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COVID-19 and Infertility: Frequently Asked Questions

Medical Contribution: Eric A. Widra, M.D.

March 19, 2021

Dear Valued Patient,

Shady Grove Fertility continues to follow the Centers for Disease Control and Prevention (CDC), American Society for Reproductive Medicine (ASRM), and American College of Obstetricians and Gynecologists (ACOG) recommendations in response to COVID-19. Practice leaders examine the implications of all recommendations with a careful focus on our duty to our patients and to public health.

SGF does not follow World Health Organization (WHO) COVID-19 recommendations.

According to ACOG, both COVID-19 vaccines currently authorized by the U.S. Food and Drug Administration should not be withheld from pregnant women who choose to receive them.

Patients who decide to get vaccinated should continue to follow the current guidelines to prevent the spread of COVID-19 after they are vaccinated. That means:

  • Wearing a mask
  • Staying at least six feet away from others
  • Avoiding crowds
  • Washing hands with soap and water for 20 seconds or using hand sanitizer with at least 60% alcohol
  • Following CDC travel guidance
  • Following quarantine guidance after exposure to COVID-19
  • Following any applicable workplace guidance

Please refer to our COVID-19 FAQ below to learn more about COVID-19 vaccine guidance for women who are contemplating pregnancy or currently pregnant.

We will continue to monitor the situation closely and change our plans as indicated, with practicing only evidence-based medicine as our standard.

Q: Is SGF prepared to manage care for patients with the recent risk of coronavirus/COVID-19?

A: SGF staff members and doctors have the knowledge and training needed to safely care for patients while taking necessary precautions against the spread and transmission of COVID-19. At this time, SGF has taken measures to limit transmission by promoting hand hygiene and disinfecting protocols, inputting screening measures, modifying appointments and schedules, performing consults electronically when indicated, and making adjustments to treatment cycles if deemed necessary.

Q: Should I avoid coming to SGF until new coronavirus/COVID-19 infections stop occurring in the US?

A: At this time appointment scheduling is subject to local conditions. We will contact you if there is a need for you to cancel appointments, consultations, or surgery due to concerns about COVID-19.

Q: Do you currently have any patients with coronavirus/COVID-19 at SGF?

A: A staff member of our SGF NY team was recently diagnosed with COVID-19. However, due to patient privacy laws and SGF policies, SGF cannot share any details regarding their care or treatment.

We will contact you if there is a need to cancel appointments, consultations, or surgeries due to concerns about COVID-19. Please contact your clinical team directly if you have questions.

Special precautions are in place for patients who display symptoms of illness while under our care. SGF follows the CDC guidelines for the safety of our patients, visitors, and staff members.

Q: I think I have coronavirus. Can you test me for it?

A: SGF does not test patients for coronavirus.

Please contact your primary healthcare provider if you feel sick and have mild to severe respiratory illness with fever, cough, or difficulty breathing – especially if you have been in close contact with someone who has COVID-19 or if you have symptoms and have recently traveled to an area with ongoing spread of COVID-19.

Your primary healthcare provider will work with the state health department and the CDC to determine if you need to be tested.

Q: Do I/we need to wear masks?

A: The CDC recommends that all individuals continue to wear a facemask when in public settings.

Q: How can I protect myself/my family from coronavirus?

A: The CDC recommends the following everyday preventative actions to prevent the spread of respiratory diseases:

  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Cover your cough.
  • Cough into a tissue and then throw it away after use. If no tissues are available, cough into your elbow, not your hand.
  • Wash your hands frequently with soap and water.
  • Visit the CDC website for more information about COVID-19 and prevention.

Q: What symptoms indicate that I should see a healthcare provider?

A: Current symptoms that have been reported include mild to severe respiratory illness with fever, cough, and difficulty breathing. Call your primary healthcare provider if you feel sick with any of these symptoms and have been in close contact with someone who has COVID-19 or if you have recently traveled to an area with ongoing spread of COVID-19. Your healthcare provider will work with the state health department and the CDC to determine if you need to be tested.

Q: What are SGF’s requirements when visiting an office?

