Although COVID-19 has disrupted or postponed many treatment cycles, with telehealth you can still move forward on your fertility journey. We understand how difficult infertility is—and how frustrating interruptions to treatment can be. That’s why we have put together a webinar with a panel of fertility experts to answer any questions you have. Learn what to expect, how telehealth differs from an in person visit, and how treatment in the clinic will look with new social distancing and safety precautions in place.
Telehealth in Your Fertility Journey: Moving Forward During This Time
- Lissa Kline, LCSW, Vice President, Member and Provider Services, Progyny
- Dr. Alan Copperman, Reproductive Endocrinologist, RMA, New York, and Medical Director, Progyny
- Dr. Philip Chenette, Reproductive Endocrinologist, Pacific Fertility Center,
- Dr. Jonathan Kort, Reproductive Endocrinologist, RMA Northern California
- Dr. Gerard Letterie, Reproductive Endocrinologist, Seattle Reproductive Medicine
Fertility Treatment During COVID-19
Fertility treatment is essential medicine, so physicians are still seeing patients. In order to limit exposure to the virus, any appointments that can be, are now done via telehealth. Please be assured, as your fertility journey progresses and you are required to come into the clinic, providers have implemented strong safety and social distancing practices.
If you have any questions or want further emotional support, please contact your dedicated Progyny Patient Care Advocate.
Welcome everyone to our webinar Telehealth in your Fertility Journey. I’m Lissa Kline, Vice President of Member and Provider Services at Progyny. Today we’re going to be talking about how you can get started on your fertility during now or keep moving forward through telehealth. The doctors who have joined us today will give their perspective during this unprecedented time and share how the fertility community is here to help you keep moving forward.
So before we get started, I’d like to introduce our guests today. I’d like to welcome Dr. Alan Copperman. Dr. Copperman is the medical director of RMA of New York and serves as the medical director for Progyny’s Medical Advisory Board, welcome. I’d also like to welcome Dr. Gerard Letterie. He’s joining us today from Seattle Reproductive Medicine in Seattle, Washington and is also a member of Progyny’s Medical Advisory Board. Dr. Phillip Chenette is joining us from Pacific Fertility Center in San Francisco.
Dr Chenette is also a member of Progyny’s Medical Advisory Board and last but certainly not least, Dr. Jonathan Kort is also joining us from the Bay Area, from Reproductive Medicine Associates of Northern California. And in case you hadn’t noticed a pattern, is also on our Medical Advisory Board here at Progyny.
So welcome everyone before we get started, I want to let our viewers know that as you’re all in mute mode, and so if you have questions as we go through the webinar. You can enter them in the chat function in a panel on your screen and we’ll get to them towards the end. So as everyone knows on March 17thand then again on April 13th, the American Society for Reproductive Medicine or ASRM made recommendations that practices should complete ongoing cycles, but not to initiate new treatment cycles in terms of fertility.
And so, Dr. Copperman, I’d love to start by hearing your perspective on a ASRM’s guidelines and what do you think this meant for you, your practice and the field as a whole?
Thanks Lissa for organizing today and for giving us all the opportunity to discuss this really important time in our history and the field of Reproductive Medicine. ASRM has given us guidance and some on the most complicated issues in that imaginable. They’ve given us guidance on ethical issues, medical issues, when it’s time to start treatment, when it’s even time to stop treatment.
And at this point they’ve given us some guidance and a framework so that we can decide the locally and regionally and nationally how to manage reproductive care for our patients. Their first attempt was fairly strict. We didn’t understand when the surge was going to be of this pandemic, of covid-19 in each of our local jurisdictions. They didn’t know the capacity of hospitals. They didn’t know the capacity of all of us as citizens of society to flatten the curve through social distancing, so they were fairly strict.
And over the last couple of weeks and in the upcoming weeks, my sense is that they’re going to become a little bit looser as we all locally realize that our situations between us and our patients are very individual and difficult to legislate on a national level. So here in New York, we believe we’re past the surge and we’re starting to look forward to how we can safely deliver care to patients and that means social distancing, that means new technology.
