This article was last updated on Monday, March 30, 2020 at 9:45 am.
Over the past few weeks, every other news headline has mentioned COVID-19, or the new strain of the coronavirus infection that’s spreading around the world. We’re being told how to wash our hands and when we should consider working from home (if that's an option for us) — but what effect, if any, does the coronavirus pandemic have on our fertility and reproductive health? Here's what the health experts say.
The biggest takeaways
- Research is still ongoing and there have not been any studies done to see if contracting the COVID-19 infection now will make it harder to get pregnant later.
- At this time, pregnant women don’t appear to be at a higher risk for contracting the virus.
- Trying to get pregnant? If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive — that said, access to medical care over the next few months may be harder to come by (and pregnant women need medical care!), so if you're flexible on conception timing, you may want to consider waiting. More on this below.
- If you don’t have COVID-19 and are interested in pursuing assisted reproductive technology (ART), the American Society for Reproductive Medicine (ASRM) recommends that clinics postpone all elective procedures, including intrauterine insemination (IUI), in-vitro fertilization (IVF), and non-urgent egg or embryo freezing. If you’re a patient going through IVF or IUI, you should speak to your fertility clinic about next steps.
- If you meet the diagnostic criteria for COVID-19, it’s recommended that you avoid getting pregnant and wait until the illness subsides before pursuing ART.
- Everyone, including pregnant women, should be exercising precautions to avoid infection.
A refresher on COVID-19
Coronaviruses are a large family of viruses common in people and many animals. In rare cases, animal coronaviruses can infect people and then spread (this happened with MERS-CoV, SARS-CoV, and now with this new virus). The virus is named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
According to the Centers for Disease Control and Prevention (CDC), the COVID-19 global pandemic (as declared by the World Health Organization on March 11, 2020) we’re witnessing now was first discovered in China, but is now affecting 100 international locations (including the US).
The CDC reports that, for most people, the risk of exposure to COVID-19 is low. For the following groups of people, though, the risk is higher:
- People in places where there’s ongoing community spread
- Healthcare professionals in contact with people who have the virus
- Close contact with people who have the virus
- Travelers coming back from international locations with ongoing community spread
- Older people or people with underlying medical illnesses
About 2-14 days after exposure, fever, cough, and shortness of breath might suggest contraction of the virus. If you’re experiencing any of these symptoms, contact your doctor ASAP.
How coronavirus impacts reproductive health
Here are the top questions related to COVID-19 and reproductive health:
Will contracting COVID-19 now impact fertility later?
Research is still ongoing in this area. There are no studies indicating that the virus has any impact on your fertility. While coronavirus fears have caused some people to seek out egg freezing, there’s no reason to panic if you haven’t contracted the virus – and there is no known medical indication to seek out egg freezing as a “preventive measure.”
Dr. Eva Luo, an OB-GYN at Beth Israel Deaconess Medical Center, says, “Nothing in what we currently know and understand about COVID-19 would justify egg freezing or other ART procedures.”
If you're trying to get pregnant, should you stop trying to conceive due to coronavirus?
If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive. However, there may be logistic, psychological, and emotional reasons to modify your plans. Postponing pregnancy is a very personal decision, and you should speak with a doctor for specific recommendations.
Dr. Emily Oster, PhD, an economist and author who debunks myths about pregnancy in her book Expecting Better, writes in her newsletter:
“I don’t think there is a strong medical case for that. On the other hand, over the next couple of months it may be more difficult to access medical care, which pregnant women need more than the average. It is hard to predict how long this will last. As has become pretty clear in the last few days, I think, societal disruption is a reality now, so worth considering the impacts even putting aside medical concerns. In the end, the right answer here may come down to your flexibility. If you are indifferent between now and three months from now, I might wait.”
If you already have COVID-19, the SART recommends avoiding getting pregnant for now and waiting until you fully recover before attempting conception (either naturally or via assisted reproductive technology).
How does coronavirus affect pregnant women and children?
According to the World Health Organization (WHO), pregnant women don’t appear to be at a greater risk for illness related to COVID-19 — and only 1% of pregnant women infected experienced severe illness that required medical attention.
The CDC does not have information on adverse pregnancy outcomes in pregnant women with COVID-19, but states that: “Pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related coronaviruses [SARS-CoV and MERS-CoV] during pregnancy.”
Though fevers in early pregnancy (because of COVID-19 or other illnesses) have been linked to neural tube defects in some studies, one large study that followed 100,000 women in Denmark over time didn’t find a connection.According to the CDC, children don’t seem to be at a higher risk for contracting the virus. They also appear to be infected at lower rates than other age groups.
Can a pregnant woman with COVID-19 pass the virus on before, during, or after birth?
The CDC says we’re still finding that out:
“Whether a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus or neonate by other routes of vertical transmission (before, during, or after delivery) is still unknown.”
But we do have a few studies to look to. One was conducted on nine pregnant women infected with COVID-19 in Wuhan, China. All women recovered from their illness and all nine had live birth without any evidence of transmitting the virus to the baby. The virus was not detected in samples of cord blood, amniotic fluid, or throat swabs from the newborn, or breast milk.
However, the COVID-19 infection was recently found in three infants born to women with the virus in China — two showed very mild symptoms which went away after a few days, and one had more severe symptoms (this infant was born premature, which could have had an impact). Since the study included 33 infants, the findings suggest that “vertical transmission” (meaning passage of the virus from mother to baby during the period immediately before and after birth) could be rare. Two new papers (read them here and here) also suggest vertical transmission is possible — but the sample size was small, we don’t know when transmission may have occurred, and none of the infants had symptoms of COVID-19.
