UNIVERSAL SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) TESTING IN A NEW YORK CITY REPRODUCTIVE MEDICINE PRACTICE

Abstract

To describe our single-center experience and results of universal SARS-CoV-2 testing in asymptomatic patients undergoing controlled ovarian hyperstimulation (COH). Retrospective cohort study conducted at a university-affiliated center. On March 21, 2020, New York-Presbyterian Hospital, where our retrieval suite is located, instituted a policy of universal SARS-CoV-2 testing prior to surgical procedures requiring anesthesia. As a result, we began testing all patients undergoing COH for SARS-CoV-2 using reverse transcription-polymerase chain reaction via nasopharyngeal swabs (Roche Cobas 6800). Tests were performed on the morning of cycle start and repeated 24 hours before oocyte retrieval. A positive test at either time point excluded patients from continuing with treatment. During the testing period, all patients and staff were required to wear surgical masks at all times when at our center and consented to symptom and temperature screening at every monitoring visit. Between March 21 and May 20, 2020, 169 asymptomatic patients underwent nasopharyngeal swabs at cycle start, four of which returned positive for SARS-CoV-2 for a center prevalence of 2.4%. All four patients were asymptomatic at the time of cycle start and were not permitted to begin their COH cycle. One of these patients had previously had a positive PCR swab over 60 days prior and had been symptom-free during this interval. One patient with a negative PCR swab on cycle start subsequently converted to positive 15 days later on her PCR swab prior to retrieval, despite the absence of COVID-19 symptoms. Per our hospital policy, she was not allowed to proceed with oocyte retrieval and was started on a course of daily GnRH antagonist and asked to abstain from intercourse for 14 days. None of the 5 patients went on to develop COVID-19 symptoms following their positive test result. All patients were referred to follow-up with their primary care provider. Prior to returning for further COH treatment, all patients will be required to undergo repeat PCR testing with a negative result. While rare, asymptomatic carriers of the SARS-CoV-2 virus were identified for a center prevalence of 2.4% in patients undergoing COH. Despite initial negative PCR testing, patients may convert to positive over the course of a COH cycle and not demonstrate symptoms. Strict personal protective equipment and social distancing use is essential to protect patients and staff alike.