A: Thank you to the SGF community for your cooperation in following these requirements when visiting our offices:

  • Patients must wear a face mask that covers their mouth and nose for all visits to an SGF office.
    • Valve Masks and Neck Gaiter Masks are NOT permitted in our offices.
    • One-way Valve masks, or masks with vents, are ineffective; it only protects the person wearing it, and not others- due to the valve.
    • The CDC recommends simple cloth masks instead. A few layers of cotton prevent most of the potentially infectious respiratory droplets from escaping into the air around you.
  • Patients may not be seen for any form of testing, treatment, or consult without having a face covering.
  • Patients who are dropping off a semen specimen also require a face mask in order to enter an SGF office.
  • The face covering must be on before entering the building, before reaching the lobby or elevator.
  • Patients must come unaccompanied to their appointment in order to limit the number of people in our space and best accommodate physical distancing.

Q: What’s the latest that we know about COVID-19’s effect on pregnancy?

A: There are current and published studies evaluating reproduction and pregnancy and the effects of COVID-19. More data will become available over time that can state more definitely the effect of the virus on mother and baby.

SGF is participating in a large multicenter study, UCSF-ASPIRE, to help track pregnancies conceived during the pandemic.

The early data are, however, reassuring. While we don’t have longitudinal data yet, preliminary data are promising. Data will continue to emerge and ACOG and ASRM will continue to monitor and share.

Some data show higher hospitalization rates for pregnant women with COVID but the morbidity and mortality are not higher. The current interpretation is that pregnant women are admitted earlier out of concern for the fetus and mother.

The majority of data indicate that the virus is not transmitted from mother to fetus in utero.

While there’s no way to have 100% certainty that risks can be mitigated, overall the data are reassuring.

Q: Should I avoid a pregnancy at this time?

A: There are no national or international organizations who are saying it is unsafe to become pregnant at this time. This is in contrast to Zika or Rubella/German measles, for example, where abstaining from pregnancy was a recommendation at one time.

Q: Will my fertility treatment outcomes be adversely affected if I contract COVID-19?

A: We have no reason to believe COVID-19 will adversely affect the outcome of your fertility treatment. Further, between the ASRM, CDC, ACOG, SMFM, and other governing bodies in our field, no one is sounding the alarm saying women should not attempt pregnancy, even in the era of COVID-19.

With that being said, women still wonder, to what lengths should I go to start or continue fertility treatment. The answer is, infertility is a disease, and for many couples, it is time sensitive. As we see every day, our patients’ suffering is acute and real. Having children is fundamental to humanity.

We do not recommend a delay in most cases and recommend a risk-benefit analysis discussion between patients and their physicians.   With caution and safety measures in place, we feel it’s appropriate to move forward with fertility treatment at this time, if that is what your physician advises.

Q: Does COVID-19 affect male fertility?

A: A recent study published in the journal JAMA in 2020 examining the semen samples of 38 COVID-19-positive patients, found the presence of COVID-19 in 15% of the samples collected, suggesting the virus can be sexually transmitted; however, it should be emphasized that sperm can carry viruses from the male reproductive tract to the female reproductive tract, and therefore that is not a unique characteristic of COVID-19.

Q: What is the risk to pregnant women of getting COVID-19?

A: Currently it does not appear that pregnant women have a greater chance than the general public of getting sick from COVID-19. Similarly, it does not appear that pregnant women are more likely to have serious illness as a result.

Q: How can pregnant women protect themselves from getting COVID-19?

A: Pregnant women should do the same things as the general public to avoid infection. You can help stop the spread of COVID-19 by taking enhanced universal precautions:

  • Wear a facial mask that fully covers your nose and mouth when in public.
  • Avoid people who are sick.
  • Clean your hands often using soap and water or alcohol-based hand sanitizer.
  • Practice social distancing.

Q: I am eligible to get the COVID-19 vaccine. Are there any special considerations I should be aware of?

A: Patients scheduled for elective surgery or outpatient procedures – including oocyte retrievals, embryo transfers, and intrauterine inseminations – should be advised to avoid COVID-19 vaccination at least three days prior to and three days after their procedure

Q: Do COVID-19 vaccines impact fertility?