If you are pregnant or thinking about getting pregnant, the Society for Assisted Reproductive Technology (SART) suggests that you avoid nonessential travel to any areas with high instances of infection. Dr. Eva Luo adds: “Seasonal influenza remains a large concern and the influenza vaccine is highly recommended, particularly for pregnant women.”
It’s important to note, though, that there could be repercussions in the healthcare system that make aspects of pregnancy more difficult. In the latest briefing from the American College of Obstetricians and Gynecologists (ACOG), the organization acknowledges that recent community mitigation efforts might impact access to routine prenatal care. Because of this, ACOG recommends that OB-GYNs “ensure that patients with certain high-risk conditions are provided necessary prenatal care and testing when needed,” “consider creating a plan to address the possibility of a decreased healthcare workforce, potential shortage of personal protective equipment, limited isolation rooms," and "maximize the use of telehealth across as many aspects of prenatal care.”
If you’re considering or already pursuing in-vitro fertilization (IVF), intrauterine insemination (IUI), or egg or embryo freezing, what should you know?
On March 17, 2020, the American Society for Reproductive Medicine (ASRM) released new clinical recommendations “based on the public health concepts of containment, mitigation, and resource optimization, and [that] apply to all reproductive medicine practices regardless of setting, and take into consideration the health of patients, providers, physicians, clinical staff, and the population as a whole.” On March 30, 2020, the ASRM affirmed their recommendations.
They suggest that clinics:
- Don’t initiate new treatment cycles — including ovulation induction, intrauterine insemination (IUI), in-vitro fertilization (IVF) (both egg retrievals and frozen embryo transfers), and non-urgent egg or embryo freezing.
- Strongly consider canceling all embryo transfers (fresh or frozen).
- Continue caring for people who are “in-cycle,” or have urgent needs for stimulation or cryopreservation (egg or embryo freezing).
- Postpone elective surgeries and any non-urgent diagnostic procedures.
- Prioritize telehealth over in-person contact.
They also state: “While age and diminished ovarian reserve are time-sensitive, at present these should not be included in the definition of urgent care.”
According to Drs. Pietro Bortoletto and Eduardo Hariton (both reproductive endocrinologists), “Assisted reproductive technology is considered an elective procedure and it is expected that the response to COVID-19 will redirect healthcare resources towards urgent and emergent endeavors.” Waiting to pursue ART will be particularly important if you’re more likely to experience complications that would require more care.
The SART recommends that anyone who’s actively pursuing ART and meets the diagnostic criteria for the COVID-19 infection consider freezing all eggs or embryos and waiting until they’re disease-free to do an embryo transfer. The American Society for Reproductive Medicine (ASRM) put out a bulletin on March 12, 2020 echoing this sentiment, stating:
"Out of an abundance of caution, patients who have high likelihood of having COVID-19 (fever and/or cough, shortness of breath, and either exposure within 6 feet of a confirmed COVID-19 patient and within 14 days of onset of symptoms, or a positive COVID-19 test result), including those planning to use oocyte donors, sperm donors, or gestational carriers, should strive to avoid a pregnancy. If these patients are undergoing active infertility treatment, we suggest that they consider freezing all oocytes or embryos and avoid an embryo transfer until they are disease-free. Please note this recommendation does not necessarily apply when there solely is a suspicion of COVID-19, because symptoms of COVID-19 are very similar to other more common forms of respiratory illnesses."
If you are actively pursuing ART and have been diagnosed with COVID-19 (or you haven’t undergone the definitive test yet but have symptoms that might meet the diagnostic criteria for COVID-19), you should call your fertility doctor’s office ASAP and follow their recommendations.
How to limit risk of exposure to COVID-19
The CDC recommends that these precautions be taken to limit the risk of exposure to COVID-19:
1. Wash your hands (often): This might sound pretty basic, but clean your hands with soap and water for at least 20 seconds after you’ve been outside, or if you’ve been coughing, sneezing, or blowing your nose. Don’t forget to wash the tops of your hands! In between hand washes, use hand sanitizer with at least 60% alcohol. (If you need some inspo, sing along to this hand-washing song that's gone viral.)
2. Stop touching your face: Most people touch their face a few times every minute — which adds up. Avoid touching your eyes, nose, or mouth while you're at it.
3. Practice social distancing, aka avoid close contact with others: Keep your distance from sick people who are exhibiting signs of the virus or in communities where the virus is spreading. This means refraining from hugs, handshakes, and other embraces. This article in The Atlantic will give you a helpful framework of what types of social gatherings and interactions you should consider avoiding.
4. This is a no-brainer, but stay home if you’re feeling sick: This isn’t the time to stay quiet about symptoms — if you’re feeling sick, tell your boss that you’re working from home or taking the day off. (Some companies are even asking all employees to stay home to limit exposure, and some are working out paid-time-off policies for hourly workers.)
5. Cover your coughs and your sneezes: Use a tissue or the inside of your elbow — and be sure to dispose of any tissues you use and wash your hands after.
6. Wear a face mask (but only if you need to): You should only be wearing a face mask if you’re exhibiting symptoms of the virus and have to be around other people.
7. Become a cleaning/disinfecting machine: Clean and disinfect whatever surfaces you touch daily. If they’re dirty, clean them with detergent or soap and water before disinfecting.
8. Avoid all unnecessary travel: The CDC also suggests that we refrain from nonessential travel to China, Iran, South Korea, Italy, Japan, and use precautions before traveling to Hong Kong.
As we learn more about the new strain of coronavirus’ impact on fertility, pregnancy, and ART, we’ll keep you updated. In the meantime, check back in with the CDC for the latest facts and figures.
This article was medically reviewed by a member of the Modern Fertility Medical Advisory Board. This article is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.