Fertility issues and IVF are stressful enough—but throw a pandemic like coronavirus (COVID-19) into the mix and it’s easy for your mind to go into an all-out tailspin. If you’re undergoing fertility treatment, you’re probably wondering things like, “should I move forward with my IVF egg retrieval?” “Is now the best time for an embryo transfer?” or “Should I freeze eggs/embryos now before waiting for things to get worse?”
Like any other part of fertility treatment or IVF, the questions about coronavirus keep coming. So, here’s what we know.
How are fertility clinics handling coronavirus?
Right now, fertility clinics (like everyone else) are looking to the Centers for Disease Control (CDC) and local and state health authorities to help prevent the spread of coronavirus to fertility and IVF patients. Most likely, your clinic already has policies and guidelines in place that are aligned with the CDC’s recommendations.
Because the majority of coronavirus cases are linked to travel in areas with active outbreaks, fertility clinics are asking patients to delay IVF or other fertility treatment if you have traveled to a high risk area, been in close contact with someone who has, or are feeling sick. If any of those conditions apply to you, do us all a favor (at fertility clinics and beyond) and, per the CDC, self-quarantine for 14 days after your last known potential exposure to the virus.
Previously, the Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM)’s guidance was that patients with a high likelihood of having coronavirus—symptoms present, exposure to a confirmed patient within 14 days of symptom onset, or a positive coronavirus test result—should strive to avoid a pregnancy. This included those using egg or sperm donors, gestational carriers, or proceeding with IVF transfers. For context, if you experience symptoms of respiratory distress (common with coronavirus), anesthesia used during a retrieval cycle could suppress respirations further when your immune system may already be compromised. Moving forward with a transfer cycle could cause risk to you, clinic staff, and other patients…and is generally just not the best idea.
At the beginning of April, the ASRM also originally recommended suspending the initiation of new treatment cycles, including ovulation induction, IUIs, IVF retrievals and transfers, and non-urgent gamete cryopreservation, due to the coronavirus pandemic. Patients and practitioners were strongly urged to cancel all embryo transfers, fresh or frozen, and were encouraged to work together to determine how “urgent” the patient’s care may be.
In other words, if fertility care was super time sensitive (say, in the case of age or diminished ovarian reserve) and an extended delay could impact the outcome, that would considered urgent. The ASRM recommended suspending non-time sensitive procedures, minimizing in-person interactions and encouraging the use of telehealth. Patients who were mid-cycle, however, may have been able to continue their treatment.
As of April 24, however, the ASRM’s recommendations now include the following (which were affirmed on July 10):
- Reiterating that infertility is a disease and its treatment should not be considered “elective.”
- Supporting the measured resumption of care, as long as fertility clinics maintain appropriate and prudent measures for coronavirus disease prevention.
- Recommending that fertility clinics also perform formal documented risk assessments of their practices, with risk mitigation plans for different procedures. Treatments should be prioritized for patients where delaying would impact treatment outcomes, access to care, or mental health issues — so don’t be surprised if your clinic is a bit backed up as they stagger treatment re-initiation. Some fertility clinics may also only be resuming some treatments and not others, depending on risk factors.
- Some of the decision-making has been punted to local governments, with the ASRM noting that local conditions and government regulations should guide healthcare practice decisions. Meaning, it’s a bit up to the clinic’s discretion depending on the local impact of coronavirus. The ASRM has advised clinics to be flexible and recognize the status of their local transmission rate, medical conditions, and any impact that re-opening their doors may have on their community. They’re also considering the well-being and availability of local healthcare workers, not wanting to overload local healthcare systems.
- Advising continued caution with all embryo transfer cycles and IUIs, since there is still a lot unknown about how coronavirus may impact pregnancy. However, the ASRM appears a bit looser in these restrictions and seems to have left this up to the judgment of individual clinics and their local governments.
As a result of these loosened ASRM guidelines around coronavirus, most fertility clinics have re-opened and initiated treatment. Contact your fertility clinic or OBGYN to see how they are handling the coronavirus situation and what you may be able to resume.
Additional third party reproduction recommendations as of July 10 include:
- Geographical considerations — as in, where the intended parents and gestational carrier or donor lives, and what the COVID-19 impact is like there.
- Utilizing oocyte vitrification or frozen sperm shipment for embryo creation instead of travel when donors and intended parents live in different states.
- Instead of additional donor screening for COVID-19, just making sure it gets documented if a donor has had close contact with someone who has tested positive for COVID-19, has had a positive test for COVID-19, or has had symptoms associated with COVID-19. Any donors or gestational carriers who test positive should have their cycle cancelled, so it’s important to consider this possibility.