The following is a statement from the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM):

“Throughout the COVID-19 pandemic, patients have had questions about the impact of the virus on their health. Now, as the rollout of the COVID vaccines progresses, patients similarly have questions about whether the vaccine is right for their individual health needs.”

“As experts in reproductive health, we continue to recommend that the vaccine be available to pregnant individuals. We also assure patients that there is no evidence that the vaccine can lead to loss of fertility. While fertility was not specifically studied in the clinical trials of the vaccine, no loss of fertility has been reported among trial participants or among the millions who have received the vaccines since their authorization, and no signs of infertility appeared in animal studies. Loss of fertility is scientifically unlikely.”

For more information, please visit ACOG’s Practice Advisory on Vaccinating Pregnant and Lactating Patients Against COVID-19.

Q: If I am contemplating pregnancy, should I receive the COVID-19 vaccine?

A:  SGF is closely following guidance from the CDC, FDA, and ACOG regarding recommendations for COVID vaccination while trying to conceive. Based on excerpts from the current ACOG statement,

Individuals Contemplating Pregnancy:

Vaccination is strongly encouraged for non-pregnant individuals within the Advisory Committee on Immunization Practices (ACIP) prioritization group(s). Further, ACOG recommends vaccination of individuals who are actively trying to become pregnant or are contemplating pregnancy and meet the criteria for vaccination based on ACIP prioritization recommendations. Additionally, it is not necessary to delay pregnancy after completing both doses of the COVID-19 vaccine.

If an individual becomes pregnant after the first dose of the COVID-19 vaccine series, the second dose should be administered as indicated. If an individual receives a COVID-19 vaccine and becomes pregnant within 30 days of receipt of the vaccine, participation in CDC’s V-SAFE program should be encouraged (see below for more information on CDC’s V-SAFE program).

Importantly, routine pregnancy testing is not recommended prior to receiving a COVID-19 vaccine.”

Q: If I am currently pregnant, should I receive the COVID-19 vaccine?

A: Based on excerpts from the current ACOG statement,

“Pregnant Individuals:

ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. While safety data on the use of COVID-19 vaccines in pregnancy are not currently available, there are also no data to indicate that the vaccines should be contraindicated, and no safety signals generated from DART studies for the Pfizer-BioNtech vaccine. Therefore, in the interest of allowing pregnant individuals who would otherwise be considered a priority population for a vaccine approved for use under EUA, make their own decisions regarding their health, ACOG recommends that pregnant individuals should be free to make their own decision in conjunction with their clinical care team.

Individuals considering a COVID-19 vaccine should have access to available information about the safety and efficacy of the vaccine, including information about data that are not available. A conversation between the patient and their clinical team may assist with decisions regarding the use of vaccines approved under EUA for the prevention of COVID-19 by pregnant patients.  Important considerations include the level of activity of the pandemic in the community, the potential efficacy of the vaccine, the potential risk and severity of maternal disease, including the effects of disease on the fetus and newborn, and the safety of the vaccine for the pregnant patient and the fetus. While a conversation with a clinician may be helpful, it should not be required prior to vaccination as this may cause unnecessary barriers to access.

Clinicians should review the available data on risks and benefits of vaccination with pregnant patients, including the risks of not getting vaccinated in the context of the individual patient’s current health status, and risk of exposure, including the possibility for exposure at work or home and the possibility for exposing high-risk household members. Conversations about risk should take in to account the individual patient’s values and perceived risk of various outcomes and should respect and support autonomous decision-making (ACOG 2013).

Pregnant women who experience fever following vaccination should be counseled to take acetaminophen, as fever has been associated with adverse pregnancy outcomes. Acetaminophen has been proven to be safe for use in pregnancy and does not appear to impact antibody response to COVID-19 vaccines.
Pregnant patients who decline vaccination should be supported in their decision. Regardless of their decision to receive or not receive the vaccine, these conversations provide an opportunity to remind patients about the importance of other prevention measures such as hand washing, physical distancing, and wearing a mask.”