That means Telehealth and that also means that during this downtime we can have more communication with our patients rather than less. So I think that ASRM has given us a framework to understand how to safely resume care, but we have to be in touch with them, give local feedback and once again focus on the patients in front of us and that’s going to give to our patients the best and the safest experience.
Thank you. That’s helpful. And so I want to pivot to Dr. Letterie. We know that this these guidelines and these recommendations meant that a lot of practices were closed for treatment and new treatments. And I do like pointing out that we’re seeing that likely start to open up. But for right now we know that there are some services including initial consultations that can be performed via telemedicine. And so I wondered if you can walk us through typically what’s completed during an initial consultation or diagnostic phase. What are the different parts of that and how long in general does that typically take for your patients getting started?
Thank you for the opportunity to chat with each of the members and thanks for arranging this. So I want to go back and just talk about what the cornerstone of a consultation is and that’s communication and establishing a relationship with your provider. And when we talk about telehealth and in particular telemedicine, telehealth being the broader category with several subdivisions, one of them being telemedicine the idea is to just establish a different venue
for communication no less intimate are no less revealing than a face-to-face across the table and all of our patients should bring to that consult online those same expectations. There should be no difference between the conversation that takes place as we’re having it now or as I have or any one of us has it with patients and what happened in the consult room across the table. It’s communication and patients should feel free to define exactly what they want.
The fact that there’s a computer and an image in a monitor interposed should not change the intensity of the exchange, nor the honesty and the frankness of it and that goes for both sides. So, I think the idea behind this is just communication no different than we would experience if we were in the same consult room. There’s a couple of practical issues that I always warn patients about and one is the relatively limited field of view.
So, if we’re sitting in a consult room and the patient can see me, they can see my activities going from a pad of paper, to the screen, the monitor, the lab tests, back to them and establishing eye contact, back to the pad. If you have a relatively limited field of view is sometimes you doing telemedicine. I always inform patients that for me to break away from the screen or to jot things down doesn’t mean I’m any less attentive but I’m doing things that they would ordinarily be able to observe.
And I think this is going to become a part of practice. If there’s any silver lining to the experience that we’ve all had, it’s the experience of telehealth and telemedicine and I think it’s going to become more important as those patients who come up through the ranks and need infertility care, those who are in their early 20s and transition to late 20s early 30s. This is part of what they do. Talking about a lot of the formats, whether that is.
GotoWebinar or Zoom. If I have any questions about the technology I consult my 18 year old because this is second nature to her, and to us, we’re sometimes referred to as digital immigrants. Everybody on our panel, a lot of the listening audience, this is all new. It’s kind of superposed on the learning paradigm. Those that are coming up, they’re digital natives. This is part of their DNA and I think this is going to be part of our clinical practice up ahead and I’ll stop there.
I think that’s great to talk about the initial consult and how you’re prepping your patients and what they should expect. Besides just that first conversation, what typically is in is involved in that first sort of introduction to your patients whether it’s at SRM or at other practices.
So, it’s a review of why they’re here, what they want to get out of the consultation trying to stratify their history. Why they might not be getting pregnant or if it’s fertility preservation, how that might play into their lives, and then a discussion of the diagnostics. A nice aspect of telemedicine is that you can turn the screen and share it and typically I try to have a series of slides that I can share with the patient. In a face-to-face across the table consult, many of us will depend on drawings, giving patients notes, opening up textbooks, whether it’s looking embryos or surgical procedures images that we can supplement the conversation with and telemedicine is no different. You can share the screen and have a stack of six or eight slides to illustrate for example in the initial consultation what each of the steps means, graphs of AMH, what the AMH decline means overtime, images of HSGs is just to give the patient a sense as to what they can expect in a very visual way.
That’s great. Dr Chenette, at PFC specifically or what your colleagues are doing. How is your practice using telehealth for those consults? And then as I said for the for the diagnostics that are happening afterwards, specifically where your patience today in San Francisco in the Bay Area may not be able to travel to see you as they used to do.
