Fertility Treatments and COVID-19

News Team's picture
By News Team on April 20, 2020

As the medical community learns more about COVID-19, questions continue to arise about the different ways it can affect people with different medical needs. For people considering or undergoing fertility treatments, those questions can intensify as time passes, and include concerns about every stage of fertility treatment, pregnancy and birth.

We shared some of those questions with Emily Evans-Hoeker, M.D., chief of Reproductive Medicine and Fertility for Carilion Clinic. Read on for her responses. 
____________________

Should I stop trying to conceive during the pandemic?
Pregnancy should be avoided if you are actively affected by COVID-19 until you are no longer infected. Aside from that specific circumstance, neither the American College of Obstetrics and Gynecologists (ACOG), the Society for Maternal Fetal Medicine (SMFM) nor the American Society for Reproductive Medicine (ASRM) currently recommend active prevention of pregnancy (birth control) during the pandemic.
 
ASRM is encouraging patients to consider other factors, including logistical, psychological and emotional reasons why you may modify your plans. As an example, access to routine prenatal care and testing may be limited and therefore, some patients may consider postponing pregnancy out of an abundance of caution.
 
This is a very personal decision to make and you may want to speak with your doctor regarding these considerations.
 
Will postponing my fertility treatment hurt my chances to get pregnant? 
It can be extremely difficult to consider postponing your fertility treatments. Many patients have been trying to conceive for months or even years by the time they see a fertility specialist, often suffering tremendous loss during their journeys.
 
We recognize that being asked to delay treatments can cause even more distress. We also recognize that the unknowns that come along with the COVID-19 pandemic can lead to feelings of uncertainty and concern as to when or if you will be able to resume treatments and have a child.
 
During this time, it may be somewhat helpful to know that there is no evidence that postponing treatment for one to two months will ultimately affect your ability to have a child, even when considering ovarian reserve and/or advanced reproductive age.
 
At Carilion Reproductive Medicine and Fertility, we are working closely with those providing clinical recommendations to determine the safest way to resume treatments as soon as possible.
 
What can I do now to improve fertility, while COVID-19 is a still a threat? 
To optimize your natural fertility, start by taking a prenatal vitamin with at least 400 mcg of folic acid and supplemental DHA.

Some studies have suggested that dietary patterns may affect fertility as well. Following a Mediterranean diet or a diet high in whole foods such as whole grains, vegetables, fruits, nuts and full-fat dairy may improve fertility. Minimizing trans fats, processed foods, excess sugar and toxins such as heavy metals, including fish high in mercury content, appears to be helpful as well.
 
Be sure to stop any use of tobacco, recreational drugs (including marijuana), excess caffeine (>300mg per day) and excess alcohol (>2 drinks per day) and avoid using vaginal lubricants that are harmful to sperm.
 
You can also optimize your fertility through maintaining a healthy body weight (both high and low extremes in weight can impair fertility), getting enough restful sleep, managing stress and anxiety to the best of your ability and increasing physical activity.

Over-the-counter ovulation prediction tests can help you improve the timing of intercourse to optimize conception. Pregnancy is most likely to occur when intercourse occurs during the 5 days leading up to and including the day of ovulation. The absolute most fertile days are the day of positive ovulation prediction test and the next two days.
 
If ovulation prediction tests are unclear or you choose not to use them, we recommend that you have intercourse every other day starting no later than cycle day 10 and continuing until cycle day 22 (cycle day 1 is the first day of your period).

Am I more at risk for COVID-19 if I'm undergoing fertility treatments, if I'm pregnant or if I have a baby during the pandemic? What about pregnancy complications?
COVID-19 is still a relatively new disease, and much is still unknown. Currently available data does not indicate that pregnant women are at increased risk of mortality due to COVID-19. However, pregnant women in general are known to be at greater risk of severe morbidity and mortality from other respiratory infections, such as the flu. As such, pregnant women should be considered an at-risk population for COVID-19 and should limit contact with COVID-19 positive persons as much as possible.

