COVID-19 Update

COVID Update - April 7, 2022
The COVID Pandemic continues to shape our lives in new and unexpected ways, and as we shift from a pandemic (outbreak) mentality to more endemic (ongoing) management, routine and specialty healthcare services are called to accommodate this shift as well. One way we have noted changes to our practice recently has been the more restrictive conditions for which telehealth visits can be utilized. For many patients, insurance companies are encouraging/mandating a return to in-person visits again. In wanting to comply with these insurance restrictions but also maintain safety for our patients and staff, all office visits will continue to be conducted with the utilization of screening questionnaire before entry to the clinic, temperature monitoring at the door, and mask-wearing for the duration of each visit in the clinic. Partners or other support persons are welcome in the clinic, but we ask for all persons entering to be 16 years of age or older please.

COVID Update 2/14/22
Most recent COVID numbers local to Fort Collins and the surrounding communities show encouraging trends including declining case rates, hospitalization rates, and positivity rate of individuals tested. Though Larimer County has recently lifted the mask mandate issued for protection during this COVID pandemic, as a medical facility, Rocky Mountain Center for Reproductive Medicine will continue masking in all patient care areas and ask that our patients and visitors do so as well. This is out of an abundance of caution as we desire to provide the safest healthcare setting we can for our patients and their families.

COVID Update - December 21, 2021

COVID infection rates appear to be on the rise once again, and new concerns also involve the Omicron variant. As we move into the months ahead, much effort is being made to minimize disruptions to routine patient care here at RMCRM. We continue our screening and masking policy among staff and visitors alike, and we are working to shift to mostly virtual consults once again to minimize clinic traffic. Office policies have been continually reviewed and updated according to local, state, and national guidelines, and the flexibility of all office visitors to follow the policies is much appreciated.

The American Society for Reproductive Medicine (ASRM) released a recent statement reinforcing their support of vaccination for patients who are undergoing treatment for infertility or who are pregnant, and the ASRM also supports surgery for fertility reasons (i.e. investigation of pelvic pain, management of endometriosis or fibroids, etc) be viewed as non-elective and therefore minimally at risk for cancellation due to COVID surges in hospitals causing elective procedures to be cancelled. Given that a woman’s age can impact success of conceptive treatments, surgical evaluation and treatment, per the ASRM, should not be delayed. We are thankful for their recommendation in this matter and are hopeful it will provided reinforcement, if needed, to continue with surgical procedures through the next few months with minimal delay as well. For full details, please click here: ASRM Update No. 19.

COVID-19 Update - NOVEMBER 9
Regarding the advisability of vaccine booster in pregnancy and pre-pregnant women, the CDC recommends booster in "high risk" categories, and they include pregnant patients in this list of high risk individuals. Additionally, the Society of Maternal Fetal Medicine (SMFM) makes the following statement:
Although being fully vaccinated provides great protection against hospitalization and serious illness from COVID-19 infection, vaccine effectiveness may decrease over time. This happens with other vaccines as well, like tdap. An extra shot can boost the immune response and give improved protection against COVID-19. SMFM and other expert organizations recommend the Pfizer [and more recently Moderna] booster shot for all pregnant people, including healthcare workers, beginning 6 months after completing the initial 2-shot Pfizer [or Moderna] vaccination series. The booster may be given at any time during or after pregnancy.

As such, we recommend Pfizer booster to patients starting 6 months after last shot. There has been no recommendation regarding the J&J vaccinations among pregnant women yet. Recently, the FDA authorized the use of "mix and match" booster dose for these two vaccines. This means that either of the two vaccines can be used as a booster regardless of what vaccine manufacturer was used for the initial primary series.

COVID-19 Update: September 23, 2021
In continued efforts to maintain up-to-date information regarding the COVID-19 pandemic, and specifically considerations for vaccination in patients of reproductive age, a joint statement was released this month by American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine, Association of Women's Health, Obstetrics and Neonatal Nurses and several other national organizations that can be read here:www.acog.org

Succinctly stated, we support the guidelines put forth by the organizations who released this statement, and we "urge all pregnant individuals - along with recently pregnant, planning to become pregnant, and lactating and other eligible individuals - to be vaccinated against COVID-19." Additionally, "data from tens of thousands of reporting individuals have shown that the COVID-19 vaccine is both safe and effective when administered during pregnancy. Moreover, COVID-19 vaccines have no impact on fertility."

