Updated as of January 2021
Navigating or considering fertility treatments (IVF, IUI, egg freezing, or other treatments) is extremely physically and emotionally challenging, and we know that the addition of the novel coronavirus (COVID-19) global pandemic is exponentially increasing this. We want anyone to know that if your fertility treatments or family planning timeline is being thrown into question by this public health crisis, we are here for you.
We’re committed to keeping you updated with all of the latest fact-based information as we have it, as well as improving access to care and to experts you can speak with from your own home about what this means for you and your family.
For the latest updates on how fertility treatments are resuming and what is shifting at fertility clinics, join our weekly Ask Maven Anything live Q&As on Wednesdays at 12p ET/9a PT on Instagram @mavenclinic with Dr. Brian Levine, Reproductive Endocrinologist and Founding Partner and Practice Director of CCRM NY.
Guidance: How COVID-19 is impacting fertility
As of June 8th, 2020, the leading American body for guidance on fertility treatments, the American Society for Reproductive Medicine or ASRM, updated their recommendations for all clinics to “gradually and judiciously resume the delivery of reproductive care”, after putting a pause on non-urgent fertility treatments (including IVF, IUI, embryo transfers, egg freezing, etc.) starting in mid-March.
This latest guidance, which is ASRM’s Update #5 in response to COVID-19, recommends that clinics continue to assess risks carefully and cautiously in order to resume fertility treatments and seeing patients in-person when possible, while outlining careful guidelines around PPE by treatment type.
Importantly, ASRM recommends that fertility clinics look to their state and local regulatory bodies and health departments for the latest guidance around delivery of care and safety precautions given their COVID-19 phase.
Here are a few key points from ASRM’s latest update:
- Fertility providers and clinics should ensure that patients have access to mental health specialists for counseling, support, and resources, given the added stress to the already-challenging treatment process caused by the pandemic. Guidance suggests that providers should equip patients with a referral list of mental health professionals who specialize in fertility/infertility counseling.
- Clinics should offer counseling and guidance for those looking to become a parent around the unknowns related to COVID-19, pregnancy, fetal development, and more.
- Research demonstrates that COVID-19 disproportionally impacts racial and ethnic minorities, meaning that providers need to focus on bias training and should keep this top-of-mind to understand unique patient needs, treatment options, patient education, and how to drive outcomes.
- Given that prospective research continues to be needed to understand the full scope of the impact of COVID-19 on both patient response to fertility treatments and on early pregnancy, ASRM encourages fertility providers and their patients to participate in clinical studies.
FAQs on fertility and COVID-19
Questions answered by Dr. Brian Levine, Reproductive Endocrinologist and founding partner and practice director of CCRM NY
What should fertility patients expect at this time, given the shifts in guidance?
We all agreed that hitting pause on treatments was the right thing to do given all of the unknowns from COVID-19. We’re so glad to be gradually resuming treatments and seeing patients again, but the reality is that so much remains unknown. So really, we’re navigating this with our patients. We’re talking with them often and transparently, including through increased telehealth appointments.
Most clinics are using their local health departments to understand when it’s safe to reopen, then really looking closely at what needs to change in terms of our standard operating procedures to meet the unique moment we’re living in and make sure we’re following all precautions as carefully as possible.
Here’s what patients can expect:
- Waiting rooms will look completely different to allow for only one patient at a time.
- Clinics are evaluating how to adopt testing and what will be possible for each clinic in terms of universal testing as we follow safety and health recommendations from the CDC.
- Most fertility providers, like us at CCRM, are having more telehealth appointments with our patients to really talk through what treatment will look like for them in this new normal and talk through their concerns and questions.
- Fertility providers and clinics are talking more and sharing more around the country to understand what we’re seeing in certain regions, what we’re learning, and what it all means for our practices, our clinics, and our patients. We’ve always been extremely open given the nature of the topics we discuss with our patients, but we’re being especially open as we navigate this all together.
If a woman becomes pregnant naturally at this time, what should she do?
If someone gets pregnant at this time, they don’t need to panic. They just need to be a good citizen and follow all of the latest recommendations from the CDC. They should talk to their OB-GYN through a virtual appointment, and ask them for their advice.
