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. The release of a series of vaccines to help protect people against COVID has been a rare bit of good news, but if you’re on a fertility journey, you’ve probably still got a whole lot of questions about what the coronavirus means for you and your conception.
Can you start fertility treatment during a pandemic? Should you get a COVID-19 vaccine, or will it affect your fertility?
Sit down, grab something warm to drink, and let’s take a look.
How are fertility clinics handling coronavirus?
Right now, fertility clinics (like everyone else) are looking to the Centers for Disease Control, the American Society for Reproductive Medicine (ASRM), 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.
First up? They’ll be talking to you about the vaccine. The experts at ASRM and CDC are both advocating that patients who are trying to conceive, pregnant women, and lactating women all be able to get the vaccine if they and their doctor decide it’s the right call. The ASRM likewise calls for gestational carriers to get the vaccine, even suggesting clinics mandate it and parents-to-be include this as a provision in surrogacy contracts.
Because many 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 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 2020, the ASRM also 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 have been 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.
But as the pandemic has progressed and lockdowns ended, there’s been a loosening of ASRM guidelines around coronavirus, and most fertility clinics have reopened and are initiating 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 2020 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, 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. While things like double masking (you wear a mask, and so does your healthcare provider) are brand-new, the clinics have always had 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.
There’s also some evidence that COVID could affect menstruation — which is something that is being currently studied. There are many factors which can cause transient variation in the menstrual cycle, so fertility doctors are not concerned about this as some cycle-to-cycle variation is normal and these types of temporary changes are not deemed to impact overall fertility or health.
There are bits of positive news. Another study of women who’d had COVID found no impact on their ability to respond to ovarian stimulation during IVF. And yet another — albeit small — study of women undergoing fertility treatments showed no difference in the success of embryo transfers between women who had COVID antibodies (from being sick or having had the vaccine) vs. women who didn’t.
Research into how COVID-19 affects male fertility is also pretty limited, but there’s already evidence that the virus can affect the testes and may limit sperm function and production down the road. There’s also the possibility that the coronavirus can cause erectile dysfunction, making conception that much harder.
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 or the need for a preterm delivery to protect mom, baby, or both. 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.
It is worth noting that 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.
One bit of good news: The amount of data the doctors have to work with is growing as we continue to muddle through this pandemic. And a large, observational study published in December of 2020 found the majority of pregnant women who test positive for the coronavirus have no serious health complications and it’s unlikely that their newborns will be affected.
However, this optimism should be balanced by data from a recent study in JAMA (Journal of the American Medical Association) that showed pregnant women with COVID-19 are 15x more likely to die, 14x more likely to need intubation for mechanical ventilation, and 22x more likely to give birth pre-term, vs. those who are uninfected. Pregnancy is a known independent risk factor for more severe disease, which is why vaccination is strongly recommended to protect women and their unborn children from serious adverse outcomes due to COVID-19 infection.
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 standard precautions recommended to protect everyone:
- 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.
- Talk to your doctor about whether or not the vaccine is right for you.
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 a woman’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.
Besides getting vaccinated, 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.