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Does COVID Reduce IVF Success?

Does COVID Reduce IVF Success?

Kindara | July 29, 2021 | trying to conceive
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COVID-19 has dominated the news since early 2020, and it shows no signs of stopping. As people get vaccinated and variants continue to pop up, so do more and more questions about COVID's potential to impact certain aspects of our lives, such as pregnancy, fertility, and assisted reproductive technologies like IVF.  If you've had COVID, will it reduce the success of IVF? Should you get the vaccine before you start IVF? Let's take a look at what the experts say. 

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Expert Recommendations:  ART and COVID 

If you were about to embark on IVF before COVID and you decided to hit the pause button, you're likely pretty stressed out about if and how to move forward, especially since IVF requires many trips to the doctor for hormone injections, egg harvesting, and other aspects of the procedure, which could potentially result in exposure to COVID. 

Early on in the pandemic (April 2020),  the American Society for Reproductive Medicine (ASRM) recommended that  folks who had been diagnosed with COVID or who had been exposed to someone who had tested positive for COVID within 14 days to avoid getting pregnant and cease fertility treatment (1).  Those with concerns about limited ovarian reserve were encouraged to take precautions if they decided to continue.  

In October of 2020, research presented at the ASRM Scientific Congress revealed that of 145 patients who planned a frozen embryo transfer and 133 patients who planned a fresh embryo transfer, 62% indicated that they would restart treatment when COVID restrictions were eased (2). The exception? Those who were using a gestational carrier decided to continue delaying treatment, given the risk of the carrier contracting COVID. 

Fertility clinics persist in taking rigorous precautions to avoid the transmission of COVID, while at the same time making it clear that there's no way to guarantee that COVID won't be transmitted. The decision to move forward with ART procedures is made by individual clinics, but ASRM recommends taking the following into consideration: 

  • How delaying the procedure may impact the patient if factors like age, ovarian reserve, endometriosis, etc, are in play.
  • The number of visits to the clinic that are necessary if your treatment requires only a few appointments, it might be prioritized. 
  • How delaying the treatment may impact one's emotional well-being. 
  • Health insurance and/or employment status: If you're about to lose your health insurance due to unemployment, for example, you may be able to get an appointment more easily. 
COVID's Impact on IVF 

Because COVID is still a rapidly evolving situation, we don't have information available about many aspects of the virus and its impact. (It's worth noting here that pregnant people have been largely excluded from vaccine trials, in spite of the fact that we know that there's a higher risk for pregnant people with COVID of hospitalization and death than those who aren't pregnant) (3). 

When it comes to COVID and IVF, one small observational (that's when researchers observe the effect of a test, treatment, risk factor) study indicated that women who had COVID didn't have decreased chances of success when they pursued IVF after recovery (4). The study tracked 46 recovered COVID patients and their levels of anti-Müllerian hormone (AMH), which indicates how many eggs one has, or her ovarian reserve. 

Why is AMH important in IVF? One of the first steps in the process of  IVF is ovarian stimulation, during which the patient is injected with a series of medications aimed at inducing ovulation, and amassing eggs for retrieval. A high level of AMH may indicate that you'll generate a high number of eggs (5). 

According to the research, there was no significant difference in those with average AMH levels before and after COVID. Those with normal AMH levels did see a slight decrease in her levels after COVID, but researchers agreed that this was unlikely to have any negative impact on fertility treatments. 

There are other aspects of IVF and COVID that are potentially confounding. Ovarian hyperstimulation syndrome (OHSS) is a condition that occurs in response to excess hormones, usually in injectable forms, and can occur in those undergoing IVF, causing the ovaries to become bloated and painful.  Mild forms of OHSS go away within a week, and symptoms include: 

  • Mild abdominal pain and tenderness in the area near the ovaries 
  • Abdominal bloating or increased waist size
  • Nausea
  • Vomiting
  • Diarrhea

More severe cases of OHSS can involve blood clots and shortness of breath, symptoms that can also be seen in COVID infections, so the jury is still out on how women with COVID would handle severe OHSS (6).

Additionally, we know that infections that cause fevers (a symptom of COVID)  can have an adverse impact on fertility treatments. A 2012 study revealed that IVF and ICSI cycles during which the patient had a fever required a longer duration of ovarian stimulation and a lower number of follicles being developed (7). Fevers can also have a negative impact on sperm concentration (the number of sperm in per unit volume of semen, as well as sperm morphology (the size and shape), and motility (the ability of sperm to move effectively) (8). Looking for a new way to identify your fertile window? Check out the Priya Personal Fertility System!

The COVID Vaccine and IVF 

We do know that the COVID vaccine does not cause infertility, but should you get it before you start IVF? ASRM and the Society of Assisted Reproductive Technology (SART) do not recommend waiting until you get the vaccine to start IVF, or if you're pregnant or breastfeeding (9). 

Your clinic may recommend specific timing for your vaccine you may be advised not to get the vaccine within a week of starting your treatment cycle or during it. 

Contracting COVID during fertility treatments will almost certainly result in stopping the procedures, depending on where you are in the cycle, until you've recovered. Getting vaccinated and continuing to take precautions against COVID will keep your treatments on track. 

If there was ever a time to have a thorough conversation  with your healthcare provider about what's right for you, it's now. Don't hesitate to advocate for yourself, make your concerns known, and get your questions answered. 

About the author:

Chanel Dubofsky's writing on gender, reproductive health, popular culture, and religion, can be found in New York MagazineLilith, RewireModern Fertility, Cosmopolitan, and others. She lives in Brooklyn, New York. Follow her on Instagram at cdubofsky.

References +
1

Patient Management and Clinical Recommendations during the Coronavirus (COVID-19) Pandemic. (2020, April 13). Retrieved July 17, 2021, from https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforceupdate1.pdf

2 Most patients resumed IVF treatment during the COVID-19 pandemic shut-down immediately when able. (2020, October 19). Retrieved July 17, 2021, from https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/most-patients-resumed-ivf-treatment-during-the-covid-19-pandemic-shut-down-immediately-when-able/
4

COVID Infection Unlikely to Jeopardize IVF Success, Small Study Suggests. (2021, June 29). Retrieved July 17, 2021, from https://www.medpagetoday.com/meetingcoverage/eshre/93335

6

Fertility Treatments in the Age of COVID-19: What We Know and Don't Know. (2020, April 17). Retrieved July 17, 2021, from https://www.medpagetoday.com/infectiousdisease/covid19/86019

9

ASRM and SART's FAQs Related to COVID-19. (2021, January 22). Retrieved July 17, 2021, from https://www.reproductivefacts.org/faqs/faqs-related-to-covid-19

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