If you do get a positive pregnancy test, it is important to know that it’s a pregnancy that is intrauterine and not an ectopic pregnancy. Right now, there’s no guidance given about changing any management or therapies, and you should just treat yourself like you would if you were pregnant any other time, except stay at home, practice social distancing, and call your doctor rather than scheduling an in-person appointment.
Here’s a question from a woman in her late 30s with low AMH levels, who was scheduled to start an egg freezing cycle, which has now been postponed: “How much difference does a month or two make if we’re taking a pause on a lot of these retrievals and treatments?”
This is probably the #1 question that we’re getting; we’re hearing, “I get it, I need to pause, but for how long because my body is still aging at the same rate it was before all of this”. The truth is, we don’t know. No one’s fertility is predictable. What we’re telling people right now is: it’s not going to be impossible to freeze your eggs in the future, but it may take longer than you would like.
What do fertility patients need to know about mental health particularly right now, given the ASRM guidance and your typical holistic approach?
I think quite often people understand that reproductive care is associated with stress and anxiety, but we don't really talk about what's happening as people are trying to come back to their fertility doctors, especially during this pandemic. The number one thing that we're seeing right now is people alternating between anxiety and guilt. People are really anxious. They're really concerned about if this is the right time to be trying to get pregnant. They're anxious about what are the long term effects of being pregnant during a pandemic, or is this the best time to place their so-called "golden embryo" back inside of them? Should they be going through treatments, and how do they affect their body? And then you see people go right back to this element of guilt. People see the news about the frontline workers and people getting sick in hospitals and they're questioning whether they should be caring about fertility when resources aren’t available for other people. And it's actually a really interesting conversation and the reality is that every patient I see is grappling with this.
It's a baseline anxiety about what's going on in the world. And it's these really strong emotions of guilt. Is it the right time then or are they risking the potential changes for this child that could be indelible? And so it's a lot of education, it's a lot of handholding to address that, and encouraging patients to access mental health support with specialists in fertility.
Should men be freezing their sperm right now?
The COVID-19 outbreak is not a reason to go to your doctor and freeze your sperm ahead of time. We know that any febrile illness (the clinical term for a fever, or elevated body temperature) can cause issues with male fertility and sperm production. It takes approximately 72 days for a man to be able to produce a single spermatozoa, but it’s a continuum and men keep making sperm every single day. If someone has a high fever, it’s expected that their sperm count will drop after that, and it will take approximately three months for them to fully recover. But COVID-19 is not similar to Zika virus, where the virus could be living in your semen, testicles, or the tissue surrounding the sperm. The key takeaway is an illness with a high fever like COVID-19 can cause a drop in your total sperm count, but your numbers do rebound and freezing your sperm proactively is not necessary.
From a member: “I’m self-pay and live in New York City, but I’m currently in Los Angeles. If I can’t make it back to my city for the procedure if my city isn’t starting egg freezing cycles, can I just do a cycle here? What are the considerations involved?”
I always urge patients who get “stuck” somewhere else that it is up to the clinic that they’re looking to go to, and their comfort level with proceeding with a cycle. There are some really basic things that need to be known before stimulating any patient: what is their risk of ovarian hyperstimulation or getting sick as a result of the stimulation itself, and also what are the other health complications or considerations had before stimulating them.
In this very charged time, some places are continuing with stay at home orders and some are beginning to slowly reopen, so while it may be possible that you’ll be able to do your cycle, it will be up to that actual clinic if they’re still running and if they do want to accept patients that were initially not their own. So it’s on a clinic-to-clinic basis.
If you have questions you’d like a Maven provider to answer, please let us know.
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Disclaimer: The information provided here is for educational purposes only. This information is not intended as legal advice or medical advice, and is provided on an “as is” and “as available” basis without any warranties of any kind. Moreover, due to rapidly changing developments, we make no warranty or guarantee concerning the accuracy or reliability of the content on this page. For the latest information regarding COVID-19, we refer you to the Centers for Disease Control and Prevention website (www.cdc.gov).
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