Ongoing monitoring of current COVID conditions at the local, state, and national level has shown increases in case rates in some areas along with a rapid rise of variant strain(s), and out of an abundance of caution to protect patients and staff, RMCRM has returned to wearing masks in all patient care areas. We ask that all patients and visitors comply with this as well. We are thankful for the continued allowance of one support person in the clinic for all visits, if desired (please, though, no persons under the age of 16), and are hopeful this can continue with more diligent measures such as masking.
Additional facts that continue to support the ongoing measures of minimizing the risks associated with COVID in the general population as well as our reproductive population include encouraging findings when considering vaccinations for pregnant women. Recent bulletin from the American Society for Reproductive Medicine summarized the following findings:

• Vaccination either pre-conception or early during pregnancy is the best way to reduce maternal/fetal complications; however, current studies suggest only 16.3% of pregnant women are choosing vaccination.
• None of the currently available COVID-19 vaccines reach or cross the placenta. However, protective antibodies to COVID-19 have been shown to cross the placenta and confer protection to the baby after delivery.
• Existing data suggest COVID-19 vaccination during pregnancy does not increase risk of miscarriage. Also, COVID-19 vaccination does not appear to impact male or female fertility or fertility treatment outcomes.

With recent CDC and statewide guideline changes, RMCRM is currently allowing patients who are fully vaccinated to remove masks in clinic. This will work on the honor system, no proof of vaccination required upon entry. Additionally, we are excited to start allowing all patients one support person in the clinic for all visits, if desired (please, though, no persons under the age of 16). We will still be screening for symptoms (via portal questionnaire prior to entry to the clinic) and registering temperatures at the door for all guests. As procedures in our IVF operating room (retrievals and transfers) are still considered a secure and clean/sterile area, we are asking for those accompanying patients to this type of appointment either be fully vaccinated or be flexible to wait in the car during procedure. We are hopeful, though, that as continue to progress through this reopening phase, more guidance will come allowing safe entrance of persons to all procedures as prior to COVID without regard to vaccination status.

We are now allowing patient spouses or partners to accompany their wife with proof of receiving the second covid vaccination. Please bring your covid card with you as we will copy your card and attach it to the patient chart

We have received many questions regarding the vaccination for the corona virus. As such, the following has been prepared.

As with all medical decisions, the potential benefit of the vaccination needs to be weighed against the potential (or unknown) risk. COVID-19 vaccine development is a rapidly changing process and recommendations will evolve as more data are collected. Their use in special populations such as those patients who are pregnant or attempting pregnancy needs further study. Below are some important facts and recommendations as they are known today:

• Compared to non-pregnant populations, recent studies show that COVID-19 infections in pregnant individuals can be more serious and result in an increased risk of intensive care unit (ICU) admissions, need for mechanical ventilation, and even death. Data has shown this to be especially true in those with underlying health conditions such as diabetes, obesity, increasing age, cardiovascular disease, and among racial and ethnic minorities. As such, vaccination, so as to avoid these risks would have merit. Unfortunately, there are NO safety data specific to use in pregnancy yet. Despite this lack of information, given the development and mechanism of action of these vaccines, it is expected that the safety and efficacy profile of the vaccine for pregnant individuals would be similar to that observed in non-pregnant individuals. That said, there are NO safety data specific to a mRNA vaccine use in pregnant or lactating individuals, and the potential risks to a pregnant individual and the fetus are unknown.
• The American College of OB/GYN (ACOG) recommends that COVID-19 vaccine should not be withheld from pregnant individuals who meet criteria for vaccination based on the Advisory Committee on Immunization Practices (ACIP)- recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there are also no data to indicate that the vaccine should be contraindicated, and no safety signals have been generated from studies for the Pfizer/BioNTech vaccine.
• According to the ACOG practice advisory, vaccination is strongly encouraged for non-pregnant individuals within the ACIP prioritization group(s). They strongly recommend vaccination of individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination based on ACIP prioritization recommendations. In nonpregnant patients the vaccination appears to be approximately 95% effective, and is likely to be just as effective in pregnant patients. Additionally, it does not appear necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.

