By Ivan Pereira
The novel coronavirus and the resulting restrictions on elective medicine that have grown out of the pandemic have created a major roadblock for prospective parents and their family planning, particularly those struggling with fertility issues.
Fertility clinics across the nation have stopped their operations after the American Society for Reproductive Medicine (ASRM) recommended that treatment cycles for most patients be suspended to prevent any COVID-19-related complications — potentially leading to delays that could affect the chance of successful fertilization and leading to additional anxiety. Some OB-GYNs are also recommending that prospective parents who aren’t struggling with fertility issues wait out the pandemic before trying to have children.
In both cases, medical experts say it’s best that mothers avoid unnecessary visits to the doctors’ offices so they can decrease the risk of contracting COVID-19 from other people. Experts have warned that other coronaviruses have led to birth complications and defects, even though the impact of COVID-19 was not known.
In the case of those undergoing fertility treatments, there are more trips to the doctor and procedures that can increase exposure.
“I’ve talked with my patients…and they understand this is a short-term pain,” Dr. Marcelle Cedars, a reproductive endocrinologist from UC San Francisco’s school of medicine, told ABC News. “It’s tough, but I say to them we have to flatten the curve.”
Scientists are still conducting studies and performing tests to see how the coronavirus affects pregnant women and their newborns. Three studies released in the Journal of the American Medical Association last month indicated that babies born to mothers infected with coronavirus tested negative.
Cedars said she would recommend that fertile couples take extra precaution and hold off on conceiving because doctors’ visits, including for complications, would likely be much tougher due to the pandemic.
“There is a lot we don’t know about the virus, but we do know that pregnant women are more susceptible to it,” she said.
For the nearly one in eight couples that are affected by infertility, medical experts are urging extra caution. The ASRM recommendation that was released in March warned that “other known coronavirus infections during pregnancy, such as SARS, have been associated with spontaneous miscarriage, preterm delivery, and intrauterine growth restriction.”
The group recommended fertility doctors to suspend in vitro fertilization, and limit non-urgent care to telemedicine. Patients who are currently “in-cycle” or who require urgent stimulation and cryopreservation can continue their treatment, according to the recommendations.
Dr. Eve C. Feinberg, an associate professor of obstetrics and gynecology at Northwestern University and a member of the ASRM COVID task force, said that in-vitro fertilization (IVF) procedures involve multiple tests and procedures including blood tests, a surgery to remove eggs and an embryo transfer to place the embryo into the uterus.
“Each visit requires the interaction of the patient with the front desk staff, a person to do the ultrasound, a person to draw the blood and a nurse or doctor,” she said.
Arc Fertility, which runs clinics across the country, estimated that for every week the pandemic continues, 3,554 babies won’t be born to expecting parents who are looking to conceive through treatments. The organization noted that more treatment cycles lead to a higher success rate.
Feinberg, however, said that current fertility data shows there are no significant decreases in vitro success rates if there is a delay of two to three months.
“Ultimately, when those patients did IVF, there was no decrease in success,” she said.
The medical specialists acknowledged that time might not be a luxury for many expecting parents, especially older ones. Cedars said doctors are racing to get enough data and information on COVID-19’s effect on pregnancies and fertility treatments, but in the meantime, they are using lessons learned from previous pandemics to guide their patients.
“When Zika was prominent, we would counsel patients if they came from a location that had Zika to delay pregnancy,” she noted. “It ultimately helped prevent more complications.”
The ASRM said it would present an updated set of recommendations on April 27 that would outline the best procedures for resuming fertility treatments.
“It is clear that patient care for the foreseeable future will need to follow strict protocols to decrease the risk of viral transmission,” the group said in an April 13 statement.
