This article was last updated on Thursday, July 23, 2020 at 4:00pm.
Over the past few months, 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 outbreak 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 people don’t appear to be at a higher risk for contracting the virus — but data shows they might be at a higher risk for severe illness.
- It’s possible, though very unlikely, for an infected pregnant person to pass on the coronavirus to the fetus.
- If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive. In terms of limited access to medical care, we don’t know how long that will last. So, just like during any other time, when to try for kids is totally up to you.
- 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 in regions with reduced transmission rates consider reopening fertility clinics after assessing disease analysis and hospital capacity in their area. If you’re a patient going through IVF or IUI, 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 people, 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, wrote in her May 2020 newsletter:
“There isn’t strong evidence for COVID-19 having an outsize effect on pregnant women. If this is the time for you, I would do it … I think my thinking has evolved along with many other people. It was easy, early on, to think about this as a short-term thing — as if a month in, things would be different. And while things are evolving every day, it now seems clear that in some form we’ll be dealing with this through the next year and beyond. I see less value in waiting now that I did before.”
Contrary to claims that we’ll see a “baby boom” because of people spending more time at home, a June Guttmacher survey found that 40% of their respondents (all people with ovaries) changed their plans for kids — when to have them and how many to have — because of the pandemic. (Our Modern State of Fertility 2020 report led to similar findings.)
Economists hypothesize that there will be 300,000 to 500,000 fewer births in the US as a result of coronavirus. (The Great Recession saw a decrease of almost 400,000 births between the years of 2007 and 2012.)
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).
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 “continue to provide medically necessary prenatal care, referrals, and consultations, although modifications to healthcare delivery approaches may be necessary,” “consider creating a plan to address the possibility of a decreased healthcare workforce, potential shortage of personal protective equipment, and limited isolation rooms," and "maximize the use of telehealth across as many aspects of prenatal care as possible.”
How does coronavirus affect pregnant women and infants?
According to the CDC, pregnant people are likely at a greater risk for severe illness related to COVID-19:
- While the patient data CDC has access to has a number of limitations — they didn’t have data around ICU admission and ventilation needs for the majority of people in the study.
- The CDC also doesn’t know if some hospitalizations were due to pregnancy issues and not COVID-19 — they’ve concluded that pregnant people are more likely to be hospitalized, be admitted into the ICU, and put on a ventilator than non-pregnant people with ovaries (of reproductive age).
- A recent report in Sweden drew the same conclusion. Since there are so many gaps in the CDC’s data on pregnancy and COVID-19, doctors at California universities are filling them with new research (like ASPIRE and a nationwide registry).
An April 2020 systematic review of pregnancy and COVID-19 looked at 18 studies of infected pregnant women:
- 87.5% of women experienced fever
- 53.8% experienced coughing
- 22.5% experienced fatigue
- 8.8% experienced diarrhea
- 11.3% experienced dyspnea (shortness of breath)
- 7.5% experienced a sore throat
- 16.3% experienced myalgia (muscle ache)
- 91% of the women delivered via cesarean (as a comparison point, as of 2017 the average C-section rate in America was 32%, according to the CDC)
Out of the infants:
- 1.2% were stillborn (as a comparison point, about 0.6% of babies in America are stillborn, according to the CDC)
- 1.2% died in utero
- 21.3% were born preterm (compared to the average of 10% of babies born in America generally, according to CDC)
- 5.3% had low birth weight
- 10.7% experienced fetal distress
- 1.2% experienced neonatal asphyxia (deprivation of oxygen)
Researchers concluded that “the clinical characteristics of pregnant women with COVID-19 are similar to those of non-pregnant adults. Fetal and neonatal outcomes appear good in most cases, but available data only include pregnant women infected in their third trimesters. Further studies are needed to ascertain long-term outcomes and potential intrauterine vertical transmission.”
On pregnant women with fevers: 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.
Race may play a role in which pregnant people are most exposed to the virus. Data collected from nearly 1,300 people with ovaries in Philadelphia points to Black and Latino pregnant people having 5x the risk of coronavirus exposure than white pregnant people.
If you’re pregnant, Dr. Jane van Dis, MD, FACOG, an OB-GYN and Medical Director at OB Hospitalist Group, recommends, “Wear a mask, wash hands, and socially distance. Get in to see your provider right away so that you can address any medical conditions, medications, or prenatal care testing."
If you are pregnant or thinking about getting pregnant, the Society for Assisted Reproductive Technology (SART) also suggests that you avoid nonessential travel to any areas with high instances of infection.
How does coronavirus affect children?
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. That said, according to the team of researchers and students running the website COVID-Explained, “This doesn’t mean that kids cannot get very sick and there are some case reports of kids who present with COVID and an illness called Kawasaki. However, the numbers of seriously ill kids remain very small, and this particular illness link is not entirely clear.”
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. But, so far, they explain that:
- Mother-to-child transmission of COVID-19 during pregnancy is unlikely. That said, after birth, a newborn can be infected if they’re in close contact with an infected person.
- A small number of infants have tested positive for COVID-19 shortly after birth, but we don’t know the exact time of transmission.
- Preterm birth — as well as other complications (not specified by the CDC) — has been reported in infants born to mothers who tested positive late in their pregnancy, but we don’t know if the problem was the direct result of the virus.
Two recent reviews of existing research on vertical transmission (i.e., mother to child, immediately before or after birth) of COVID-19 during pregnancy is possible, but it’s very rare. In one June review published in Obstetrics & Gynecology, researchers identified a transmission rate of 0% in a sample size of 310 pregnancies. But this July review published in the Journal of Clinical Virology found the rate to be 1.7% (3 out of 179 infants).
There are a few other studies we can also 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 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’re considering or already pursuing in-vitro fertilization (IVF), intrauterine insemination (IUI), or egg freezing, what should you know?
On July 10, 2020, the American Society for Reproductive Medicine (ASRM) released an update to their clinical recommendations from March 17. The original 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,” suggested 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.
The July 10 update affirms the guidance to take a measured approach to reopening fertility clinics from the April 24 update, which acknowledged that certain regions "are seeing evidence of a ‘flattened’ transmission curve." It is now up to "national, regional, state, and municipal regulations produced by authoritative health organizations and agencies" to determine their next course of action, "based on their analysis of disease transmission and hospital capacity data."
However, they add, "Individual programs, physicians, and other healthcare providers need to be flexible and fully prepared to recognize and address the status of their local coronavirus transmission rate, medical conditions, and the impact that resuming operations would have on their community’s risk and resources, even when clinical activities are permitted by law."
On the original recommendations: 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: If you’re at a location where social distancing isn’t possible, wear a cloth covering over your nose and mouth to prevent the spread of possible infection (not everyone shows symptoms!).
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 Brazil, China, Iran, most European countries, the UK, and Ireland.
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.