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COVID-19 and Infertility: Frequently Asked Questions

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

December 30, 2020

Dear Valued Patient,

SGF’s physician leadership continues to diligently review the American Society for Reproductive Medicine (ASRM), Centers for Disease Control and Prevention (CDC), American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM) 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.

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

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: 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: 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.

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
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