What Infertility Patients Need To Know About the Coronavirus

These are tense times. On March 11, the World Health Organization declared the coronavirus (COVID-19) outbreak a pandemic. Next, one after the other, more big announcements filled Wednesday’s breaking news feed: President Trump banned travel from almost all of Europe to the United States. The NBA canceled its season after a Utah Jazz player tested positive for COVID-19. And then, Actor Tom Hanks and his wife Rita announced they are in isolation after being diagnosed with the virus.

Is it a bad time to be trying to get pregnant?

There’s still a lot we don’t know about COVID-19 – like its impact on reproduction and pregnancy. The Center for Disease Control and Prevention (CDC) says that because pregnancy causes changes to a woman’s hormone levels and immune system, it makes them “more susceptible to viral respiratory infections, including COVID-19.” The CDC also warns that based on prior cases of other related coronavirus infections, like SARS and MERS, pregnant women might be at higher risk for “severe illness, morbidity, or mortality compared to the general population.”

There’s no vaccine for this highly contagious new strain of the coronavirus. With the growing fear of getting sick – or getting someone that you love sick – one of the last places most of us want to be – besides stuck on an infected cruise ship- is in a hospital or clinic. Many people are choosing to postpone non-imperative surgeries, procedures, and visits to the doctor’s office. So, what if you’re about to start fertility treatments – like a round of In Vitro Fertilization (IVF), or you’re utilizing a sperm or egg donor? Is it a bad time to be trying to get pregnant?

We spoke with three leading fertility doctors and one Obstetrician/Gynecologist who specializes in Maternal Fetal Medicine – so we could find out everything you need to know if you’re trying to conceive during the COVID-19 outbreak.

The CDC says COVID-19 has been more difficult to contain than previous epidemics like SARS and MERS, because symptoms can be mild or non-existent. So many people are spreading the disease before they ever realize they’re sick. What advice are you giving your patients right now, besides – wash your hands for 20 seconds? Do you suggest delaying fertility treatments?

Dr. Jennifer Hirshfeld-Cytron, Fertility Centers of Illinois: As of now we are continuing treatments as usual, it is important for patients to appreciate that if a public health measure occurs in your city or state requiring a “shutdown” approach for containment that would include your IVF center. Therefore, approaching treatment needs to be with that awareness and inherent flexibility. If someone works in a high-risk environment, like a hospital isolation ward, it likely makes sense to hold off on treatments.

Dr. Edward Marut, Fertility Centers of Illinois: Remember that fertility patients are not in the high-risk group. All the common-sense measures should be followed as well as avoiding friends and family who are sick. Severity of COVID-19 increases with age and underlying medical conditions.

Dr. Lora Shahine, Pacific NW Fertility: We are recommending excellent hygiene, we are maintaining our highly clean clinic environment, we are not shaking hands or hugging (I miss that), and we are asking anyone (team members and patients) to stay home if they are sick. We are not recommending that everyone stop treatments or trying to conceive. We are screening patients for symptoms, and travel exposure, and asking sick patients to stay home. We are doing more consults and answering questions over the phone to decrease the number of people in and out of the clinic. We have not canceled any retrievals or embryo transfers to date but if someone is sick and may have COVID-19 we will most likely recommend canceling the treatment in order to keep that patient out of clinic, to reduce the risk of infecting other patients, and our team

Dr. Rashmi Rao, Assistant Clinical Professor, Maternal Fetal Medicine,
Department of Obstetrics and Gynecology, Ronald Reagan UCLA Medical Center: We know that being pregnant does not put women in a higher risk category for contracting COVID-19. With that being said, the early data is not yet conclusive and based on prior coronavirus strains, pregnant women diagnosed with the disease could be at a higher risk for complications. But, I don’t think women who are pregnant need to be in quarantine right now, unless they’ve been exposed, or have symptoms. However, it is imperative that we all focus on good hygiene, avoid crowds larger than 25 people, and practice social distancing whenever possible. I also recommend that pregnant women who are taking medications, get an extra refill or two, in case there are supply issues down the line.

What if you or someone in your family gets diagnosed, while you’re in the middle of a round of IVF, or other fertility treatment?  

Dr. Hirshfeld-Cytron: If you or a family member is diagnosed with COVID-19 it is recommended to self-quarantine at a minimum for two weeks (potentially longer if someone is ill) and during that time you would have to stop treatment. The necessity to minimize exposure to others at a clinic is a significant concern and would limit one’s ability to continue IVF treatment given the monitoring appointments.

