COVID-19’s Impact on Fertility Treatments, Birth Plans, and Pregnancy in America [Updated July 28, 2020]

UPDATE: The American Society for Reproductive Medicine issued an update for April 24 – May 11, 2020. During the height of the COVID-19 pandemic, the ASRM called for the suspension of new fertility treatment cycles. This guidance has changed. As many parts of the nation position to re-open in the coming weeks, ASRM encourages patients and doctors to follow local guidance regarding what is permitted and not permitted in each region based on COVID-19 transmission rates, hospital resources, availability of personal protective equipment, and the individual resources each fertility clinic may or may not have available. 

What does this mean for your fertility treatments? It means that your doctor’s ability to resume fertility treatment will depend on resources available in your region and your doctor’s ability to perform formal risk assessments and formal risk mitigation efforts. The ASRM notes: “With appropriate risk assessment, risk mitigation, consideration of resource availability, and thorough counseling, it is possible to resume providing reproductive services in an environment where COVID-19 exists.” 

The ASRM’s most recent update for July 10, 2020 through August 10, 2020 notes the increase in infection rates across states that have reopened. These are the facts:

• Infection rates in recent weeks have increased by 90% from infection rates noted in late May.
• In 32 states infection rates have increased dramatically after re-opening their economies.
• Many states where infection rates have increased have had to put new measures in place to stop the spread of disease.
• Because of the increased spread of disease in some states, ASRM notes that it might have to reinstate more restrictive measures on the delivery of fertility treatments in areas where medical resources have become strained due to the spread of Covid-19. Individuals who live in states where hospitals are strained, or where case numbers have increased dramatically, should watch closely for updated guidance. In some cases, fertility treatments may need to be paused until regions can get their case numbers under control.

Patients should keep in mind that this is an evolving situation and that in many parts of the country, fertility clinics may still be unable to offer services, or may be operating with limited services. If you have questions, reach out to your fertility clinic and doctor.

Key Takeaways From This Article:

• The American Society for Reproductive Medicine’s new guidelines for fertility treatment during the COVID-19 pandemic calls for doctors to follow regional and local guidelines and to perform appropriate risk-assessment and risk mitigation procedures before offering fertility services.
• There are many unknowns regarding whether the coronavirus can impact the developing fetus and whether getting the virus while pregnant can put a woman at risk of severe respiratory illness, though doctors believe that pregnant women can’t pass the virus to an unborn baby and that coronavirus isn’t likely passed through breastfeeding, though much is not certain. Now, we know that it’s likely that pregnant women may be more at risk of ending up in the ICU or on a ventilator. Limited case studies also indicate that coronavirus can pass from the mother to the fetus, though these cases appear to be rare.
• The choice to continue trying to get pregnant during this challenging time is a personal one that should be discussed with your doctor, and families will need to consider how the pandemic will impact prenatal care and birth plans. For some women who want to continue trying to get pregnant, there may be ways to improve chances of conception while they wait to resume fertility treatments.

Note: This article was written with the information that was available at the time. Last updated: May 11, 2020

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For couples struggling with fertility who have been seeking treatment, this is an understandably stressful time. Many women who are seeking fertility treatment may already feel like they are racing against the biological clock to get pregnant. Recent recommendations released by the American Society for Reproductive Medicine had called for the postponement of virtually all new I.V.F., I.U.I., and embryo transfer procedures. More recent guidelines issued by the ASRM call for fertility clinics to follow local regional guidelines as states re-open.

Yet, these recommendations come at a time when the healthcare system is anticipating unprecedented shortages and strains on supplies, beds, and staff. Cities across America have been asking citizens to stay home to reduce the transmission of the coronavirus. Most schools in the nation had to shut down, and it remains unclear whether many will be able to successfully reopen in the fall.  While many states have reopened, infection rates have been climbing, leading many to wonder whether a second wave of shutdowns is on the horizon.

All of this is being done to “flatten the curve” of coronavirus infection.

A high curve of infection indicates a rapidly spreading virus, while a flatter curve represents a more slowly spreading virus. A spike in cases could leave doctors, intensive care units, and hospitals overextended. The alternative to these measures is a situation like the one we have seen in Italy, where hospitals don’t have enough respirators for the patients who need them. According to the Atlantic, doctors in Italy don’t have the resources to care for all patients, and hospitals have had to ration care.

COVID-19 has impacted all aspects of our lives. Here are some of the ways it has impacted fertility treatment, birth plans, and pregnancy in America:

COVID-19’s Impact on Fertility Care

UPDATE: The most recent guidelines issued by the ASRM ask that fertility clinics and doctors follow local guidelines regarding resuming fertility care. In some parts of the country, fertility treatment is now available. Contact your doctor for more information.