The good news? Most clinics are super equipped to handle viruses all year. They’ve got procedures in place to keep their facilities ultra-sterile to (hopefully) keep things like this under control.
Sounds like common sense, but we’re just going to say it anyway: if you’re feeling sick with a fever or have any health concerns, contact your primary care physician ASAP. For current travel advisories and up-to-date information on coronavirus, please visit the CDC’s coronavirus website.
Does coronavirus impact fertility?
Currently, there’s limited scientific evidence about the association between coronavirus and fertility. However, this is a pretty touch-and-go situation. COVID-19 is relatively new, so the CDC and other scientists will need to continue monitoring its effects upon fertility and beyond.
What we do know is that infections can sometimes cause a fever that may affect fertility treatments. One study has reported that having a fever during their egg freezing or IVF cycle was associated with a lower number of eggs retrieved, a longer cycle, and a higher level of required medication. However, there’s no evidence that a fever causes longer-term effects on female fertility.
How does coronavirus affect pregnancy?
With pregnancy, we have a bit more info to go off of. We know that full-term newborns delivered from mothers with active COVID-19 infections have done well, although severe illness (COVID-19 or otherwise) may lead to premature labor. And, a (very small) case study of women affected with COVID-19 that delivered via C-section showed that the virus had not been transmitted via amniotic fluid, cord blood or breastmilk, but it is still unclear if transmission is possible. In another study, however, preeclampsia was reported in 6 out of 8 women with severe COVID-19 pneumonia admitted to the ICU, while no preeclampsia symptoms were observed in 34 women with more mild coronavirus.
This data is somewhat limited, though. Pregnancy loss, including miscarriage and stillbirth, has been seen in cases of infection with other related coronaviruses (SARS-CoV and MERS-CoV) during pregnancy, and the CDC notes that high fevers during the first trimester of pregnancy can increase the risk of certain birth defects. So this explains the ASRM’s cautious stance on initiating transfer cycles during this time, although no data exists yet of the implication of COVID-19 actually impacts a fetus during first or second trimesters of pregnancy.
How can I steer clear of coronavirus while undergoing IVF or fertility treatment?
To prevent the spread of coronavirus while undergoing IVF or fertility treatment, take the same precautions as you would if you were just a regular, extra fertile, average Jane/Joe:
- Wear a mask. Case closed.
- Wash your hands frequently with soap and water for at least 20 seconds—we recommend singing the chorus of Lizzo’s “Good as Hell” twice over if you need a distraction. This especially counts if you’ve just gone to the bathroom, before eating, and after blowing your nose, coughing or sneezing (when, honestly, you should be washing your hands anyway!).
- If you can’t get your hands on soap and water, use an alcohol-based hand sanitizer with at least 60% alcohol.
- Cover your hands and nose with a tissue or your sleeve/elbow, NOT your hands. Take a hint from Pam from The Office and do a “vampire cough.”
- Clean and disinfect frequently touched surfaces using cleaning sprays or wipes. Think: your phone, your keyboard, doorknobs, etc.
- Avoid traveling to areas with active outbreaks of coronavirus and keep away from others who may have traveled for a minimum of 14 days.
FAQs about coronavirus and fertility or IVF
If you get sick with a fever (100.4°F/38°C or higher), cough, or have trouble breathing, head to your primary care doctor or emergency room. Just make sure you call ahead first. Tell your doctor about any recent travel and symptoms, and avoid contact with others until you know what’s going on. Be sure to update your fertility clinic as soon as possible.
If you test positive for coronavirus while undergoing IVF, we hate to break it to you, but your cycle will probably be canceled. Unfortunately, this may also be the case if you experience respiratory distress symptoms but don’t get an official diagnosis. Anesthesia during a retrieval cycle would be bad news for your already-compromised immune system, and moving forward with your cycle would pose a risk to you and others at the clinic.
A fever may impact the amount of eggs retrieved, length of fertility treatment or IVF cycle, or amount of medication needed, but right now, there’s no scientific evidence that coronavirus has any long-term impact upon one’s fertility. However, this — and any other effects of coronavirus — is something that will continue to be monitored by the CDC. There is also currently no data that indicates impact upon babies born from pregnant women affected by coronavirus, besides increased risk of premature labor.
To prevent the spread of coronavirus while undergoing fertility treatment, wear a mask when out in public and wash your hands with soap frequently for 20 seconds or more, or use an alcohol-based hand sanitizer made with 60% alcohol or more. During coughs and sneezes, cover your hands and nose with a tissue or your sleeve, and continue to disinfect frequently used surfaces often. And of course, avoid traveling to affected areas with active outbreaks and hold off from socializing with those who have for at least 14 days.