COVID-19, fertility, and pregnancy
By now, everyone knows about the novel coronavirus (COVID-19). It has taken the world by storm and affected almost every country. Transmission, both though travel and community spread, has been well documented. Many of you are taking precautions to self-isolate and practicing “social distancing” in an effort to “flatten the curve.”
This is the right thing to do to protect yourself and our vulnerable populations and to help reduce spread of COVID-19.
Many young men and women are asking, What do I need to know about the coronavirus, and how will it affect me?
Particularly in the young population, people are wondering, what risk is there to my fertility, my pregnancy, or my plans to conceive soon?
While we certainly don’t have all the answers, here is some information on what we know, to help separate fact and fiction.
Keep in mind that we are gathering new information on a daily, even hourly basis, and guidelines and recommendations are constantly changing and being updated.
1. What is the coronavirus (COVID-19)?
COVID-19 is a highly infectious member of the coronavirus family, originally identified in China in late 2019. It originated from an animal source but was then passed to humans. It spreads from an infected person to others through airborne droplets from coughing or sneezing or touching surfaces, where the virus can live from hours to days. On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic. Currently, many US states and Canadian provinces have declared a state of emergency, making this a significant health concern.
2. What do we know?
COVID-19 is a highly infectious virus that originally emerged from an animal source in China but then spread. Symptoms of COVID-19 include fever, cough, myalgia (muscle pain), fatigue, shortness of breath, and occasionally gastrointestinal (GI) disturbances. Less common symptoms include sore throat, runny nose, headache, and diarrhea.
The elderly, those with medical problems such as obesity, high blood pressure, diabetes, or heart disease, and those with compromised immune systems or lung disease are more susceptible to severe disease and symptoms. While young people usually have only mild symptoms, equivalent to a bad cold or flu, there have been reports of healthy young patients requiring hospital admission, ICU support, or a ventilator.
Pregnant women may be at a higher risk of infection due to changes that occur naturally during pregnancy. While it seems that they will usually have mild to moderate disease, those with other medical issues in pregnancy are likely at a higher risk.
It is reassuring to know that most young healthy people will either have no symptoms at all or mild symptoms, such as a cold, cough, or a few days of a flu-like illness. While this is reassuring, this makes those with mild or no symptoms potential sources of infection to others, which can increase spread of COVID-19 in the community.
3. “I am currently pregnant, how will COVID-19 affect my pregnancy?”
Preliminary data has shown that COVID-19 has minimal risks to pregnancy (unlike the Zika virus). It does not pass through the placenta, and passage to the fetus is unlikely during pregnancy. Tests have been done on the placenta, amniotic fluid, umbilical cord blood, breast milk, and neonatal throat swabs on babies born to COVID-19+ moms, showing no evidence of infection. There have been no reports of increased risk of miscarriage or birth defects in COVID-19+ moms. Early infection in the first trimester may be an indication for an earlier anatomy scan in the second trimester, to make sure the fetus is developing normally. Nevertheless, pregnant patients are still considered a high-risk group for COVID-19 infection, and appropriate precautions to avoid exposure to the virus are advised.
Some COVID-19+ moms have experienced moderate to severe disease and even needed ICU care, but most have had mild symptoms, and all have recovered and delivered healthy infants to date. However, the data is based on small numbers, so caution must be taken when interpreting these results. There have been a few reports of newborns born to COVID-19+ mothers who are COVID-19+, but we do not know whether this is from delivery, infection during pregnancy (unlikely), or from close contact after delivery. However, the data and studies to date are very small, and while so far the information about preganancy is reassuring, we cannot be 100% sure. There is a possibility that pregnant woman, because of the changes in their body, are more susceptible to respiratory tract infection.
If you are pregnant and have symptoms of COVID-19, such as cough, fever, or shortness of breath, contact your doctor because you may be eligible for testing. If you are in your third trimester and have COVID-19, your doctor might wait to deliver your baby until you recover from the illness or, in the case of severe symptoms, deliver your baby earlier. They might do additional ultrasounds to assess fetal growth if infection was acquired in the third trimester. There have been reports of moms with severe cases of COVID-19 who require a ventilator and that have resulted in recovery and safe delivery of healthy infants. In the delivery room, to minimize exposure to others, you might be asked to have only one supporting person with you. There is no need for a C-section if you have COVID-19. Vaginal delivery is still considered OK.
When a woman who is COVID-19+ delivers, the baby is considered a PUI (person under investigation) for possible infection. And there will likely be a need for temporary separation of mom and newborn as the mom recovers from infection and to test the baby for the virus.
Unfortunately, current COVID-19 treatments are limited, and those medications that are being studied are not safe in pregnancy. Therefore, pregnant and breastfeeding women are currently unable to be treated with these medications if they are positive. For this reason, it is very important for this population of patients to be cognizant of transmission risk.
