There are some specific special circumstances in the United Kingdom which have made our experience of COVID-19 unique. First, is the existence of the Human Fertilisation and Embryology Authority (HFEA) our regulator; second, the substantial contribution to both secondary and tertiary fertility care from the National Health Service (NHS) which is also responsible for the vast majority of acute COVID-related care and third, the Government’s influence in resumption of fertility services.
The priority when COVID-19 hit was support of the acute health services primarily related to capacity, staff redeployment, and personal protective equipment. In March, private health services were asked to make space for NHS work and increasingly NHS hospitals reduced elective and nonurgent work. On March 23 the HFEA placed a Condition on our Licenses requiring active treatment to cease by April 15. Many centers had already wound down services as staff were redeployed from both NHS and some private clinics into other areas. For some private centers the majority of staff were furloughed. All centers retained a minimum staff to maintain labs and storage and provide a source of information and support for patients.
On May 1, the Secretary of State for Health made the unexpected announcement that fertility centers were to reopen. Although generally welcomed the announcement took the specialty by surprise and the HFEA quickly published a set of self-assessed criteria for centers to apply to allow resumption of treatments and the UK professional societies have provided timely guidance to their members and the specialty on both winding down and resumption of safe services1,2.
Applications to the HFEA have been quickly processed and the majority of centers have resumed their work albeit in regimes designed to reduce the risk of COVID transmission. Much is now undertaken remotely, however, for investigation and treatment, distancing in particular, means that no clinic is capable of working at full capacity. All will be catching up with backlogs of patients who had treatments postponed and the lag effect is likely to extend as time goes on. This has a knock-on effect for NHS patients with age-defined funding limitations.
Overall we can look back at the efficiency of “shutdown” and the positive behavior of most clinics. Much harder to gauge is the effectiveness of reopening, the impact on access to care for our oft-beleaguered fertility patients and what the consequences of delay maybe for older women.
Conflict of interest disclosures
The author declares that there is no financial conflict of interest with regard to the content of this report.
2. The Association of Reproductive and Clinical Scientists (ARCS) and British Fertility Society (BFS) U.K. best practice guidelines for reintroduction of routine fertility treatments during the COVID-19 pandemic. 2020. Available at: www.britishfertilitysociety.org.uk/wp-content/uploads/2020/05/ARCS-BFS-COVID-19-guideline-v1.1-1.pdf
. Accessed May 7, 2020.