harder. That’s another thing that, before the pandemic, we all worked at what we thought was our 100%, generally our 110%, some would say, and then this happened. And then this took out, let’s say, especially if you’re in a leading position, this now takes up a significant amount of your work time to just handle this, and learn about this, and deal with this, which was never in the book before. So suddenly where you had a hundred percent of your time to delve into everything else, now you have 80, 70% of your time, or whatever’s left after you deal with COVID. How do you adjust to COVID as a distractor from your regular work life?

Dr. Thomas Molinaro:
I don’t know that I have the answer to that question. Mostly, it just involved working more. I think in some ways there’s no easy answer to that. We definitely had to carve time out of schedules for people who had administrative responsibilities. And there was a slight dip in patient volume, especially early on, as patients were unsure. And so we had a dip just like everybody else, and that also freed up some time. So I think that has been less and less as patients have returned back to the office, since June really, we’ve been moving ahead, full steam ahead. But, you have to find the time to step back and look at what’s happening, and look at the latest CDC guidance, and look at what’s happening in our state, and really understand what are the issues and what are the choices that we have to make, and try to see as far ahead as you possibly can, understanding that we’re going to have to adjust and we’re going to have to react to what happens based on something that could change within a day or two days even.

Dr. Thomas Molinaro:
So we’ve been very, very fortunate from that point of view. We’ve had a great team of managers and leaders who’ve been able to help us navigate this, but early on in the COVID crisis, we were having a noon phone call every single day with all of the important managers trying to figure out, «Okay, what do you guys know? What are you guys worried about? What are you hearing from your staff? How do we prepare for what’s next?» And I think that it paid off in the end because we were able to maintain our practice and to keep everybody as safe as possible.

Andres Reig:
In terms of communicating, you’re mentioning with employees and with your staff and everything, even the other managers, there’s another link in the chain of patient care that is the referring doctor, the OBGYN that refers you a patient, and you have your protocols for when you want to test patients before they come in and how these works. How was the communication between you and the referring OBGYN, and the referring physicians, to convey all of this?

Dr. Thomas Molinaro:
Yeah, I think the OBGYNs themselves, I think we’re in a very different situation from the reproductive endocrinologist. We’re office-based, we are dealing with elective type of procedures, although we can argue about how elective they are in some ways, but at least we have more of an opportunity to cancel cycles or keep people home if there’s illness or exposure. The OBGYNs we’re really on the front lines dealing with pregnant patients, but not just pregnant patients, but sick, pregnant patients, walking into the hospital and other things like that. So they were in a much different place, I feel like. Early on, especially. We tried to offer whatever support we can and many of us have personal relationships with those OBGYNs. We also have physician liaisons who are basically tasked with communicating to OBGYN offices, and they also moved online.

Dr. Thomas Molinaro:
So they did as much communicating with office managers to find out what was happening in their offices, what they needed, if there’s anything that we could provide them in terms of support. I think the OBGYNs were very quick to adapt, and while they managed to get through the early part now, the majority of them are back to full schedules and doing routine annuals and other things like that, that they weren’t doing early in the pandemic. And I think that they’re actually very supportive of us remaining open throughout this time because those patients would be lost, those infertility patients might be looking to see their OBGYNs if we weren’t around to take care of them. We took care of plenty of early miscarriages and even a few ectopic pregnancies that OBGYNs would have had to take care of if our offices were closed.

Dr. Thomas Molinaro:
So I think from that point of view, the OBGYNs have been supportive of us throughout this process as well. And we had one of our attendings, Jamie Morris, presented at the grand rounds in her hospital where she presented all the strategies that we had used and implemented to try to stay open and maintain patient and employee safety. And at the end of it, she received so many questions and compliments from the general OBGYNS in the audience saying, «Wow, I can’t believe you guys were able to do all of this and stay open and continue to take care of patients. That’s great. That’s amazing.» Granted it was a Zoom grand rounds, so it wasn’t exactly a in-person type of thing, but it’s definitely been well received by the OBGYNs in the area.

Andres Reig:
Good. In terms of adaptation as well, you’re mentioning all these different things we’ve adapted to. One of the things is you were saying that you already had a very computer-based practice and you already had a lot of this technology implemented, you already had virtual meetings before any of this happened. Has there been any adaptation of the infrastructure in terms of the EMR and things like that, to be able to have remote access, to be able to work from home more, to kind of streamline this a little more?

Dr. Thomas Molinaro:
As I said, so we pretty much had most of this already set up, we’ve had remote access for years. For the last 10, 12 years we’ve been able to log in and use the EMR from home, which has been very helpful. I think the challenge was that not every employee had access to those resources, and so we had to scale up a bit. We ultimately decided to use the Zoom platform, which everybody else had been using. We were using a different platform beforehand. And so there was a little bit of adjustment there. We were actually able to integrate the actual Zoom APIs into our EMR. So our electronic medical record is homegrown. We built it into our EMR. So our electronic medical record is homegrown. We built it ourselves. We have an engineering team that maintains it. And so they were actually able to link into the backend of Zoom, so that from our EMR, you could schedule the patient appointments without going out to the Zoom application. And you could actually start your telehealth appointments from within the EMR. So that allowed a little more effective streamlining of the processes for staff and for providers to be able to access their Zoom schedule within the EMR as well. I think that for the most part, patients were really great about it. And I think most of them were working from home anyway, so it was very convenient for them.