Q. If I have been vaccinated and exposed to someone with COVID-19, do I still need to quarantine?

CDC Recommendations for Vaccinated Persons:

While mRNA COVID-19 vaccines have demonstrated high efficacy at preventing severe and symptomatic COVID-19, there is currently limited information on how much the vaccines might reduce transmission and how long protection lasts. In addition, the efficacy of the vaccines against emerging SARS-CoV-2 variants is not known. At this time, vaccinated persons should continue to follow current guidance to protect themselves and others, including wearing a mask, staying at least 6 feet away from others, avoiding crowds, avoiding poorly ventilated spaces, covering coughs and sneezes, washing hands often, following CDC travel guidance, and following any applicable workplace or school guidance, including guidance related to personal protective equipment use or SARS-CoV-2 testing.

However, vaccinated persons with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet all of the following criteria:

• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine)
• Are within 3 months following receipt of the last dose in the series
• Have remained asymptomatic since the current COVID-19 exposure
Persons who do not meet all 3 of the above criteria should continue to follow current quarantine guidance after exposure to someone with suspected or confirmed COVID-19.

Persons who have recovered from COVID-19 within the last three months are exempt from quarantine if exposed to a person with suspected or confirmed COVID-19.

Per ASRM recommendations, patients should be advised not to receive the COVID-19 vaccine 3 days prior to or after a procedure – i.e. oocyte retrievals, IUIs, elective surgery/procedures, embryo transfers.

For more information, please follow this link to the CDC’s website.

Q: Where do I turn for more information about COVID-19?

A: For more information about COVID-19, visit www.cdc.gov or your local health department.

Read the CDC’s vaccination guidance for people who are pregnant or breastfeeding.
Read more about SGF’s safety guidelines.
Read more about coronavirus symptomsdisease prevention, and pregnancy and COVID-19.

Additional SGF + COVID-19 Informational Documents:

 