Dr. Marut: If you get sick, self-quarantine so you don’t infect others, no matter what the source is. I don’t suggest that you scrap an egg freezing cycle. But if you are diagnosed with COVID-19, you should convert an IVF cycle to an egg retrieval, and freezing cycle.

Does that advice differ at all if you don’t have the coronavirus, but you do get a typical cold or flu?

Dr. Hirshfeld-Cytron: If you are sick with a fever or cough, you will likely be asked to suspend treatment and coming into the clinic, until your symptoms have resolved. 

Dr. Marut: If severe, obviously bail on it. You don’t want to be ill and newly pregnant, if you’re even able to conceive while sick.

What if your partner gets sick?

Dr. Hirshfeld-Cytron: If a partner is diagnosed with COVID-19, they will be quarantined per CDC guidelines, which could impact ability to do a fertility treatment.

Dr. Marut: Put him in another room no matter what the illness is.

What should you do if your city has reported cases at the hospital where you’re scheduled for a procedure?

Dr. Hirshfeld-Cytron: If concerned you should ask your physician about the hospital’s policy.

Dr. Marut: Those patients aren’t going to be in the IVF center. Good reason to stick with freestanding centers.

Are there any new concerns regarding surrogacy that may impact gestational carriers or intended parents? For example, what if the gestational carrier lives in a town where there’s a COVID-19 outbreak?

Dr. Hirshfeld-Cytron: The majority of towns and cities will likely have a COVID-19 patient positive in the very near future.  If your GC is not sick, nor been directly exposed, then there is no need to stop treatment.

Has COVID 19 been detected in sperm samples – and can the virus be spread through the exchange of bodily fluids?

Dr. Marut: We don’t yet know if it’s a Sexually Transmitted Disease. It doesn’t seem to cross the placenta, but a severe systemic illness can prevent or disrupt a pregnancy.

Dr. Shahine: It’s too soon to tell if it is transmitted with semen or vaginal secretions. But we do know that close contact with respiratory droplets (kissing) can spread the virus.

Given that we don’t know when a vaccine will be readily available – do we even want to be pregnant right now?

Dr. Hirshfeld-Cytron: As of now COVID-19 is not believed to be more severe in pregnant women. Unfortunately, COVID-19 is not going to disappear in the next few months. And viruses exist today that pose increased risk to pregnant women, namely influenza, varicella, rubella, ebola, etc.  The decision to wait for pregnancy needs to be based in the reality that there is never going to be a time that is 100% safe.

Dr. Shahine: The warnings to pregnant women to be more cautious are important, as is advising people to be careful. But there is currently no evidence that suggests the coronavirus can be passed from mother to baby during pregnancy or delivery. Last month a medical study reported that babies born from women with documented coronavirus in pregnancy did not contract the virus, after blood tests on the newborns and swabs taken from placenta.

Dr. Rao: Pregnant women with heart, lung, or kidney disease, and those with diabetes should follow the CDC guidelines for people at high risk. Most of my patients are keeping pretty calm, and level-headed about the situation. I am getting a lot of patients asking whether or not they should cancel their baby shower. My advice is, if you trust that the people coming aren’t sick, and it’s not for more than 25 people, just use common sense, and go for it.

Dr. Marut: You always take a chance; cut the odds by following medical advice on prevention. But, it’s not realistic to let COVID-19 rule your life.

A joint statement from American Society for Reproductive Medicine (ARSM) and the Society for Assisted Reproductive Technologies (SART) takes things a step further, recommending that: “Patients, including prospective oocyte and sperm donors, as well as gestational carriers, who meet the diagnostic criteria for COVID-19 infection should avoid becoming pregnant. If they are undergoing active infertility treatment, we suggest that these patients consider freezing all oocytes or embryos and avoiding an embryo transfer until they are disease-free.”

It’s not realistic to let COVID-19 rule your life.

I think we can all make ourselves a little crazy as we watch COVID-19 start to impact our daily lives – and our best-laid plans. But, in times like these, I like to remind myself of something my late Grandma Sarah always used to say: “This too shall pass.” So let’s try to be kind, and help each other through this crisis. Remember, you are not alone – we are all in this together.