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COVID-19, IVF and Pregnancy: Interview with Fertility Experts

COVID-19, IVF and Pregnancy: Interview with Fertility Experts

Kindara | April 7, 2020 | trying to conceive

Interview with fertility experts Dr. Alex Polotsky and Dr. Liesl Nel-Themaat conducted by Jackie Vinyard. Recap written by Nicole Knight.

The novel coronavirus pandemic has hit the pause button on everyday life, and that goes for fertility treatments too. Last month, the American Society for Reproductive Medicine (ASRM) issued new guidelines to fertility doctors to stop "new, non-urgent treatments" for infertility, dashing the hopes of individuals and couples around the country (1). 


ASRM has indicated that the guidelines are needed to spare medical resources amid the pandemic and protect patients, because so little is known about how COVID-19 might affect pregnant women, their pregnancies, and newborns (1).

The blanket hold on infertility treatments has left countless couples questioning why infertility is considered “non-urgent” and wondering whether it’s safe to conceive right now. Others are asking about concrete steps they might take now to be best prepared to get pregnant once the coronavirus pandemic is over.

To answer these questions and more, Kindara interviewed Dr. Liesl Nel-Themaat, director of the IVF Lab, and Dr. Alex Polotsky, director of the Reproductive Endocrinology and Infertility Division with University of Colorado Advanced Reproductive Medicine. Click here to view the entire interview

Below is a lightly edited transcript of the interview. We start with a quick summary of key points from the ASRM guidelines and the American College of Obstetricians and Gynecologists (ACOG) guidelines on fertility treatment and pregnancy amid the coronavirus outbreak.

ASRM Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic as of March 30, 2020  (1):
  • Stop new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF), including retrievals and frozen embryo transfers, and non-urgent gamete cryopreservation.
  • Strongly consider cancelling all embryo transfers, whether fresh or frozen.
  • Continue to care for patients who are in-cycle or who need urgent stimulation and cryopreservation.
  • Suspend elective surgeries and nonurgent diagnostic procedures.
ACOG Practice Advisory as March 13, 2020 (2):
  • Pregnant women are considered an at-risk population for COVID-19 based on evidence from other respiratory outbreaks.
  • Pregnant mothers with COVID-19 may experience pre-term birth based on very limited data on the novel coronavirus.
  • It’s unclear if COVID-19 can be transmitted in utero to a fetus. Limited research has so far shown that mothers with COVID-19 have not passed coronavirus to their newborns.
Can you start by telling us why infertility treatments are being put on hold?

Dr. Liesl Nel-Themaat

Most medical disciplines are governed by professional societies that publish guidelines on an array of different topics that are relevant to a particular field. Most infertility clinics in the U.S. adhere to guidelines published by the American Society of Reproductive Medicine, or ASRM. When the coronavirus outbreak started, ASRM put together a task force and composed guidelines specifically about what they recommend we do during this outbreak as far a fertility treatment goes. The current guidelines recommend against starting new nonurgent cycles for the safety of the patient, the staff, and the whole community. 

To make this recommendation, the task force considered information set forth by the World Health Organization, the Centers for Diseases Control and Prevention, local and national regulatory agencies, as well as considering the voice of its members and patients. 

The task force reviews the guidelines every two weeks and might amend or update them. Check the ASRM website for updates

While the majority of the U.S. is on lockdown, some towns are not, and some clinics remain open. If my clinic is closed, should I go to one that is open?

Dr. Alex Polotsky

We advise our patients to delay the initiation of any fertility treatments at this time. Our clinic and many others are open for telehealth visits, and we have seen a lot of folks successfully using this technology. It is super easy to use, even for individuals who are not tech-savvy. 

The bottom line is that at present, nonurgent treatments should be delayed or postponed. Local conditions could be different. Things are very different in New York City or Colorado and Idaho, so you should check with your local provider.

My clinic is still doing treatments, but recommends I freeze my eggs or embryos. Will freezing them reduce my chances of success in getting pregnant later on?

Dr. Polotsky

I would definitely advise all men, women, or couples who are seeking fertility treatments to discuss their circumstances, which are often unique, with their provider. That said, rest assured that frozen embryos, sperm, or eggs can be maintained indefinitely. There was a story a number of months ago about an embryo that resulted in a live birth after being frozen for more than 20 years. So if somebody is currently in treatment, then freezing is the safest thing to do.

