TELEMEDICINE AND AT-HOME IVF KIT: NOVEL APPLICATION DURING THE COVID-19 PANDEMIC

Abstract

During the COVID-19 pandemic, access to fertility has been difficult due to fear of contracting the virus. Many patients, especially those with diminished ovarian reserve (DOR), strongly desire to pursue their fertility treatments that include oocyte and/or embryo freezing for fertility preservation because it is a time-sensitive matter fearing the loss of all their ovarian reserve. Given this challenging situation and in order to minimize the repeated office visits for monitoring during an IVF cycle, we aimed to test the efficacy of a new modality for IVF treatment using telemedicine and a patented kit called At-HOME IVF kit. Large fertility clinic with university affiliation. A retrospective study assessed the outcome of using telemedicine with At-HOME IVF kit in patients who have DOR (n=22) based on previous history of poor ovarian response, previously documented low serum anti-Mullerian hormone (<1 ng/mL), elevated day 3 follicle-stimulating hormone (>10 mIU/mL), or low antral follicle count (<8). Patients desired either embryo (n=17) or oocyte (n=5) freezing. Telemedicine was used for consultation in order to reduce the total waiting time for seeking fertility treatment and to minimize office visits. The kit was mailed to the patient's home, contained no injectable medications and contained all the necessary medications needed for ovarian stimulation, ovulation suppression, and oocyte maturation trigger. The oral pills were clomid 100 mg taken from cycle day 3 until cycle day 11 and letrozole 5 mg taken from cycle day 3 until cycle day 7, the vaginal pill was the GnRH antagonist (Elagolix) 50 mg taken on cycle days 9 and 11, and nasal spray (lupron 30 IU) taken on cycle days 12 and 13. Oocyte retrieval was then performed on cycle day 14. Each patient took the medications included in the kit without office visits for monitoring and presented only on the day of the oocyte retrieval. The main outcome included the number of oocytes and embryos (cleavage-stage or blastocyst-stage) cryopreserved. Because of the COVID-19 pandemic, embryo transfer was not currently recommended or performed. Data are presented as mean ± sem. The mean age of the participants was 39.9 ± 0.9 years. Upon presentation on the day of oocyte retrieval, blood hormonal testing and transvaginal ultrasound showed that none of the patients had ovulated and that all patients had appropriate ovarian stimulation response with the number of mature follicles (>18mm) up to 8 (3.3 ± 0.4). All patients underwent oocyte retrieval with 21 out of 22 patients having up to 8 mature oocytes collected (2.4 ± 0.4). Ten out of 17 patients who underwent IVF had up to 4 embryos cryopreserved at either the cleavage-stage or blastocyst stage. During the global health emergency and current/future pandemics due to a highly transmissible infectious organism, oocyte and embryo cryopreservation can be performed without frequent monitoring and without the injectable medications using At-HOME IVF kit. This will allow patients with DOR the possibility of proceeding with fertility treatments with minimum exposure to office visits.