It is unlikely that COVID-19 passes to a fetus during pregnancy, labor or delivery, but more research is needed.

All pregnant women should follow CDC guidance in preventing COVID-19 infection and take precautions to minimize exposure, including:

  • Regular handwashing
  • Social distancing
  • For those in health care professions: wearing appropriate personal protective equipment

Both continuity of prenatal care and communication with your physician, midwife and other maternity care professionals remain essential at this time.

Another consideration regarding pregnancy during COVID-19 is the availability of medical resources in your area. If COVID-19 becomes extremely prevalent, medical resources may need to be diverted, becoming less readily available than usual as a result.
 
Will the pandemic affect my ability to get my treatments?
Fertility practices must abide by regulations set forth by national and local governments as well as their individual health systems. In addition, ASRM has issued—and continues to monitor and amend—recommendations for physicians providing fertility care to follow. These include:

  • Postponing initiation of new fertility treatment cycles of any type
  • Postponing elective surgeries and non-urgent diagnostic procedures.
  • Strongly considering cancelling embryo transfers
  • Prioritizing telemedicine over in-person contact

ASRM recommends that reproductive care physicians continue caring for patients who are in the middle of fertility treatment cycles or who have urgent needs for fertility treatments, such as those facing surgery or cancer treatments that could significantly affect their fertility. Providers may consider providing other types of urgent fertility care at this time as well, including treatments for patients with diminished ovarian reserve.

We would encourage you to reach out to your physician to see if they are able to provide these treatments for you.
 
What resources are available to help?
RESOLVE.org is a national patient advocacy organization that has resources available to support couples who are struggling with infertility.
 
Your fertility physician can inform you about specific resources available in your area.
 
Am I still able to make an appointment? What services are currently available? 
Many fertility offices are providing telehealth services during COVID-19. At Carilion Reproductive Medicine and Fertility, we are currently still seeing obstetrical patients and patients with surgical urgencies, and are preparing to implement a plan for beginning to see some of our fertility patients back in the office to resume testing and treatments in accordance with amended ASRM clinical recommendations.
 
In the meantime, we are continuing to provide full consultative and follow-up services, typically via video telehealth.
 
Our goal during this mandated pause in fertility treatments is to assist patients in developing a plan that allows for immediate resumption of testing and/or treatment as soon as restrictions are lifted.
 
Meeting with patients virtually allows us to discuss methods of optimizing fertility during this time while minimizing exposure to the coronavirus for both patients and staff. Via telehealth, we can also discuss methods of optimizing the testing and treatment process even further so that we can minimize the amount of time it takes to start treatments when regulations and evidence-based recommendations allow.

If you are over 35 years old and have been trying for 12 months or more, or 35 and under and trying for at least 6 months, reach out to our office or a fertility specialist in your area for assistance. We recommend the same if you have any risk factors for infertility, such as irregular cycles, endometriosis or a history of pelvic infections.
 
How do I make a telemedicine appointment?
Most fertility offices do not require that patients have a referral, so if you do not have a fertility doctor, reach out to your local fertility office and schedule an appointment. At Carilion Clinic Reproductive Medicine and Fertility, telemedicine appointments are available Monday through Friday from 8 a.m. to 4:30 p.m. To make an appointment with one of our fertility specialists, call 540-985-8078 and our staff will assist you.
____________________

As Dr. Evans-Hoeker noted, guidance from ACOG, SMFM and ASRM continues to evolve as the scientific community learns more about COVID-19, and state and federal regulations are subject to change as well. Your primary care provider or fertility specialist is your best resource to learn about options and risks in your area.

Carilion Clinic message saying wash your hands and stay home when you are sick
Visit CarilionClinic.org/coronavirus for up-to-date information about our response to COVID-19. Call our Community Hotline for general questions about symptoms, resources, guidelines and more.

COVID-19 Community Hotline
1-866-604-2873

Monday - Friday, 8 a.m - 5 p.m.

Do not call the Community Hotline to make appointments, or to request testing or test results. For information about COVID-19 and your personal health, talk with your primary care provider