Will my eggs or embryos be safe frozen since my treatment has been put on hold? What are the risks?

Dr. Nel-Themaat

The art of freezing eggs and embryos especially has been refined over the last few years and is to a point now that we have well over 90% survival typically. At our lab, we are at around 95% survival. So we can definitely reassure patients that the risk of freezing your eggs, embryos, and sperm is very very low. Survival is very high.

Another concern patients have, especially after the report a few years ago about tank failures is whether their embryos, eggs, or sperm are going to be safe during storage. Certifying agencies now require all labs to comply with rigorous criteria. Labs must maintain continuous monitoring of storage tanks and must check the liquid nitrogen, which is what the specimens are stored in. And you have to have an alarm system. So we have very stringent procedures that we have to follow. 

At our lab, we have two different systems. It’s overkill, but it’s such a tremendous loss if something does go wrong with the storage tanks. We have temperature probes inside each of our tanks, and a secondary alarm system with a thermal camera in the room where the tanks are located. The first sign of tank failure is when the temperature on the outside of the tank drops. If this happens, the camera system can warn the lab and call us 18 hours earlier than most alarms can. So we now have two systems — because it just makes me sleep better at night. Any reputable lab will have alarm systems in place to call if anything goes wrong. 

That’s reassuring. Is that the standard for labs across the U.S.?

Dr. Nel-Themaat

Most labs that adhere to the gold standard of certification, which is the College of American Pathology, which we adhere to, are required to have these systems in place. However, not all labs get certification by the American College of Pathology. So it would be a good idea to check with your lab and see what certifying agencies they follow and what their procedures are. 

Our next question is a bit of a loaded question, but it's asked by many. It sounds like fertility treatment is being paused because it is considered an elective procedure. For many women, this is their only option, so why is this being considered elective?

Dr. Polotsky

That's a question that comes up quite a bit these days. It is appropriate to make a distinction between something that's considered urgent and nonurgent. Nonurgent fertility treatments are not elective. Infertility is a disease — and treatment of any disease is not elective. 

Nonurgent is usually defined as a treatment or evaluation that is not time-sensitive and would not be affected by a delay of a couple of months. Now, we're complying with the guidelines from the American Society for Reproductive Medicine, and we are not initiating any new nonurgent fertility treatments at this time. 

However, when men, women, and couples require freezing for eggs, sperm, or embryos because they're facing imminent cancer treatment, that’s different. We're open for those procedures at this time. 

It is an important distinction between nonurgent and elective, and we implore everyone to understand what that implies. We are definitely not saying that it is elective for folks to have the family they want. It is not. We’re here to help.

Any advice for women who are concerned about suspending treatment due to their age? Will a couple of months make a difference?

Dr. Polotsky

This is definitely a very sensitive topic for many patients. While a couple of months would usually not make a difference for a majority of folks, individual circumstances may vary. Some folks might be affected by an age-related decline in fertility. 

My heart really goes out to people who might be affected by the impact of this delay, and I'm not in the position to estimate how long it’ll last. These are conversations I’m having on a daily basis with patients I’m counseling. At the present time, we should do what is safest, and not initiate any treatments that are not recommended by our professional society and our government advisors and overseers.

What should women who are in the middle of treatment whose appointments have been canceled expect to happen now?

Dr. Nel-Themaat

It depends on what type of treatment they’re pursuing and where they are in the process. If they haven't started any type of stimulation, the guidelines are that we should take a pause and wait until the pandemic has subsided or until the guidelines tell us otherwise.

If you're doing an ovulation induction cycle for insemination, for example, then the guidelines say that we can continue with the stimulation and do the insemination, and just not start any subsequent cycles. 

If you are in an IVF cycle for either egg-freezing or to make embryos, if you've already started your stimulation, the guidelines advise us to continue with stimulation and do the egg retrieval. Then those eggs or embryos will be frozen because the guidelines advise against embryo transfer at this point. As I’ve explained before, the egg and embryo freezing process is very safe, and we can confidently tell patients that it should not affect their outcome in that regard. 

As soon as the guidelines recommend that we can resume, we will do our best to get patients in as quickly as we can to continue with their fertility journey and help them get pregnant. 