We’ve been developing telehealth resources for quite some time. A month ago. We were forced to jump into it totally and now almost all of our normal first patient contacts and advice, diagnostic reviews and treatment plans are created by telehealth, by telemedicine. That differentiation between telehealth and telemedicine is Dr. Letterie mentioned is a very important one.
Telemedicine is basically just doing what we’ve always done. Telehealth though is helping you achieve your health goals and there’s so many more resources we can bring to bear in an electronic visit than we can with our traditional in-person visits. I can bring in expert resources on the outside. I can bring my embryologist online to have a comment on the embryos, we can show pictures of the embryos that were created in the in vitro fertilization lab. We can look at your test results, your hysterosalpingogram, your anti-Mullerian hormone levels. We can look at your ultrasound results. I can put them right up here on the screen and let you see what I what I see. It is a tremendous tool. I’m really pleased we’re here with this, with those resources now and wondering a little bit why we didn’t do this long ago. We do still some inpatient things. I mean, this is the fertility world, it’s a hands-on thing.
We’ll do the initial consultation, review your records, help you think about your family building goals and where you want to go with that and then we’ll bring you in for a 15-minute visit for a specific ultrasound or a diagnostic procedure. That enables to us to achieve all of these goals of getting you educated, getting you the appropriate treatment plan, getting the appropriate treatment in place and this helps with the community needs of social spacing and limiting viral transmission, protecting the clinics in the staff and our patients.
At PFC specifically, I know there are some ways that people can do, for example at home hormonal testing, so finger prick for estrogen FSH, LH. Are you having patients today come into the office or you finding Ways for them to complete those diagnostics?
Yes. We’re still doing traditional lab tests, blood draws and things, but not generally in our office. There are mobile blood draw stations that will actually come to your home to do that. And yes, absolutely. There are more user-friendly tests of finger pricks and things like that that we’re bringing into practice. There’s an issue is just to evaluate on those and it’s going to that’s going to take some time. But absolutely those consumer-friendly diagnostic tools are going to become a big part of what we do.
I like what you and Dr. Letterie said how there’s a silver lining to what Americans and really the world is going through, is that the community we know is a really resilient and creative community in that the doctors, all of you and your colleagues are helping to adapt so patients aren’t missing out on getting started or continuing their journey. That’s great.
We’ve been surfing a wave of technology for the last 25 years. Right and this is one more piece. We will master this and it’ll be a tremendous tool for all of our patients.
Yeah, that’s great. Dr. Kort I wanted to ask you, similar to what Dr. Letterie and Dr. Chenette were saying, we know that the initial consult and a follow-up during that diagnostic phase can be done via video. Tell us a little more about other pretreatment services that can be done from home, may be genetic testing, preconception carrier screening etc and why it’s important really for patients who are thinking that they want to get started, why it’s important that they do in fact get started now
. Yeah, a lot of the testing that we do during the initial consult includes genetic carrier testing and at a minimum at least a discussion of what genetic carrier screening is and why it is worth considering for our patients. And a lot of the testing companies that perform these tests can actually mail a cheek swab to our patients and have that done remotely. These tests also have a turnaround time time of two or three weeks. And so, getting that testing done now is a good idea even if you’re not able to start your treatment cycles for another two or three weeks because that information is helpful to have before you start your treatment cycle in case there are results that may change the type of treatment that is recommended.
Yeah, and then typically do you see in your practice that that patients will come in and have that initial consult, do that follow-up testing that you’re talking about and then don’t they usually sit back down with you or one of your colleagues and review those results and are you continuing that during this time?
We are and you know those visits really lend themselves to telehealth visits because if they need to have a counseling with a genetic counselor, they need to discuss those results. It’s very easy to do through a video chat. And so that’s something that patients can really make the most of this time while they’re actual treatment might be delayed, and in around 1 percent of couples that information may change the type of treatment that we recommend and so it’s good to have that information before any treatment plan is started.
I like to about telemedicine, about telehealth that you know before if I was entering treatment with my partner and we both had pretty hectic work schedules and lived across town San Francisco from each other and it’s hard to both meet up at your clinic, via Zoom or other modalities y can both join the conference with the position from where you’re sitting. I think that’s really convenient for a lot of people.
