Making the decision to start trying for kids can be tricky no matter when you’re thinking about it. In light of the current coronavirus outbreak, though, it’s understandable that you might feel even more stressed out about these decisions — especially given how little we know about COVID-19’s impact on pregnancy and infants.
Factors to consider when thinking about getting pregnant and the coronavirus
Both of our experts agree that having kids is a personal decision. Given both the healthcare and societal implications of COVID-19, here are some factors to take into consideration:
1. Hospitals and clinics will be stretched thin — but it’s impossible to say for how long.
“There are just too many unknowns to say absolutely: ‘Don't get pregnant.’ But just know that the staff and clinics are going to be stretched and stressed [because of the outbreak],” says Dr. van Dis. “If you're considering getting pregnant, factor that into your decision making.”
“If you do get pregnant,” Dr. van Dis adds, “Know that your OB-GYN and those who care for pregnant women are going to do everything possible to care for you.” But there may be changes in the frequency of in-person appointments. Some OB-GYNs are already established on telehealth networks, and many are being encouraged to do so to reduce the impact on the healthcare system and exposure to the virus.
According to Dr. van Dis, if you’re pregnant, it’s important to check in with a doctor (by phone first!) early on — even if the healthcare system is impacted by the coronavirus outbreak. “I would not miss the opportunity for pregnancy care in the first few months,” she says. “Getting an ultrasound in that first trimester to confirm that the pregnancy is inside the uterus and … [getting] important baseline labs should not be foregone.”
2. Fertility clinics have changed their policies.
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.” As of March 30, 2020, the ARSM 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.
The ASRM clarifies: “While age and diminished ovarian reserve are time-sensitive, at present these should not be included in the definition of urgent care.”
As a result, many women who were expecting to go through egg freezing or IVF in the near future — or those who were already in the process — have to postpone their plans until the crisis subsides.
3. Your anxiety might be at an all-time high.
All of the unknown is the perfect breeding ground for increased stress and anxiety when making these decisions. “We can somewhat limit the uncertainty that's going on by gathering data points all along the way, rather than thinking about all the ‘what ifs.’ Because, right now, the ‘what ifs’ are very numerous and they change a lot,” says Dr. Hutner.
But there are many resources that can help — the Shine app released a free toolkit, the Headspace app is offering free mindfulness meditations, and the New York Times put together a roundup of expert tips.
If you’re already seeing a therapist or if your stress levels have (understandably) increased lately, many mental health practitioners are able to see patients through video chat or on the phone. Search the Psychology Today database for teletherapy providers or check out apps like Talkspace and LARKR. (Alma is also a great resource for providers in New York City.)
4. Social distancing can make friends and family members feel less accessible.
“We know that four out of five people who contract the virus get it from someone who wasn't having symptoms. And that's why [many states are issuing] more stringent regulations about social distancing,” says Dr. van Dis.
As Dr. Hutner explains, “‘Social distancing’ is a difficult term because ... humans are meant to be social. That’s a common denominator of all of our humanity.” Here’s her recommendation: “I know it's not the same, but having video and phone calls, texts, etc. [can help maintain] those social ties.”
What we know about pregnancy and COVID-19
Because COVID-19 is caused by a new strain of the coronavirus, we only have limited studies and research done on similar viruses to look to when trying to understand its impact on pregnancy. Here’s what our experts know so far, based on the information available.
Does being pregnant increase the risk of contracting COVID-19?
As of right now, “We do not think that pregnant women are at increased risk of getting the virus or being infected,” says Dr. van Dis. However, she explains, “Once infected, we know that there are underlying conditions of pregnancy, such as a suppressed immune system and changes in the physiology of the lungs, that put pregnant women at increased risk of having complications from COVID.” Put simply: “Same risk for contracting the virus, but increased risk if they have the virus.”
Even if the risk of complications is increased with pregnancy, according to the World Health Organization (WHO), only 1% of pregnant women infected with the virus have experienced severe illness requiring medical attention.
Is there an increased risk of miscarriage with COVID-19?
Dr. van Dis explains that we don’t have a lot of data around miscarriage and COVID-19 quite yet, but “we think that there might be an increased risk.” “As a [medical] community,” she says, “We are looking to experiences with [other] coronaviruses, and those are SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome-related coronavirus). And in those cases, they did see an increased risk of first trimester miscarriage.”
That said, Dr. van Dis adds that the datasets are too small to know exactly what we can expect from the new coronavirus. As more information becomes available, we’ll better understand the possible risks.
Are children at risk for health issues if women are exposed to the virus before or during pregnancy?
To answer this question, Dr. van Dis looked through the existing studies on coronaviruses and the impact on children before or during pregnancy — there was no evidence that there were any “neurobehavioral or developmental problems associated with infants who were born to women [who] contracted MERS or SARS,” she says. “Having said that,” she adds, “I feel like we will obviously be collecting [more] data during this pandemic.”
Here’s what we do know: “When women have fever (which is also a symptom of the coronavirus) in the first trimester, there is evidence that [there’s a] 1.5-3x increased risk for congenital abnormalities,” says Dr. van Dis. "It's also important to say that there's a 3-4% background risk for any woman — without a fever, without COVID in pregnancy — for congenital abnormalities."
There are always potential risks. But from what we know so far, there’s no substantial evidence that supports an increased risk of health issues in a child just because of exposure to the coronavirus before or during pregnancy.
How to manage stress and anxiety around getting pregnant
Now that we've covered what we know so far about the coronavirus medically, let's talk emotions and mental health. Making a big decision like postponing or continuing your pregnancy — especially right now, when so much is uncertain — can be the cause of anxiety. Here are Dr. Hutner's tips for getting through this stressful time.
- Allow yourself to feel it all: “Your feelings and your reactions to this are valid. Any ‘normal’ person will feel upset, disappointed, frustrated, angry, worried, anxious — those feelings are real and they're a real response to a shifting landscape,” Dr. Hutner says.
- Take things one day at a time: What we know is changing day by day. “Try to see if you can narrow the scope of uncertainty,” Dr. Hutner says. “Reassessing [your decision] at small, consistent intervals is what I would recommend.”
- Try to be as flexible as you can: “During times of anxiety and stress, all of us get into more black-and-white thinking,” Dr. Hutner says. She suggests maintaining a “highly flexible mindset” and asking yourself: “If I can’t do it this way, then what is another way I can still get my goals met?” Just because things don’t look exactly how you envisioned them right now doesn’t mean you can’t still work toward the future you want.
- Give yourself breaks from the news: Dr. Hutner explains that we should try not to get “too overloaded by the information stream, which can be coming at us from all sides.” Keep yourself updated on what’s happening in the world, but balance what you’re watching, reading, and listening to with things that make you happy.
- Practice self-care: “The same elements that have been important for getting through [anxiety before] are the same elements that are important here,” says Dr. Hutner. She recommends “making sure you have enough support [and] making sure you still have time for yourself and to connect with people.”
We’ll be updating the Modern Fertility blog as new info becomes available, so keep checking back in for the latest. In the meantime, take care of yourself!