REFERENCES

  1. Advisory Committee on Immunization Practices. ACIP recommendations. Available at: https://www.cdc.gov/vaccines/acip/recommendations.html. Retrieved December 11, 2020.
  2. Centers for Disease Control and Prevention. COVID-19 (coronavirus disease): people with certain medical conditions. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Retrieved December 11, 2020.
  3. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): people with certain medical conditions. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Retrieved December 7, 2020.
  4. Centers for Disease Control and Prevention. Local reactions, systemic reactions, adverse events, and serious adverse events: Pfizer-BioNTech COVID-19 Vaccine. Available at: https://www.cdc.gov/vaccines/covid-19/info-by-manufacturer/pfizer/reactogenicity.html. Retrieved December 13, 2020
  5. Centers for Disease Control and Prevention. Understanding mRNA COVID-19 Vaccines. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html. Retrieved December 13, 2020
  6. Centers for Disease Control and Prevention. Health equity considerations and racial and ethnic minority groups. Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html. Retrieved December 13, 2020
  7. Collin J, Byström E, Carnahan A, Ahrne M. Public Health Agency of Sweden’s Brief Report: pregnant and postpartum women with severe acute respiratory syndrome coronavirus 2 infection in intensive care in Sweden. Acta Obstet Gynecol Scand 2020;99:819-22. Available at: https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13901. Retrieved December 11, 2020.
  8. Delahoy MJ, Whitaker M, O’Halloran A, Chai SJ, Kirley PD, Alden N, et al. Characteristics and maternal and birth outcomes of hospitalized pregnant women with laboratory-confirmed COVID-19 – COVID-NET, 13 states, March 1-August 22, 2020. COVID-NET Surveillance Team. MMWR Morb Mortal Wkly Rep 2020;69:1347-54. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e1.htm. Retrieved December 11, 2020.
  9. Ellington S, Strid P, Tong VT, Woodworth K, Galang RR, Zambrano LD, et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22-June 7, 2020. MMWR Morb Mortal Wkly Rep 2020;69:769-75. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm. Retrieved December 11, 2020.
  10. Ethical issues in pandemic influenza planning concerning pregnant women. Committee Opinion No. 563. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:1138-43. Available at: https://journals.lww.com/greenjournal/Fulltext/2013/05000/Committee_Opinion__No__563__Ethical_Issues_in.47.aspx. Retrieved December 11, 2020.
  11. Hamel L, Lopes L, Muñana C, Artiga S, Brodie B. The undefeated survey on race and health. San Francisco, CA: Kaiser Family Foundation; 2020. Available at: https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/. Retrieved December 11, 2020.
  12. Knight M, Bunch K, Vousden N, Morris E, Simpson N, Gale C, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-CoV-2 infection in UK: national population based cohort study. UK Obstetric Surveillance System SARS-CoV-2 Infection in Pregnancy Collaborative Group. BMJ 2020;369:m2107. Available at: https://www.bmj.com/content/369/bmj.m2107. Retrieved December 11, 2020.
  13. Moore JT, Ricaldi JN, Rose CE, Fuld J, Parise M, Kang GJ, et al. Disparities in incidence of COVID-19 among underrepresented racial/ethnic groups in counties identified as hotspots during June 5-18, 2020 – 22 states, February-June 2020. COVID-19 State, Tribal, Local, and Territorial Response Team. MMWR Morb Mortal Wkly Rep 2020;69:1122-6. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm. Retrieved December 11, 2020.
  14. Panagiotakopoulos L, Myers TR, Gee J, Lipkind HS, Kharbanda EO, Ryan DS, et al. SARS-CoV-2 infection among hospitalized pregnant women: reasons for admission and pregnancy characteristics – eight U.S. health care centers, March 1-May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1355-9. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6938e2.htm. Retrieved December 11, 2020.
  15. Pfizer-BioNTech COVID-19 vaccine (BNT162, PF-07302048). Vaccines and Related Biological Products Advisory Committee briefing document. Available at: https://www.fda.gov/media/144246/download. Retrieved December 11, 2020.
  16. Schlake T, Thess A, Fotin-Mleczek M, Kallen KJ. Developing mRNA-vaccine technologies. RNA Biol. 2012;9(11):1319-1330. doi:10.4161/rna.22269. U.S. Food and Drug Administration. December 11, 2020 communication to Pfizer Inc. Available at: https://www.fda.gov/media/144412/download. Retrieved December 13, 2020
  17. S. Food and Drug Administration. Fact sheet for healthcare providers administering vaccine (vaccination providers). Emergency Use Authorization (EUA) of the Pfizer-Biontech COVID-19 vaccine to prevent Coronavirus Disease 2019 (COVID-19). Available at: https://www.fda.gov/media/144413/download. Retrieved December 13, 2020
  18. S. Food and Drug Administration. Fact Sheet for Recipients and Caregivers. Emergency Use Authorization (EUA) of the Pfizer-Biontech COVID-19 vaccine to prevent Coronavirus Disease 2019 (COVID-19) in individuals 16 years of age and older. Available at: https://www.fda.gov/media/144414/download. Retrieved December 13, 2020
  19. S. Food and Drug Administration. Emergency Use Authorization of medical products and related authorities. Monitoring and reporting of adverse events. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/emergency-use-authorization-medical-products-and-related-authorities#monitoring. Retrieved December 13, 2020
  20. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status – United States, January 22-October 3, 2020. CDC COVID-19 Response Pregnancy and Infant Linked Outcomes Team. MMWR Morb Mortal Wkly Rep 2020;69:1641-7. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6944e3.htm. Retrieved December 11, 2020.
  21. Zhang C, Maruggi G, Shan H and Li J (2019) Advances in mRNA Vaccines for Infectious Diseases. Front. Immunol. 10:594. doi: 10.3389/fimmu.2019.00594

 

2 Comments

  1. Helen McMahon

    February 3, 2021 - 3:40 pm
    Reply

    Good morning,
    I am 79 with a history of lung cancer, high blood pressure, and smoking. I have been trying to locate a place that I am able to receive my first covid -19 vaccination. Please, please, please let me know if you have any available. Thank you so much for all of your heroism and stay safe.

    Helen

    • Shady Grove Fertility

      February 3, 2021 - 4:09 pm
      Reply

      Good Morning Helen,
      Thank you for reaching out; however, our facilities do not have any COVID vaccines. If you haven’t already, please reach out to your primary physician and enroll with your local vaccine registries.

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