Due to the COVID-19 pandemic, your health and safety are forefront in our minds. We have implemented and continue to follow strict protocols our clinic has set in place. The safety of our patients and staff is our top priority. If you have been exposed to someone who has tested positive to or has COVID, we may request to reschedule your appointment. Please contact our office to report exposure and discuss appropriateness to keep or reschedule your appointment. During this time, we are asking all patients to reschedule their appointments if they are showing the following symptoms:

• Cough
• Sore Throat
• Fever
• Loss of taste or smell
• Body aches

As local and state health agencies continue to monitor the COVID-19 infection rates, we are noticing a rapid increase in diagnosed cases, hospitalizations, and ICU utilization in area hospitals that exceeds even the highest local case counts from earlier this year. With increased demand of healthcare resources to continue to combat COVID-19, we at RMCRM are continually tracking recommendations and guidance from county and state health officials as well as recommendations specific to our patient population as outlined by the American College of OBGYNs (ACOG) and American Society for Reproductive Medicine (ASRM).

At this time, surgical services and office-based treatment plans and procedures continue with appropriate measures in place to include wearing of masks, frequent hand washing, screening of all persons entering the office, and limiting office entry to patients only. We appreciate the willingness and understanding of our patients and partners to participate in these safety measures as well. Should access to care be restricted due to recommendations or mandates outside our control, though we recognize the inconveniences of halting care, we consider compliance with potential restrictive measures to be in the best interest of patient, staff, and community safety.

Per CDC guidelines: air travel increases the chances of getting and spreading COVID-19. Airports, bus and train stations, and rest stops are areas where social distancing is difficult or impossible. State and local travel restrictions vary from state to state and even locale to locale. As such, it is possible a state or local government may put into place travel restrictions such as stay at home orders or shelter in place orders, mandated quarantine upon arrival, or even state border closures. Travelers to other states should research destinations for their travel restrictions, infection rates, etc. This continually continues to be increasingly important to consider as some states are seeing a significant increase in reported cases, as opposed to a decline seen in some other states.

As of June 18, 2020 the latest public health order from Governor Polis is "individuals are encouraged to limit travel to necessary travel (not recreational). People who must use public transit only for purposes of performing necessary activities or to travel to and from work to operate businesses and maintain critical government functions."

It is critical for YOU to take responsibility for keeping updated by accessing reliable information outlets such as those provided by the CDC website: www.cdc.gov/covid19 . You must frequently check the website. This specialized information changes very frequently, and it is not possible for RMCRM to keep up with all of these changes and notify everyone as these changes are made.

We are pleased to announce that following the directives of the American Society for Reproductive Medicine, infertility testing and treatment can now be resumed in most locations nationwide with considerations given to appropriate safety precautions. As of May 4, 2020, we will be accepting appointments for consultations for new and return visits as well as for scheduling appropriate testing and treatments. For any questions, please call 970-493-6353.

Due to the coronavirus (COVID-19) outbreak, federal, state, and local mandates have required the clinic to suspend non-emergent in-person consultations, fertility testing, fertility treatments, surgery, and IVF. It is abundantly clear that no one is certain as to when these conditions/mandates will return to "normal". It is our belief that in-office consultations have certain advantages, and we have made allowances for the COVID-19 outbreak by temporarily suspending all in-office consultations. Nevertheless, we are all anxious to continue with our lives, even if this involves alternatives to traditional office visits moving forward. As such, beginning May 1st, we will begin scheduling consults once again for now and existing patients. Consultations will take place in the office (if allowable by regulatory agencies) or by phone if not yet permitted to resume face-to-face meetings. Please feel free to call the office with any further questions or concerns, or to schedule an appointment.

In coordination with federal, state, and local mandates regarding the management of coronavirus (COVID-19), our office has added restrictions and policies to protect patients, visitors, and staff during this time.

• All patients will be screened upon entry for recent travel history, symptoms of fever, cough, shortness of breath, or other upper respiratory symptoms. Should you have any such symptoms, please call the office (do not come in) to reschedule your appointment.
• Spouses, family members or other individuals will not be allowed in the office during the patient appointment.
• Anyone under the age of 16 years of age will not be permitted in the office (including the waiting area)