This year, many people using fertility services will have had their treatment postponed, or even cancelled, causing unprecedented demands on the care they need.
Fertility nurses look after women throughout their fertility treatment, from guiding them on how to take medication and self-inject, to undertaking scans and tracking their cycles.
“Everything that you need during a fertility treatment journey pretty much falls on the shoulders of the nurses,” says Francesca.
Redeployment, furlough and the shutting down of services has had a huge impact on nursing staff
But in March 2020, most clinics closed when lockdown restrictions were introduced as the care they offer was deemed non-essential.
This resulted in fertility nurses being redeployed to different sectors, including intensive care, where they had little expertise, but also to more familiar areas like gynaecology and early pregnancy units – however, a significant number of nurses in private clinics were furloughed.
“Redeployment, furlough and the shutting down of services has had a huge impact on nursing staff,” says Francesca.
“Getting back into the swing of things and going back into full-on, busy clinics can be challenging.”
They’re already a very anxious group of patients and they go on a hell of a journey
Meeting new patient needs
In the UK, patients who meet certain criteria, such as age and weight, are entitled to funding for fertility treatment in the NHS, but this varies depending on where they live.
While those with frozen embryos, eggs or sperm have had their freezing period extended by a year, many patients already undergoing treatment were not so lucky – and it often fell to fertility nurses to break the devastating news.
“Fertility has a huge emotional impact on people’s lives,” explains Francesca.
“They’re already a very anxious group of patients and they go on a hell of a journey to get through the doors of a fertility clinic to start with.
“Patients were stopped mid-treatment and had their cycle cancelled; some were told they had to wait an extra six months. This year has really taken its toll.”
The impact of the past year on patient mental health has been immeasurable.
“We’ve seen a lot more patients take up counselling with specialist fertility counsellors and reaching out to nurses for support,” explains Francesca, who offers mental health support to fertility patients in her role.
Those who are anxious about their fertility treatment, and have struggled in the past year, are likely to carry their anxiety with them going forward, even during a pregnancy. This can have adverse outcomes for the mother, her family, and any babies they may conceive.
As the need for support is skyrocketing, Francesca notes that many clinics were already struggling to offer enough support under normal circumstances.
“It’s mandatory for all clinics to offer counselling to patients, but you have some clinics running two thousand, even three thousand cycles a year and they’ve only got one or two counsellors,” says Francesca.
“The demand is huge, and I think there needs to be more done to help support these patients, especially coming through this pandemic.”
We’ve seen a lot more patients take up counselling with specialist fertility counsellors and reaching out to nurses
Tackling vaccine hesitancy
The pandemic has seen swathes of misinformation spread, online and through word of mouth – particularly around vaccines.
There are unsubstantiated theories that the COVID-19 vaccines affect fertility, and now nurses are having to spend precious time in appointments debunking the myth.
“Hesitancy goes from one extreme to the other,” says Francesca.
“I’ve spoken to patients who have outright said that they’re not having the vaccine – especially now with the information about the AstraZeneca jab. People are worried they might get a blood clot during pregnancy.
“Some people are more understanding if you reassure them that the risks of contracting COVID-19 during pregnancy are a lot higher if you don’t have the vaccine, so it’s a good idea to have it.”
Initially, patients were advised not to try to conceive within three months of having the vaccine, and even though that advice has changed, it had a lasting impact.
“We have to explain why some information is not true and provide all the right evidence to reassure our patients – but it takes a long time.”
Maintaining compassionate care
Like many health services, fertility clinics have moved some services online.
“We have Zoom consultations and lots of clinics have started using online consent and patient information platforms, in order to educate and gain informed consent from their patients,” says Francesca.
“A lot of work is being done from home and patients are only really coming in for the medical procedures and the scans.”
However, this was not achieved without “bumps in the road,” says Francesca.
That was a real thing for me, not being able to hug and provide support for a patient
Private clinics were better equipped to set up virtual services straight away, while in the NHS there are more resourcing and processing limitations when setting up new technology.
“It’s been different for everyone and it’s a huge team effort to get these things up and running. Everyone is so used to working face-to-face with patients, it’s very difficult now to start working virtually and being able to still reassure and care for your patients through a computer screen.”
While using virtual services has had its benefits, there are still some cons to not having face-to-face consultations.
“In the early days of the pandemic, just before we were being shut down, I sat with a woman who had miscarried and I couldn’t put my arms around her,” says Francesca.
“That was a real thing for me, not being able to hug and provide support for a patient because we weren’t allowed to touch each other.”
As services resume and restrictions lift, Francesca hopes that the public’s respect for the nursing profession carries across all sectors.
“Things this year just moved so fast and our services changed all the time, but our practice covers all areas. We do oncology because we do fertility preservation for patients. We feed into midwifery services, early pregnancy and gynaecology and women’s health,” she says.
“We sit in so many different areas and we have to have a huge skillset to refer and advise appropriately.
“There is a huge population of fertility nurses, but we don’t always get a voice to talk about our experiences.”
Francesca is Chair of the RCN Fertility Nursing Forum. Find the latest news, advice, and guidance on fertility nursing by visiting the forum’s webpages.
For further reading, take a look at the following publications:
- Fertility care and emotional wellbeing
- Education and Career Progression Framework for Fertility Nursing
- RCN's position on the provision of fertility treatment in the UK
Top image by Getty, in-text image by Francesca Steyn