Resumption of medically assisted reproduction activities The Agence de la biomédecine (French Biomedicine Agency) has published an update of its recommendations on patient management in the context of SARS-CoV-2 circulation.

The working group set up by the Agence de la biomédecine last March, bringing together learned societies, experts, a patient association, representatives of regional health agencies and the French Ministry of Solidarity and Health, is continuing its reflections on how to manage the resumption of medically assisted procreation activities, taking into account developments in the health situation linked to the SARS-CoV-2 epidemic. The Agence de la biomédecine is today issuing a new update to its recommendations, designed to help centers resume their activities in compliance with conditions of safety and quality of care, while preserving as far as possible equal access to care.

Please note The recommendations issued by the Agence de la biomédecine are intended to help healthcare professionals assess the situations they face. However, it is up to multi-disciplinary medical teams to implement them, after examining each situation on a case-by-case basis, taking into account the health context and constraints specific to each center.

Pre-requisites to be met Medical assistance for procreation activities have gradually resumed at the various centers. Any new resumption of activity must comply with specific procedures relating to the circulation of Covi-19.

These include

• Define the patient pathway within the healthcare establishment and the MPA center, to avoid any interference between MPA/gamete donation and Covid+ patient circuits,
• Define new team organizations,
• Guarantee continuity of care, by anticipating the risk of donation and/or MPA activities being halted, for whatever reason.

It is also advisable to follow the recommendations of health authorities concerning, in particular, working arrangements in healthcare establishments during the Covid-19 period, barrier measures and social distancing for both healthcare professionals and patients, SARS-CoV-2 diagnosis and screening procedures, and surface decontamination procedures.

Resumption of gamete donation - oocytes and sperm The resumption of oocyte punctures and sperm collection as part of the donation process is now possible under certain conditions:

• Human and material resources must be available in the establishment hosting the center;
• After receiving detailed information from the medical team, the donor gives his or her consent. Donor candidates must be made particularly aware of the possibility of having their treatment cancelled at any time during their stay, should the health situation require it again;
• The donor undertakes to comply with the health safety instructions issued by his or her center, and to report any symptoms or changes in his or her situation without delay;
• It is also recommended to test for SARS-CoV-2, even in the absence of symptoms, 48 hours before ovulation induction for oocyte donation and 48 hours before the first collection for sperm donation. In the case of sperm donation, serology with total antibody assay is recommended 48 hours before each collection and one month after the last collection.

The teams will give priority to individuals and couples in the following situations: An indication for urgent fertility preservation - for people with cancer whose treatment is toxic for fertility; Decreased or cancelled chances of procreation linked to a longer delay in treatment, such as advanced age, reduced ovarian reserve or severe ovarian endometriosis; Cancellation of a stimulation attempt in progress in March 2020, when AMP activities are halted due to the epidemic. For all women, regardless of the type of MPA they undergo, and for men prior to testicular surgery, certain medical histories may represent a risk factor for seriousness at Covid-19. For these individuals, the situation may be discussed on a case-by-case basis at a multidisciplinary meeting to decide whether or not to take charge.

The Agence de la biomédecine recommends that couples remain in contact with the medical team at the AMP center that treated them. The medical teams will keep patients informed of any measures and developments that may be implemented concerning their MPA course.

For treatments considered urgent, if the nearest center or the one that treated patients before the epidemic is not or is no longer able to welcome couples, they may be referred to another center, if possible within the framework of a cooperation agreement.

Certain situations are likely to interrupt the activities of an MPA or gamete donation center, whether linked to the patients themselves, to the center and its medical team, or to developments in scientific knowledge:

• Personal situation of the patients: change in the state of health of one of the members of the couple or of the potential donor, or of a close relative, which could suggest a Covid-19 infection during treatment.
• Situation of the MPA or donation center: arrival of a new wave of the pandemic; too many center staff assigned to the care of patients with Covid-19 in other units, or too many center staff affected by Covid-19.
• Evolution of scientific knowledge: if a risk to the health of women, men or the foetus is identified in connection with Covid-19, the management of all patients may be reconsidered.

These recommendations will be updated and circulated to all centers concerned as new information on the virus and its consequences becomes available.

To find out more about the Agence de la biomédecine's new recommendations: https://www.agence-biomedecine.fr/Recommandations-sur-les-modalites-deprise-en-charge-des-couples-dans-le

Composition of the working group Association française d'urologie (AFU) Fédération nationale des biologistes des laboratoires d'étude de la fécondation et de la conservation de l'œuf (BLEFCO) Fédération nationale des centers d'étude et de conservation des œufs et du sperme humains (CECOS Federation) Collège national des gynécologues et obstétriciens de France (CNGOF) Fédération française d'étude de la reproduction (FFER) Fédération nationale des collèges de gynécologie (FNCGM) Groupe d'étude pour le don d'ovocytes (GEDO) Groupe d'études sur la fécondation in vitro en France (GEFF) Groupe de recherche et d'études sur la cryoconservation ovarienne et testiculaire (GRECOT) Société d'andrologie de langue française (SALF) Société française de diagnostic préimplantatoire (SFDPI) Société de médecine de la reproduction (SMR) Société française d'hygiène hospitalière (SF2H) Institut national du cancer (INCa) Agence régionale de santé (ARS) Grand-Est Agence régionale de santé (ARS) Ile de France Collectif des centers privés en AMP français Collectif BAMP ! Direction générale de l'offre de soins (DGOS) Dr Jade Ghosn, Infectious Diseases Department, Hôpital Bichat Dr Florence Damond, Virology, Hôpital Bichat Dr Nadhira Fidouh, Virology, Hôpital Bichat About the Agence de la biomédecine A public body under the authority of the French Ministry of Health, created by the 2004 French Bioethics Act, the Agence de la biomédecine carries out its missions in four main areas of human biology and medicine: assisted reproduction, prenatal and genetic diagnosis, embryo and embryonic stem cell research, and organ, tissue and cell procurement and transplantation. www.agence-biomedecine.fr Twitter : @ag_biomedecine

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