Nasopharyngeal swabs for RNA testing by PCR are the most reliable for identifying the presence of the novel coronavirus, but false negatives continue to be a problem and the sensitivity of RNA testing is estimated to be about 70%. The positive and negative predictive value of the test will differ depending on the prevalence of the disorder in the specific geographic region where the clinic resides, with a greater number of false positives occurring in areas with lower prevalences.
Consequently, recommendations regarding pre-op, pre-ART, or intracycle cycle testing using PCR vary across institutions and often are controversial. Some institutions require pre-operative testing, while other institutions and free-standing fertility centers may not have readily available PCR testing.
If a clinic or institution has access to such testing and the patient is positive for coronavirus, the ART cycle should be cancelled regardless of the absence of symptoms due to the known asymptomatic window of COVID-19.
Regardless of your clinic’s access to testing, universal precautions and screening for symptoms as described in the previous questions are recommended, as follows:
- The safety of staff and patients is maximized if you treat everyone as potentially infectious.
- N95 masks are recommended if staff is in direct/proximity to a patient’s face (e.g., anesthesia) and/or the risk of aerosolization with airway management, other than the sole use of an oxygen mask, is necessary.
- If a patient is asymptomatic and both provider and patient are masked, the risk of transmission is likely to be low.
- Antibody testing is helpful ONLY for tracking patients for future immunity and research at the present time.
- Many unvalidated tests are on the market.
- It is inappropriate and unreliable to use antibody testing for triaging healthcare workers or to determine the need for PPE use.
- Even if an antibody test is positive, it is not clear how this should be interpreted, as immunity is not guaranteed.
- Inappropriate use of antibody tests may create risks to those who presume they are protected.