UPDATE: The most recent guidelines issued by the ASRM ask that fertility clinics and doctors follow local guidelines regarding resuming fertility care. In some parts of the country, fertility treatment is now available. Contact your doctor for more information.

The American Society for Reproductive Medicine recently issued new guidelines regarding fertility care during the COVID-19 pandemic. In light of recent events, the ASRM had  called for a suspension of most fertility treatments. Though the ASRM issued new guidance calling for the “measured resumption of care with appropriate and prudent measures for disease prevention” the recently increases in case numbers, particularly in the south and west have led ASRM to warn that it might need to implement restrictive recommendations for some areas, similar to those issued at the start of the pandemic.

But, before you cancel your next appointment with the fertility doctor, it is important to understand what these new guidelines might mean for you. If you live in an area where caseloads are low and the medical system isn’t strained, you should be able to continue care. If you live in a region where caseloads are higher, you should contact your doctor for guidance. What do these recommendations mean more specifically for people living in regions where caseloads are increasing? Individuals should monitor the situation closely, because some states might need to shut down again

Let’s review the ASRM’s earlier restrictive reco mmendations, which called for:

1. The suspension of any new fertility treatment cycles. This includes suspending ovulation induction, I.V.F., I.U.I., retrievals, frozen embryo transfers, and non-urgent gamete cryopreservation.
2. If you had planned to have an embryo transfer performed, the ASRM strongly recommends that these procedures be cancelled until a later date.
3. However, you should continue care if you are mid-I.V.F. or I.U.I cycle or if you need urgent stimulation or cryopreservation (for example, cryopreservation can be continued if you will soon start chemotherapy or cancer treatments that could put your future fertility at risk).
4. The recommendation is to suspend non-urgent elective surgeries and non-urgent diagnostic procedures, but you should speak to your doctor first to determine whether your procedure is urgent.
5. Your doctor may use telehealth or video conferencing for discussions about fertility treatment and for consultations.

What does this mean for fertility patients?  If you already have been seeing a doctor for fertility treatments and care, stay in touch with your doctor, who will be best able to help you understand what fertility treatments are urgent at this time, and what treatments might be best delayed until the pandemic has passed. If you were planning to see a doctor to discuss fertility treatments or your reproductive health, you may still be able to make a telehealth appointment to discuss whether you need urgent fertility care, urgent fertility testing, or urgent fertility procedures. The COVID-19 pandemic has led to the cancellation of many elective and non-urgent medical procedures, but these cancellations should always be done in consultation with your doctor.

How Will Coronavirus Impact Me If I’m Already Pregnant?

According to the Centers for Disease Control, there isn’t a great deal of information about the susceptibility of pregnant women to COVID-19, though experience with other respiratory infections and SARS indicates that pregnant women could be at higher risk of developing more severe illness. A recent paper released by the Centers for Disease Control indicates that pregnant women may be more susceptible to severe illness when they contract COVID-19. Among women of reproductive age who contracted COVID-19, pregnant women were found to be hospitalized more often and more likely to end up on a ventilator. Among women of reproductive age, one third of pregnant women were hospitalized compared to only 5% of non-pregnant women. It is important to keep in mind that these figures come from COVID-19 surveillance data received by the CDC, and that some of the data includes missing information.

We also don’t know much about whether COVID-19 could increase the risk of birth defects. What we do know is that other coronaviruses have led to stillbirths and miscarriages, and that high fevers in the first trimester of pregnancy can put the fetus at risk of birth defects. However, the risk of high fever to the baby is not unique to COVID-19.

While early research indicated that COVID-19 couldn’t be passed from the mother to the fetus, some case studies indicate that in limited cases, fetal transmission may be possible. The New York Times reported on a case where testing indicated that the virus had infected the mother’s placenta. The baby was born with COVID-19 symptoms and the mother’s placenta showed evidence of inflammation. Placental transmission may still be quite rare, much like the rare cases of COVID-19 that infect the brain and heart.

For some doctors, fetal transmission is worrisome, because the fetus is particularly vulnerable to viruses in the first trimester. Ultimately, we won’t know how COVID-19 affects the fetus until studies are performed to address how the virus affects the fetus at different stages of development, research which is at least several more  months away. Finally, while there is no evidence that COVID-19 can be passed on from the mother to the baby through breastmilk, close contact can result in transmission of the virus. Doctors remain much in the dark regarding many of these issues.