Dr. Thomas Molinaro:
And I think what it showed us is that there’s a lot of viability and telehealth. Especially in this type of world where some patients really do need a little more information upfront, a little more education. They’ve been on the internet. They’re not quite sure what to expect from an in person visit. And sometimes that can be overwhelming. But to be able to do a telehealth consultation from your home, and it doesn’t involve driving back and forth to the office or taking time off from work. And to sort of get some of that upfront information and to have the expectations set for you about what’s involved in an infertility workup. What treatments are involved?

Dr. Thomas Molinaro:
There’s patients out there who think that the only thing available to them as IVF, and if they don’t want to do IVF that we’re going to kick them out of the office. So obviously, that’s not true. And being able to get some of those patients to do a telehealth consultation, which is a lot less intimidating, and a lot less threatening, I think has been very, very helpful. And a lot of those patients have expressed that saying, «Well, I put this off for so long, until the pandemic. And now there’s telehealth and it seemed like I should take advantage of this opportunity. Maybe this is a positive that can come out of a negative.» And to be able to understand that they have more options than they previously assumed, has been really great.

Andres Reig:
So it sounds like, throughout everything, you’ve been through a lot that you’ve handled it pretty well. What is your opinion? This is just obviously your personal opinion, But how long do you think this will last? Will we go back to normal? Will it be normal, like before normal, before everything happened? Or will it be normal like new normal?

Dr. Thomas Molinaro:
Well, that’s the phrase, right? The new normal is what we’ve all been saying. My guess is as good as anyone’s, but I think that with the pace of vaccine development, and a few other things like that, we would be hopeful that sometime next spring, early summer, that we might see at least the majority of individuals have access to vaccines and whatever that means for herd to immunity, et cetera. I think masks will be with us for a little while, whether it’s another 12 to 18 months, probably, until people feel more comfortable. It’s going to be a slow transition, I think, for people to leave it behind. Especially here in New Jersey, I don’t know about the rest of the country. But it was the kind of thing that was incredibly frightening to a lot of patients, and to a lot of staff, sort of the way the virus snuck up on the State and hospitals that were full, ICUs that were running out of ventilators, those kinds of things.

Dr. Thomas Molinaro:
I don’t think that this is going to be easily forgotten. Probably in a few years, we’ll look back at this and say, «Wow, can you believe we survived that, and stayed open throughout the whole process?» But I think that timeline, 12 to 18 months is probably my best guess for a return to what’s normal. And normal will always be a little bit different. And I think that people will probably be more comfortable wearing masks in the future than they’ve ever been. And I think that, that’s probably not a bad thing in certain situations.

Andres Reig:
What do you think we’ll keep from all of this? When we do go back to this normal or new normal, what do you think are things we’d learned that are not just good for when we get the next pandemic, if we do, and then we will have a precedent that we can base things upon. But what do you think we will keep for just daily, operation, regular stuff?

Dr. Thomas Molinaro:
Right. I think to me, the most striking thing that has come out of the pandemic has been that patients really do not want to wait. Infertility care is not elective to them. And to tell somebody that you have to put your dreams of having a family on hold, is not something that goes over well with patients. And sure, there’s some that will always be a little hesitant and be cautious. But the majority of our patients, after about three or four weeks of the pandemic, said, «Well, this thing isn’t going anywhere and I’m not going to wait.» And they showed up back in the offices pretty quickly, and wanted to move on, and they wanted to continue their treatment. They wanted to continue their care. And they were so appreciative that we stayed open throughout the pandemic.

Dr. Thomas Molinaro:
The internet has connected the infertility community across the whole country, across the whole world. And people were hearing reports from their internet acquaintances around the country, that their clinics had closed, that their clinics had shut down and that they were essentially abandoned in the middle of a cycle. And the fact that we didn’t do that to them, I think really, really resonated with our patients. And I can’t tell you how many compliments and how much appreciation we’ve received in the last six months from patients who really understood that we stayed open for them to sort of keep the momentum going. And I was surprised as anyone that patients really, really wanted to come. They really wanted to come in and get their ultrasounds and have their retrievals. And they were not willing to wait.

Dr. Thomas Molinaro:
And I think that, that’s a testament to the infertility community, and how important it is to have a child, how important it is to add to your family. And patients are amazingly resilient and they’ve shown us time and time again in the last few months that they’re willing to do whatever it takes. And I think that I’ll take that with me as we move from this pandemic into whatever comes next, how important it is for patients and how important my job is to help those patients on their journey.

Andres Reig:
That’s a valuable lesson, for sure. Thank you so much for being with us, Dr. Molinaro.

Dr. Thomas Molinaro:
Oh, thank you, Andres. It was a pleasure to be with you and to have a chance to talk about these things. And I hope that the day comes where we’ll all be able to meet in person again soon.

Andres Reig:
This has been another episode of Fertility Pod by IVIRMA. Thank you so much for listening. Tune in next week for more research and topic discussions and all things reproductive medicine. See you next week.


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