Definitely, you know, a lot of our patients who have partners are both working from home. And so we’re finding that, you know, a lot of our follow-up visits are involving both partners, which is great. And something that when visits her in person and harder to get to we may have seen less frequently.
I like that so Dr. Copperman, you mentioned, and I like that we have this lens, we’re starting to hear of clinics who were totally closed starting to open up and clinics who have been partially open starting to expand services. As regions across the country are starting to open back up, I’d love to get your perspective on should patients feel safe moving forward now and what do you think that looks like in New York and across the country?
Great questions. I think that the overwhelming theme here is that we’re a precise specialty and we have precise recommendations. So, on the female side, this is eggs and ovaries and hormones and timing and ovulation and preconception counseling. On the male side there’s also the opportunity for health and wellness and engagement and they’re even at home sperm kits. And on the couple side we can help time and do the carrier testing.
So I think we hearing a story that this isn’t really down time, but this is time for precise encounter for precertification, pre-authorization, prenatal vitamins, pre everything. So, as we start to lift some of these stay-at-home restrictions as we start to become feel a little bit safer. I think what we’re looking for is a safe environment to resume our essential reproductive care. So, what does that mean for a clinic visit? I know we built in text messaging into our electronic medical records so that there’s a precise 15-minute window when a couple or patient is going to (normally a patient in the partners is downstairs), but when a patient comes into the office and there’s disinfectant of every surface and, of course—not that we need props to this—there are masks everywhere and every single surface has a disinfectant and the way were actually practicing medicine is completely different than it was 60 days ago because we’re learning from our colleagues in Southeast Asia. We’re learning from our colleagues in Europe who are just getting better at this. So I can’t say that it is a safe world yet, I do think we’re vectoring towards better and I think that we’re using knowledge to help drive decisions. What I really am hearing from the biologists in the virologist is this coronavirus, this novel coronavirus is fairly similar to SARS MERS, neither of which caused really catastrophic or even significant effects on eggs sperm and embryos and it’s truly my hope that as we acquire data, we can comfort our patients, reassure patients, and most importantly appropriately counsel our patients when it’s safe and that it’s safe to resume treatment. But I think that it’s through conversations like this that we’re going to actually lower the anxiety by giving some control back to our patients and that control comes from real hard scientific knowledge.
That’s helpful. We talked a lot about new patients. So, patients just getting started whether that’s trying to conceive immediately or preserve fertility for later. I also want to spend a little bit of time talking about established patient.
So those patients of yours who were already on a journey. Maybe They’ve done the testing and done one treatment and are waiting to start the next and Dr. Letterie, when you and I spoke the other day, you mentioned that there are services for fertility patients besides just the medical services and I like that you view your patients holistically, right? And you mentioned behavioral health in particular how have you been today in your practice and with your colleagues? Have you been connecting your patients to those resources? And how is that going?
So I the emotional aspect of this something for our patients that just simmers along to Dr. Copperman’s comments were getting things in line so that when the moment comes patients can initiate their IVF, it’s more postponement than an actual missed opportunity for those patients. The emotional aspect or the or the personal aspect for our patients continues on uninterrupted and if anything during this way just kind of increases, goes from a simmer to a boil. So our patients, we had an outreach program where we tried to contact patients that we knew were having their cycles postponed and offering them counseling services online and with each of the patients we talk to now, we emphasize that although the practical, the nuts and bolts aspects of their infertility care and testing will be in place, they should also as an ongoing effort to contact our mental health specialists to discuss the emotional aspects. It’s not as intimate as it is if you’re across the table, there’s something about being in the same room with a person or a provider that really can’t be replaced. But that’s not to say that acute issues can’t be addressed very effectively online.
Yep. In my life before Progyny. I’m a licensed clinical social worker. And so I used to provide individuals and couples counseling and support groups. I know all of you really integrate that into your practices and I think that’s really important. I want to hear a little bit from Dr Kort and Dr. Chenette and I’ll start with Dr. Kort. How are you using telehealth today to connect with your existing patient? So those you’ve already seen in your practice?
