'Authorised to resume licensed treatments' following COVID-19 closure: what does this actually mean for a fertility clinic?

Since fertility centres have been allowed to apply to reopen following their temporary closure during the COVID-19 pandemic, as reported in BioNews 1045, many fertility clinics have been approved by the Human Fertilisation and Embryology Authority (HFEA) as 'authorised to resume licensed treatments'. This has naturally meant that patients previously left waiting for their treatment now desperately wish to get going again on their journey towards achieving a family. 

This understandable desire to resume treatment has led to clinic websites constantly being checked, phone lines in clinics becoming busy and many questions being asked across other channels of communication such as social media. Patients will often assume that if a clinic is now 'open' or can 'resume treatment' that this means it will happen immediately. It is sometimes difficult to explain to them the impact that COVID-19 has had on treatment plans and why things will take a long time to get back to any kind of normal. 

The COVID-19 pandemic has brought huge challenges to our health service and to society, and I hope that by explaining some of the challenges that fertility clinics face, I can remove some of the confusion, and help to restore some faith in the fertility service.

HFEA-licensed fertility clinics come in all shapes and sizes. Some provide only NHS treatment, some both NHS and private, and others just private treatment. A number of clinics are standalone facilities, whereas others are attached to existing NHS hospital sites. Some clinics may have the capacity within the laboratories, scan rooms and procedure rooms to provide additional treatments, whereas others may be bursting at the seams and unable to grow any more in their current location. 

Some fertility clinics provide only a few hundred fertility cycles per year, and others provide several thousand, which means clinics will also differ significantly in the number of patients whose treatment was put on hold when clinics were instructed to stop providing treatment.   

The types of staff providing the specialist fertility services also differ between clinics. Some private clinics may rely on NHS anaesthetists, medical consultants and nursing staff to provide private fertility treatments outside of their contracted NHS hours. Others may have a dedicated team of specialists providing private fertility care. Clinics within the NHS will also rely on anaesthetists working elsewhere within the NHS. Some clinics may be part of a group of clinics, offering more deployable staff, whereas others operate in isolation with staff dedicated to just one clinic. Furthermore, during this period of closure, nursing, medical and scientific clinic staff, from both private and NHS clinics may have been redeployed to support NHS services during the COVID-19 crisis, again affecting the number of staff available for fertility services.

Clinics within an NHS Trust may have HFEA approval but may be awaiting local NHS Trust approval to reopen due to restricted footfall in the hospital and the continued need for redeployed staff to support other services, whereas standalone private clinics may not have the same problem. On the other hand, clinics within an NHS Trust will have secured supplies of suitable personal protective equipment (PPE) and local infection control expertise, whereas private clinics may not have sufficient PPE nor advice available to be able to open immediately. 

In short, although our clinics provide very similar fertility services, each has its own unique circumstances determining what will be a suitable strategy for reopening. This means that the way and the rate at which they re-open will be very different, and the number of patients 'on hold' and desperately waiting to re-start their treatment will also vary. 

Although some clinics submitted their self-assessment to the HFEA for approval at the earliest opportunity, other clinics may need a little longer to build or implement their strategy. And although the HFEA list of approved clinics is growing each day, those approved clinics all have very different strategies created for their own unique service. All clinics, regardless of size, location or funding type, will have a number of patients who had to have their treatment cancelled or postponed and who need to be given priority in resuming their treatment. All clinics will undoubtedly need to re-open services at a lower capacity than before to ensure they keep their patients and their staff safe.   

To answer the question directly: the differences between clinics means that the resumption of licensed treatment will look different across centres. Whatever the unique circumstances for your clinic, please be reassured that they, and the HFEA, are prioritising patient and staff safety by minimising the risk of COVID-19 transmission but still ensuring that you have the very best chance of a successful outcome within a high quality service.