When Alyssa*, a 30-year-old infertility patient, began fertility treatments last September, she discovered that on top of her endometriosis, she had a low ovarian reserve (meaning that she has fewer-than-normal eggs for her age) and low-quality eggs. After four egg retrieval cycles, she was left with only one healthy embryo—aka just one shot at getting pregnant with her own eggs. Her doctor suggested moving on to an embryo transfer (where the embryo is implanted into her uterus) in mid-April.
To prepare for the procedure, Alyssa took a shot of the synthetic hormone Lupron in early March. It temporarily put her body into a medically-induced menopausal state that caused hot flashes, night sweats, and headaches. She also went on a strict anti-inflammatory diet to help manage her symptoms and increase her odds of a successful transfer. But after all that, and just five days away from beginning the official prep for her embryo transfer (a new round of hormone shots to help her uterus prepare for a baby), all fertility treatments at her clinic were postponed due to COVID-19.
This isn’t a one-off situation: On March 17, the American Society for Reproductive Medicine (ASRM) called for fertility doctors to suspend most new, non-urgent fertility treatments, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF), and egg and sperm freezing to preserve resources and prevent the spread of the new coronavirus. Many states have also issued orders forbidding elective surgeries and procedures during the COVID-19 outbreak, a designation that applies to most fertility procedures as well as things like cataract or joint-replacement surgery.
But being denied fertility treatment right now feels more personal than having to delay your annual physical or eye exam, because it’s your chance at a future family hanging in the balance. “This isn’t an elective surgery. Fertility patients have no choice,” says Alyssa. “Every time we’re given a little bit of good news, it’s taken away. It feels like that all over again, and we were so close to the end.”
“Patients feel that infertility is not being treated like a disease right now. Many feel it’s unjust…[and] are frustrated,” says Brian Levine, MD, the founding partner and practice director of the fertility clinic CCRM New York, who is board-certified in reproductive endocrinology and infertility as well as obstetrics and gynecology. But as the epidemic continues to grip the U.S. and most of the world, fertility patients will have no choice but to put their plans on hold indefinitely.
The complications of family planning during an uncertain time
The pandemic is also causing many people who are not experiencing fertility issues to put their pregnancy plans on ice, so to speak. A survey of nearly 2,000 women released by Modern Fertility and financial startup SoFi found 31 percent of respondents were changing their fertility or family planning decisions due to COVID-19. One reason? It’s unclear what effects a COVID-19 infection could have on a mom or developing baby.
Thankfully, the World Health Organization says that pregnant people don’t appear to be at higher risk of contracting a severe case of the disease, a conclusion echoed by another small new study and statements by the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine. But for those who do contract the illness, fever (which is a symptom of COVID-19) in the first trimester of pregnancy may cause birth defects and miscarriage. These groups also add that pregnant people may be more likely to have potentially life-threatening complications from respiratory infections like the flu or COVID-19. Dr. Levine points to two New York women who had asymptomatic COVID-19 infections and didn’t know they had the virus; they were admitted to the emergency room soon after delivery because they got very sick very quickly.
Amy, mother of a 3-year-old and founder of the blog The Postpartum Party, says she and her husband had been trying to conceive but may put their plans on hold for other reasons related to the pandemic and lockdown. “Being stuck at home all day with a toddler has definitely made us question if we want to keep trying for number two,” she says. “I’m also worried about getting pregnant and having to go out more for care and doctor appointments.” Similarly, 46 percent of the Modern Fertility-SoFi survey respondents say that they’re worried about access to prenatal care during COVID-19. (For the record, care is still available for pregnant women; the American College of Obstetricians and Gynecologists (ACOG) recommends that OB/GYNs providing care to expectant mothers should take appropriate precautions to limit unnecessary contact, including transitioning some appointments over to telemedicine and staggering the amount of patients in the office.)
Aviva Romm, MD, a midwife, herbalist, and internal and family physician, says stress and uncertainty are taking their toll on many people who are planning their families. “Most of my patients and quite a few friends have decided to wait a few months and let ‘the dust settle’ a bit before [trying to conceive],” she says.
“Even though I’m just 30 years old, my reproductive system is saying otherwise. Time is of the essence.” —Alyssa*, infertility patient
However, for fertility patients, delaying a pregnancy indefinitely is a bitter pill to swallow, especially since these treatments are a huge investment of time and money (to the tune of tens of thousands of dollars). Mary Sawdon, ND, says that planning for a frozen embryo transfer IVF cycle in March got her through her darkest days after her miscarriage in December. However, her fertility clinic has closed indefinitely to ride out COVID-19—a conundrum that 18 percent of the Modern Fertility-SoFi survey respondents are facing, too.
“I know in my rational brain that cancelling all new cycles in light of the pandemic is a necessity for public health and safety, but it still doesn’t make it any easier for my emotional heart to grapple with,” Sawdon says. “I feel like I’m in limbo. There are a lot of things out of my control.”
Many patients also feel like they can’t afford to just “wait.” Alyssa is deeply concerned that the longer her embryo transfer is delayed, the less likely it will lead to a healthy, successful pregnancy. “Even though I’m just 30 years old, my reproductive system is saying, ‘Time is of the essence. I can’t really wait much longer.’ This is my life, and I’m ready to start a family.”
“I do think we will need to re-address [the guidelines] if [the pandemic] goes on a long time,” says Molly Quinn, MD, an OB/GYN specialized in endocrinology and infertility at the UCLA Medical Center in Santa Monica, California.. “There’s no data that a month or two of delay will impact success [of fertility treatments]. But six months will have an impact.”
Getting through the COVID-19 pandemic when conception plans are delayed
Despite the necessary limitations to fertility treatments right now, many health-care providers have shifted their practices to serve their patients remotely as best they can. Both Dr. Quinn and Dr. Levine have moved their consultations to telehealth for all fertility prep work, including initial consultations, lifestyle optimizations for diet and exercise, treatment plans, and orders for future diagnostic tests.
Dr. Levine says working almost exclusively online actually allows him to consult with more patients in a day. “As frustrating and sad as this is on a daily basis, we have an even greater reach and can go deeper into the patient population that we wouldn’t have had access to before,” he says.
People who want to pursue pregnancy are finding other ways to manage their time and handle disappointment with delays. Fertility patient Cassie Lando says her clinic recently allowed her to start a timed intercourse cycle with medication that stimulates ovulation since her IVF treatment was delayed. She’s now giving it her all from home, monitoring for ovulation with LH test strips, basal body temperature charts, and the at-home progesterone test kit Proov. “It’s giving me great peace of mind,” she says, to feel that she’s making some kind of progress on her fertility journey right now.
Otherwise, patients are being told to focus on what they can do to hit the ground running when treatments can resume: eating a healthy diet, exercising, and reducing as much stress as possible. In addition to telehealth consultations, people who are struggling to conceive can try the app Fruitful Fertility, which pairs them with mentors who’ve already been through fertility treatments, or other online infertility groups for comfort and support. RESOLVE, an infertility advocacy organization, also offers information and resources. The ASRM will also revisit its guidelines every two weeks as the pandemic continues, with the stated goal of “resuming usual patient care as soon and as safely as possible.”
It might feel like little comfort to people who have tried for so long to conceive, but doctors want their patients to know that they’re doing everything possible to support them during this extremely difficult time. “Patients are not being left alone. Providers are doing whatever we can to bridge the gap so patients know they’re being supported and set up for success to hit it out of the park once we get that green light,” Dr. Levine says. Hopefully that comes sooner rather than later, for everyone’s sake.
*Name has been changed for privacy reasons.