4. “What can I do to reduce the risk of infection to me and my baby?”
Practice good hand-washing and hand hygiene. Wash frequently with warm soap and water for 20 seconds, or use an alcohol-based sanitizer. As much as we adore our loved ones, try to avoid hugs, kisses, and very close contact, especially with young children and the elderly.
Try as much as possible to “socially distance.” What does this mean? Avoid gatherings of over 50 people. Stay indoors as much as possible, although walks around the neighborhood or stepping outside for fresh air are totally OK! Connect with others using the phone or technology! FaceTime, Zoom, and Skype are all great options. Stay healthy.
Continue your prenatal vitamins if you’re pregnant, and consider extra vitamin C and zinc to boost your immune system. Exercise at home. Yoga is great for relieving stress and is safe during pregnancy. Minimize outings unless they are for medical purposes — for example, to go to your obstetrics appointment or for an ultrasound. If anyone around you has flu-like symptoms, try not to be close to them, and encourage them to self-isolate.
5. “I just had a baby! Is it safe to breastfeed?”
Because COVID-19 does not pass through breastmilk, breastfeeding with COVID-19 symptoms is considered safe in that respect. The risk, however, is that the newborn could acquire COVID-19 from close contact, and there have been reports of severe illness, especially in very young infants. For those moms who are COVID-19+ or who have symptoms, it would be ideal to pump and have a family member or close friend feed the baby, or else substitute with formula. Speak with your doctor if you are concerned.
6. “What if I am trying to conceive?”
Because there is currently no documented risk to a pregnancy with COVID-19 that we know of, there are no official guidelines that say you should not conceive. However, many young people who are considering conception are delaying by one month as a wait-and-see approach to see how the situation changes (hopefully, for the better). Also, if you have any symptoms of COVID-19, it is likely best to defer pregnancy until you are symptom-free or test negative.
With regards to fertility treatment, if you are being seen at a fertility clinic, there is a strong possibility that new treatment cycles will be put on hold for the time being until the COVID-19 situation becomes clearer. Talk to your clinic and fertility doctor about what is happening at your clinic and about your situation.
7. “I am in the middle of an IVF cycle! What’s going to happen?”
Doctors first and foremost want to care for their patients. Currently, most fertility clinics are completing ongoing IVF cycles. You might be advised that it is best to do the egg retrieval and to freeze embryos and wait to do a frozen embryo transfer (a freeze-all cycle) until the COVID-19 situation improves. Many clinics are delaying cycles by a month for now in patients with good prognosis. Non-urgent diagnostic testing such as hysterosalpingograms, semen analysis, and bloodwork might be delayed for now. Your fertility doctor might put you on the birth-control pill to delay your cycle for a month or so. Frozen embryo transfers, IUI cycles, and future IVF cycles might be placed on hold for the time being.
Many doctors are doing telemedicine consultations, so that you can still have your initial consultation or follow-up. Of course, any necessary procedure that is important for the patient and pregnancy’s health will be ideally done as doctors want the best for their patients.
When coming to the fertility clinic (or any doctor’s office), you might be asked a series of screening questions before entering the clinic (such as your travel history, contact with those with COVID-19+, and flu symptoms) in order to minimize the risk of viral spread. Most clinics are asking that you come to the visit with only one supporting person and avoid bringing children and the elderly. It is best to check with your clinic regarding its policies.
8. “Should I worry about COVID-19 and freeze my sperm or eggs? Does COVID-19 affect future fertility?”
There is no data that COVID-19 infection can affect sperm or egg quality. Currently, we don’t believe the virus passes through gametes or genital fluids. While consideration of egg freezing might be right for you due to other reasons, you do not need to rush to freeze your eggs or sperm due to the possibility of getting infected with the COVID-19 virus.
9. “Can I get tested for COVID-19?”
There is a test for COVID-19. It is a viral kit that tests for the virus using a nasopharyngeal swab. The swab must be taken by a certified medical professional who wears appropriate personal protective equipment (PPE). They would put a swab in the nose and down to the throat to access an adequate sample.
Currently, testing is being offered to those patients who have severe symptoms or who are more susceptible to severe disease or who work in a high-risk environment. Those with mild symptoms in general are being asked to stay home and self-isolate for 14 days, unless symptoms worsen. If you have any symptoms, it is best to call your doctor’s office and find out whether you are eligible for testing; they will direct you to a COVID-19 testing centre if necessary. Go to the emergency room only if you have severe symptoms, such as worsening shortness of breath, a very high fever, chest pain, or severe fatigue, or if you have any risk factors for severe disease. Young people with mild symptoms are being advised to stay home, monitor their symptoms and fever for 14 days, and reassess if the symptoms worsen.
We are entering an unprecedented time in history. If we, as a community, all work together, hopefully we can decrease the toll on patients, and society as a whole. Stay safe! #flattenthecurve!