Medical Contribution: Eric A. Widra, M.D.
July 28, 2020
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 now being determined to be 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 studies being done currently looking at reproduction and pregnancy and the effects of COVID-19. Because this virus is novel and hasn’t been around for the length of a full-term pregnancy yet, those women who contracted the virus during their first or second trimester are likely still pregnant. 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, 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 few reports that include infected pregnant women showed they delivered successfully, and the babies were either not affected, or they recovered very well in weeks’ time.
In some early reports out of China, pregnant women with the virus gave birth to healthy, uninfected babies and no traces of the virus were found in their breast milk or amniotic fluid. However, more research is needed to further explore.
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. Delaying treatment until we are safe from COVID-19 presumably means postponing pregnancy until there’s a vaccine. Unfortunately, for some viruses a vaccine will never emerge or will prove to be ineffective. And therefore, waiting until a vaccine is available may significantly lower a women’s ability to get pregnant, given her eggs will continue to age, which lowers her chance for pregnancy.
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 last month 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: 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.