IS UNIVERSAL SCREENING OF IVF PATIENTS FOR SARS-COV-2 JUSTIFIED?

Resuming all ART treatments in Israel, following the COVID-19 lockdown put into effect on March 22, 2020, was fraught with concern, as the pandemic is still raging. One of the safety measures implemented was universal screening for SARS-CoV-2 of all ART patients. Our aim was to assess the usefulness of this measure. Cohort study. All women initiating ART treatment from May 1st, through July 17, 2020, at one of the two IVF Units of the Assuta Medical Centers, were required to undergo screening with nasopharyngeal swabs and a quantitative polymerase-chain-reaction test to detect SARS-CoV-2 infection. All women with symptoms of Covid-19 or those with recent exposure to an infected person were not allowed to commence ART treatment. Since almost all of the IVF cycles performed at our centers are fully covered by the Israeli national health insurance, treatment is very accessible, and thus we believe that our sample is representative of the country's COVID-19 prevalence. A total of 4,259 asymptomatic women underwent ART treatments at the Assuta Medical Centers, 2,787 ovum pick-ups and and 1,472 frozen embryo transfers. Overall, 23 women (0.54%) tested positive for SARS-CoV-2. The rate of women who tested positive was similar in our IVF center in Tel-Aviv, 11 of 2,299 women (0.48%), and in our more southern Rishon Lezion center, 12 of 1,970 (0.61%). An additional 11 women had to cancel their IVF treatment as their male partner was tested positive for SARS-CoV-2. Only a fifth of the positive patients came from cities declared by the Ministry of Health as Covid-19 hotspots. Our use of universal SARS-CoV-2 testing in all ART patients initiating ART treatment revealed that at this point in the pandemic in central Israel, one in 200 asymptomatic women starting an ART treatment cycle was positive for SARS-CoV-2. This ratio is approximately 10 times lower than the current rate among women screened in Israel due to Covid-19 related symptoms or exposure to a positive person. The potential benefit of universal testing for Covid-19 includes the ability to protect patients and health care staff during these challenging times by lowering the risk of novel coronavirus exposure in the ART clinic. However, universal screening may burden the limited testing resources and may lead to less vigilant use of personal protective measures.