Yeah for our patients who are trying to conceive now, we appreciate how disruptive a pause with the in-person treatments might present to them, you know, our patients want to be pregnant yesterday and we want them to be pregnant as soon as possible. And a lot of times things like lifestyle interventions or treatment strategies, which may involve longer preparations before the actual treatment, get put on the back burner because we’re so eager to get our patients in a treatment now and I think what Dr. Copperman mentioned about this not being time off or a complete pause, is really important that we want to make sure that we’re making forward progress. And for patients who are not able to resume in person treatments currently, this is a great opportunity to have counseling on lifestyle factors or you know, occasionally weight loss or supplements that that might be helpful in preparing for when their in person treatments can resume and that can really help maximize the chances that they’re going to be successful when they are able to start those in person treatments. And so I think really focusing on that this isn’t just time off, that there are things that we can do through telehealth, through counseling that can really help their chances when they’re when we’re ready to resume.
That’s great. And Dr. Chenette, are you seeing similar things or have other experiences with your existing patients that you’re seeing in your practice?
We’re seeing a lot of concern. I mean, that’s who we are as a species, right? We love to worry. We’re not seeing any real trouble associated with coronavirus and I think we all would point out to you that the patient group we work with is actually fairly low risk for viral infections and for problems. When you think about coronavirus, how long does it actually in your system if you get it? We don’t really know but the guess is maybe 14 days and so the chance of that actually impacting you while you’re on your fertility journey or during pregnancy is actually fairly low. And then what we’ve done is to institute—all of us have—instituted protective measures for the clinic. That we take that initially very low risk and reduce it to an ultra low risk just by screening procedures and testing, things like that to protect the staff and our patients and the system. So at the end of the day it is safe to do fertility care and all of us are working hard to ensure that safety for all of our patients.
That’s great. I want to also mention that for Progyny members, they have access as an added support, of course to their Patient Care Advocate and we know that goes a long way. And so not only do they have the care teams at all of your practices and the other practices in our network, but they have access to their Patient Care Advocate as a support. You know that so important through the journey. And I also know that Resolve has turned a lot of their support groups into virtual support groups, which is a just another way for patients out there to get the support that they need.
So I want to answer some questions. As I said in the beginning if you have a question, you can enter it in the chat function and if we don’t get to it today, please feel free to email us at firstname.lastname@example.org and we’ll have someone get back to you and answer your question. So let me take a look at the questions that have been coming in. I also don’t know that I said at the beginning but for Progyny members telehealth is covered through your Progyny benefit in the normal typical way. So if that’s a question anyone had we want to make sure that you understand that. And that so the first question that came in, I’ll ask Dr. Copperman to answer it. And the question is how do I initiate my initial consultation via telehealth. So how do they get started if they’ve never been in contact with your practice? What’s their first step?
I’m so glad that we’re talking a little bit about mental health as well as telehealth and as well as reproductive health and then we’re bringing them all together. This fear, anxiety and isolation that a lot of people are feeling during the quarantine. It has to be addressed and Progyny’s PCAs and Resolve’s mental health groups and each of the programs support groups I think are essential because there is a feeling of loss time. There is a feeling of being derailed and I think we have to give people on track. So starting off with that phone call to the PCA. What is the geography, what is the problem being matched for the program and immediately getting connected with the right reproductive endocrinology program, the right infertility program, or for somebody who wants to freeze the eggs, the right fertility program and then setting up a telehealth consult. All the doctors here are in our practice that are make are providing Telehealth. In fact, some of them seven days a week. So, there is this feeling that their needs can be met and the telehealth consult as discussed by this panel is an important conversation. It’s not a monologue but it’s actually a dialogue. It’s a conversation. It’s a getting to know you, it’s an informational session and then that will establish what the right treatment plan is, what the right coverage is. So really just it starts with a phone call and then the doors start to open up.
That’s great for Progyny members they can contact their PCA. I like that you called that out. That’s a good first step and you can also find on our website, you can start by looking at our in-network providers on Progyny.com and find any of these four physicians or one near you. The next question that came in I’ll ask Dr. Kort if he would be so kind as to answer it. A members saying what kind of technology is being used by the doctors on the panel. Do I need to download an app and can my actual appointment be recorded so I can reference it later? That’s a good question.