My husband is scheduled for sperm retrieval. Should men be freezing their sperm right now?

Dr. Nel-Themaat:

This is also a tricky one, simply because we do not have a lot of information. We do not know if the coronavirus can be transmitted through semen. The current guidelines are that sperm retrieval is a nonurgent procedure. If, for example, you want to harvest sperm for an IVF cycle, delaying that for a few months is not going to make a difference, so we recommend not doing it at this time. 

However, if the male is going to have fertility-altering therapy, such as chemotherapy or radiation for cancer, then we absolutely recommend they continue with sperm harvesting and freeze the sperm so they’ll have that after treatment.   

This question is asked quite often, and it’s a pressing question for women here in the United States and globally. Is it currently recommended to delay getting pregnant?

Dr. Polotsky

Yes, that's something that could be particularly sensitive to folks who may require fertility professionals to help them conceive. At the present time, there is no blanket recommendation not to conceive for the general population. 

The impact of the coronavirus pandemic is still poorly understood. We don’t know how it might affect each stage of the process, and we’re definitely advising caution. As we find out more information, we’ll be able to advise folks in a more specific way.

At this time, what is known is that coronavirus does not appear to affect pregnant women in the way that makes them more vulnerable than a lot of other individuals, which was the case with the regular flu. It was more dangerous to be pregnant, for example, during the Spanish flu pandemic. That doesn’t appear to be the case with coronavirus, which is something that's potentially reassuring.

Okay, so if I’ve had my fertility treatments put on hold, what is something I can do now to prepare for pregnancy until I go back to my clinic and begin treatment?

Dr. Polotsky

This is a very good question because we should be encouraged to use this time productively. There are lots of things that people could do to optimize the chances of success. Weight management, if it applies to individual circumstances, is a good thing. Also maintain your overall well-being, including physical and mental health. We have mental health professionals who are available for telehealth visits. 

We just decided with some patients to proceed with medications to improve their chances of success with implantation and embryo transfer. This is a good time to do it, so we’re doing it at this time. 

I think you should definitely make arrangements to speak with your provider. And I think it's important to realize that this is a very difficult time, it's probably the most difficult time since World War II. Yesterday, we just discussed with our staff about the reason that people who emerged from the Great Depression are called the greatest generation. There is this common phrase, What doesn't kill you makes you stronger. I think we will emerge stronger from this. It’s not going to be forever. 

I also want to use this opportunity to thank the Colorado State Legislature and the governor for signing the law for insurance coverage for fertility treatments yesterday. That’s something that will provide better access to care. I think there’s going to be a coronavirus baby boom 9 months from now from all the folks who are stuck at home. For fertility treatments, it’s probably going to come 10 months from now. 

I just want to recap what we've covered, because there’s confusion about trying to get pregnant or not trying to get pregnant now.

Your chief points are that there is no current recommendation to address whether you should or should not try to conceive at this time. Little is known about the coronavirus, so it’s fine to continue to try. Also, if you need fertility treatment to get pregnant, there’s no need to feel hopeless now because you can continue to take care of your health and contact your clinic for help remaining fit for pregnancy. And, as you said Dr. Polotsky, we will emerge from this stronger and ready to go once this has ended. 

I'm curious about the risk to early pregnancy if by chance we do conceive during this time. 

Dr. Polotsky

Any pregnancy should be followed just as it would be under regular circumstances. Once somebody is pregnant, we recommend regular ultrasounds, evaluations, and everything that is typically recommended. This should not be postponed. 

I’d love to know about trying to conceive if both parties are healthy. 

Dr. Polotsky

If you have questions, seek professional advice. Call us, we have telehealth. It's really individual circumstances. We’d be happy to help. 

If they're both healthy and live in an area that's not like New York or in Colorado, where we’re in lockdown, and both parties are healthy, is it okay to try and conceive?

Dr. Polotsky

Yes. At this time, there is no blanket recommendation not to conceive anywhere in the U.S. You should exercise caution.

Dr. Nel-Themaat

And trying to conceive might help with fitness and stress relief!



Photo by Almos Bechtold on Unsplash

References:

  1. American Society for Reproductive Medicine. (2020, March 30). Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic.
  2. American College of Obstetricians and Gynecologists. (2020, March). Practice Advisory: Novel Coronavirus 2019 (COVID-19).