Karavani Gilad, Chill Henry H, Meirman Cherut, Dior Uri P, Ben-Meir Assaf
Faculty of Medicine, Hebrew University of Jerusalem Israel; Department of obstetrics and gynecology, Hadassah Medical Center.
Faculty of Medicine, Hebrew University of Jerusalem Israel; Department of obstetrics and gynecology, Hadassah Medical Center.
Eur J Obstet Gynecol Reprod Biol. 2021 May;260:154-158. doi: 10.1016/j.ejogrb.2021.03.023. Epub 2021 Mar 17.
To assess the impact of the COVID-19 pandemic on the activity of a tertiary fertility service and compare telemedicine and face-to-face meetings during this time.
This was a retrospective cohort study conducted in a university affiliated tertiary medical center. Included were patients scheduled for an appointment in the in-vitro fertilization (IVF) unit between March 18th and April 15th. A comparison was made between patients who chose telemedicine as opposed to face-to-face meetings. Additionally, the population of patients who chose to cancel their appointment was characterized. IVF cycle outcomes were additionally compared between the groups.
Overall, 90 IVF clinic appointments were scheduled during the study period. Thirty-four (37.8 %) patients chose to arrive to the clinic in spite of the COVID 19 pandemic and partial quarantine, 27 (30.0 %) patients chose to avoid in person meeting and scheduled a telemedicine appointment and 29 (32.2 %) patients cancelled their appointment. On comparison between patients who chose telemedicine vs. face-to-face meeting, the telemedicine group had lower prevalence of primary infertility (20.0 % vs. 47.1 %, p = 0.037) and higher rates of preimplantation genetic testing indication for in-vitro fertilization (48.2 % vs. 20.6 %, p = 0.026). Rate of a first-ever clinic visit was higher in patients that arrived for a face-to-face meeting, as compared to telemedicine encounter (55.9 % vs. 28.0 %, respectively; p = 0.036). Patients that opted to avoid attending the clinic or meeting via telemedicine had higher rates of medical comorbidities compared to patients who chose to attend their appointment (51.7 % vs. 29.5 %, p = 0.016). Rate of appointments that led to fresh or frozen-thawed embryo transfer and these transfers' outcomes (clinical pregnancy rate) were similar in the telemedicine and face-to-face meeting groups (72.2 % vs. 88.0 % and 30.8 % vs. 31.8 %, p = 0.73 and p = 1.00; respectively).
Telemedicine is a valuable tool for delivering fertility care during the COVID-19 pandemic. There is need to determine which patients will benefit most from this modality.
评估2019冠状病毒病疫情对三级生殖服务活动的影响，并比较这段时间内远程医疗和面对面会诊的情况。
这是一项在大学附属三级医疗中心进行的回顾性队列研究。纳入的患者为3月18日至4月15日期间计划在体外受精（IVF）科室就诊的患者。对选择远程医疗而非面对面会诊的患者进行了比较。此外，对选择取消预约的患者群体进行了特征描述。还比较了两组之间的IVF周期结局。
总体而言，研究期间共安排了90次IVF门诊预约。尽管有2019冠状病毒病疫情和部分隔离措施，仍有34名（37.8%）患者选择到诊所就诊，27名（30.0%）患者选择避免面对面会诊并安排了远程医疗预约，29名（32.2%）患者取消了预约。在比较选择远程医疗与面对面会诊的患者时，远程医疗组原发性不孕症的患病率较低（20.0%对47.1%，p = 0.037），体外受精的植入前基因检测指征率较高（48.2%对20.6%，p = 0.026）。与远程医疗会诊相比，前来进行面对面会诊的患者首次门诊就诊率更高（分别为55.9%对28.0%；p = 0.036）。与选择就诊的患者相比，选择避免到诊所就诊或通过远程医疗会诊的患者合并症发生率更高（51.7%对29.5%，p = 0.016）。远程医疗组和面对面会诊组中导致新鲜或冻融胚胎移植的预约率以及这些移植结局（临床妊娠率）相似（分别为72.2%对88.0%以及30.8%对31.8%，p = 0.73和p = 1.00）。
在2019冠状病毒病疫情期间，远程医疗是提供生殖护理的一项有价值的工具。需要确定哪些患者将从这种方式中获益最大。