I think this likely varies, you know between different practices. I’m sure that any practice within the Progyny network has some platform that is HIPAA compliant and secure. So that patients can feel comfortable talking about very personal aspects of their reproductive lives. We either will use a platform called Spruce Health. It’s a HIPAA compliant platform for messaging that we also use for communication, but it also has video chat capabilities and Spruce does not have the ability to record chats. Although that is something you know, we could inquire about and but I’m sure that other platforms probably do have that ability..
I would say to you if you have a phone as long as you’re letting your doctor know that that you are going to record it, most phones have a voice memo app. And so you could record it as long as the physician understands that they’re being recorded too. I suppose you could do that in person as well and that same person ask the follow-up question. Do I need to sign a separate consent for telehealth? Do you know Dr Kort, are you having your members or your patient sign separate consents for telehealth?
Not one specific for telehealth We’re not you know, we feel like our usual documentation would cover anything that we would be doing over telehealth that we would otherwise be doing in person.
Doctor Letterie, I’ll ask you this next question. A member is saying or is asking what is being asked for the screening questions before coming to the clinic. So what questions am I asked before I make my appointment and will that be the same now as when the restrictions potentially loosen? So is your team asking any specific questions to patients before they sit down or dial in to see you?
Oh you mean relevant to any potential lurking infections?
Yeah, I think that’s what they’re asking. They’re saying for screening questions. What is what is happening before I’m coming to the clinic.
So I think there’s a two-part answer to this. We always alert patients that they’ll be asked these questions so that they can anticipate, and we also alert them that they respond positive to questions. Like have you had any symptoms of a URI, that temperature elevation, anything that would queue us of probably nothing.
more than a typical viral infection but a potential latent infection for Coronavirus, that they’ll be asked not to come into the clinic. All of us staff have their temperatures taken daily and everyone wears a little colored button kind of approving them for participation for the day, but most importantly I think just advance notice to the patients. Those two things. One is it gives them reassurance that the environment is going to be safe for them, that were thinking about this. It’s not business as usual. But the second is, in the unfortunate circumstance where somebody might have a temperature elevation or tick off one of the symptoms, they’ll be asked to leave and we don’t want that to be as surprised and disappointment.
It’s helpful. This is a question of mine and I guess if I’m thinking it others might, be do you continue that through a cycle? For instance, If someone’s doing a treatment cycle? Are you continuing those screenings throughout their visits to your practice?
I think the best answer to that is until further notice.
That makes sense. And then the last question that’s come in so far and I’ll ask Dr. Chenette if he’s willing to take this one. This is a good question and I can I can help you answer this too Dr. Chenette. If my partner is not covered under my benefit, can they still listen in on the telehealth appointment? And would I be charged additionally for this? How are you handling those scenarios in your practice?
Well, look, this is generally a couple’s problem in the fertility world and we absolutely support approaching it that way, as a couple’s condition. The Progyny member will talk to their partner. They should both be together on the conversation and frankly the insurance issues really don’t come into play when I talk to patients about their issues. It’s what do you want to accomplish? What are your goals? And what do we need to achieve those goals?
Yep. So, for the initial consult, as far as Progyny is concerned if the member is covered, whether or not their partners covered under their benefit, for that visit their partner is welcome to attend. Obviously for follow-up testing that that changes slightly. So, if I have a male partner and they need a semen analysis that would be handled differently in terms of covered. But typically speaking they their partner could attend and there wouldn’t be an additional bill.
So that is all of the questions that have come in so far I want to thank the doctors for joining me today. I think this was a really great conversation. So thank you to Dr Letterie, Dr. Copperman, Dr. Kort and Dr. Chenette. We really appreciate you taking the time. It’s really clear the care that you’re giving to your patient some whether their Progyny members or not. And we really appreciate that and I think I speak for the viewers by saying thank you very much for being so adaptive and thinking through not only their safety but their mental health and their physical health, and always keeping their family building goals at the top. So we appreciate you and we thank you, and we’ll talk to you soon.