What we do know for sure is that if you’re pregnant during this pandemic, you’ll likely find yourself navigating quickly evolving hospital policies and prenatal care plans. If you are pregnant and planning your delivery, COVID-19 will likely have a major impact on your birth plan. According to ProPublica, in just the next three months, approximately one million women are expected to give birth, and many will be seeking medical care at a time when the hospital system is expected to be overwhelmed. Women’s birth plans may have to change. Hospitals may limit how many people will be permitted to be present during labor and delivery (the New York Times reports that some hospitals in New York have told women that they can have no visitors with them in the delivery room, though a recent executive order will permit women to have their partner present in the delivery room), and hospitals may work to get women released from the hospital sooner. Some women are even considering home deliveries, but this option is only available for low-risk pregnancies and it has its risks. Women seeking prenatal care in the near future may have to do so over the phone or through video conferencing. Women are being advised to not skip prenatal appointments, but to speak to their doctor if they are concerned about contracting COVID-19. Some appointments may be held through telemedicine.

Being pregnant during a pandemic can also raise other questions, including questions about psychological and emotional health. It isn’t clear yet how long we will need to socially isolate to contain the virus, and much of this will depend on the decisive action of our leaders now. This is an emergency that can potentially last for some time. The most vulnerable among us, and the elderly, may be asked to quarantine. This may mean that expecting mothers might find themselves isolated from family and friends at a critical time in their life. In some cases, it isn’t clear when grandparents may be able to see their newborn grandchildren.

Can I Keep Trying to Get Pregnant?

If you are in the middle of a fertility treatment cycle, or are still trying to get pregnant during the pandemic, what things might you want to consider? The reassuring news released by the American Society for Reproductive Medicine is that “there are reports of women testing positive for COVID-19 delivering babies free of disease.” Yet, broad generalizations shouldn’t be made from this information because we just don’t have the research nor the numbers yet to confirm that this will be true in all cases. What we do know is that other types of coronaviruses have been associated with adverse pregnancy outcomes. No medical professional can tell you whether now is the best time to try to grow your family. The American College of Obstetricians and Gynecologists note that “individuals should make their own decisions based on their unique needs, desires, and values.” Daily Wellness has also written an article about the pros and cons of getting pregnant in the era of the Covid-19 pandemic, with a list of factors couples might want to consider.

Should only healthy women who have tested negative for the virus continue trying to conceive? If you are healthy and don’t have symptoms of COVID-19, it is important to note that you can have the virus and have no symptoms. In fact, a recent letter published in the New England Journal of Medicine, reports that when the Columbia University Medical Center tested every pregnant woman for COVID-19 (whether or not she exhibited symptoms), nearly 14 percent of women tested positive for the virus.

But, if you have already had the virus and have immunity, we don’t know how long immunity lasts. Ultimately, whether one should or should not try to get pregnant during this pandemic will be a personal decision. “The decision to undertake pregnancy right now comes down to your health history, personalized recommendations from your healthcare provider, and the state of your mental health,” writes Jessica Zucker, a reproductive psychologist in Good Housekeeping.

If you do choose to keep trying, it is important to also consider how seeking prenatal care during a time where the hospitals are overwhelmed might impact your pregnancy and care. The Atlantic reports that on an average day,10,000 babies are born. If the mother tests positive for coronavirus, it isn’t yet clear whether the baby will be isolated from the parent for 14 days, and because there is so little research on the virus, doctors may consider a range of factors, including the mother’s wishes. As case numbers grow in some states, prenatal care, birth plans, and postnatal care may adjust accordingly to changing circumstances.

Ultimately , the decision to continue to try to conceive in a time of great uncertainty is a personal one. Some women Some women will find their fertility treatments put on hold, especially women who live in regions where case numbers are growing. If you were planning to undergo I.V.F. or I.U.I., and are being asked to wait, here are some questions you can ask your fertility doctor right now:

• Do I qualify for urgent fertility treatment? Some patients, who may be starting chemotherapy do still qualify for urgent fertility treatment and testing.
• If I don’t qualify for urgent fertility treatment, what steps can I take now so that when my treatment is resumed, I’m ready?
• Is it okay for me to keep trying to conceive naturally? Is that a viable option for me?

Couples who want to keep trying to conceive, for whom there is no underlying medical condition for their infertility, can still take important steps to improve their chances of conception. Eating healthily, getting good rest, cutting down on the coffee, quitting smoking, reducing stress, and taking wellness supplements may be alternatives couples can try while they wait for the pandemic to subside and for doctors to begin offering fertility treatments again. Here are some resources about herbal supplements that could potentially improve fertility, based on current research. And, here’s an article about how those without access to I.V.F. and I.U.I. can naturally improve their fertility and increase their chances of conceiving.

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