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Fertility and COVID-19
Pregnant women have some reason to be concerned about COVID-19. Women in the midst of fertility treatment do too.
Like everyone else, I am consumed by news about COVID-19. Every day, I read for hours, and almost everything I read feels apocalyptic.
For people who are in the middle of trying to have children, this is an especially fraught time.
Some women are currently pregnant and they may be concerned about the risks to themselves and their fetuses. There is some preliminary information — though not much.
A study in the Lancet investigated nine births after the mothers were infected with the virus in their third trimester. There were some complications, including pre-eclampsia and fetal distress, and all the babies were delivered by C-section within one to seven days after the mothers got sick. But the good news is that all the mothers and all the babies survived; none of the babies contracted the virus. Another even smaller study, looking at four births, also reported no deaths and no transmission. But the American Society for Reproductive Medicine (ASRM) reminds us that when numbers are small, we have to be cautious about the findings.
Pregnant women do have some reason to be concerned. They are more susceptible to respiratory illnesses and pneumonia. Their immune systems are suppressed, for one thing, and pregnancy causes physiological changes: the diaphragm gets pushed upwards by the uterus, the lungs get a bit compressed, and so on.
During the Spanish flu of 1918, the general population had a mortality rate of less than six percent, whereas for pregnant women it was 37 percent, the authors of the first study note. More recently, during the 2009 H1N1 pandemic, pregnant women were four times more likely to be admitted to hospital with complications.
The most useful comparison might be with SARS, another coronavirus disease, but the data on that is scant as well. One paper studied all 12 pregnant women who presented with SARS in Hong Kong. These women were nearly three times as likely to require ventilation. Three of the 12 women died. That's a 25 percent death rate compared to 10 percent in the general population.
Four of the seven women who were in their first trimester miscarried. Four of the five women who got ill after their 24th week had to deliver preterm. Two women recovered without having to deliver, but both had pregnancies complicated by intrauterine growth restriction. None of the babies were born with SARS. A Canadian SARS case study reported a patient who delivered a healthy baby at term.
The American College of Obstetricians and Gynecologists (ACOG) have developed an algorithm for managing pregnant women who have confirmed or suspected COVID-19.
Patients whose surrogate is pregnant, and who do not live near their surrogate, will be dealing with these concerns from afar. Travel restrictions mean they may not be able to attend appointments with their surrogate, may miss the birth of their baby, and may even need to appoint someone to care for their newborn until they are allowed to get there.
Then there are the patients who are not yet pregnant. Clinics are grappling with what to do. One clinic in Toronto, for instance, is asking women to reschedule if they have common cold symptoms, if they have had any contact whatsoever with people who have been quarantined or tested positive, or if they've travelled outside of Canada in the last 21 days. It is easy to imagine that guidelines like these will be overtaken in the coming days, as cities and regions go into lockdown.
What happens to intended parents and donors who are in the middle of an egg donation?
What happens to surrogates who are about to give birth?
What happens to older women who are going through IVF — for whom a delay of a few months might mean never getting pregnant?
The European Society of Human Reproduction and Embryology (ESHRE) is advising that "all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid becoming pregnant at this time." Further, they reaffirm that "all medical professionals have a duty to avoid additional stress to a healthcare system that in many locations is already overloaded."
The whole enterprise of fertility medicine may come to a standstill as this crisis barrels through.
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