The COVID-19 pandemic has led to great confusion and anxiety for folks on their fertility journeys. We’re thankful to Dr. Witt, Medical Director of WINFertility and Greenwich Fertility. He is a board-certified reproductive endocrinologist and OBGYN who has been offering reproductive care for more than 25 years. And for National Fertility Awareness Week he shares his insight on how we can navigate this challenging time and provides tangible resources for folks to use as they navigate this time.
This is a time of great anxiety for everyone, but if you’re in the midst of a fertility cycle, there are added layers of uncertainty. What can people who are currently in cycle do to ease their anxiety?
In general, infertility treatment can be stressful but the current COVID-19 pandemic certainly adds to that stress. There are things that can be done to help reduce stress. If you are in the midst of a fertility cycle, your clinic can provide you with a referral to a mental health provider who can work with you with strategies for managing the stress and emotions at this incredibly difficult time. Many mental health providers can offer telehealth options that may be covered by your insurance carrier.
Our current understanding is that if folks haven’t begun treatment, that they wait until their provider gives clearance based on the latest information from the CDC and The American Society for Reproductive Medicine (ASRM) is that correct? What does that mean for families and individuals that are planning?
The ASRM recommendations for the pandemic allowed for those patients who were already in cycle (IVF, intrauterine insemination, or frozen embryo transfer cycle) to continue their treatment cycle after a discussion of the potential risks associated with conceiving during the pandemic. Patients who were doing IVF were advised to freeze all their embryos and not undergo a fresh transfer. This would allow for delaying the transfer until it is deemed safe to do so. There was also a recommendation not to start any new fertility treatment cycles or to proceed with any diagnostic tests (like hysterosalpingograms). At this point, several weeks after the recommendations were published, most patients who were in cycle, have completed them, so there are few fertility treatment cycles happening in most clinics currently.
It is understood that postponing treatment is a difficult task for patients, many of whom have already gone through a great deal of stress and grief as a result of their infertility. It should be somewhat reassuring to hear that there is no evidence that delaying treatment for a month or two will ultimately affect the ability to have a child, even in the face of advanced age or decreased ovarian reserve (low number of eggs in the ovaries).
It should be noted that people facing an urgent need for fertility preservation (for instance, those diagnosed with cancer who are planning chemotherapy that will adversely affect their future fertility) can proceed during the pandemic, if this is deemed to be reasonable after consultation with their doctor.
The ASRM recommendations are not guidelines that are being enforced so individual practitioners may decide how and when they think it is appropriate to resume treatment in their clinics. However, most fertility clinics will likely wait for guidance on this. The ASRM recommendations will be continuously reviewed and updated with this in mind.
How can the compounded stress surrounding COVID-19 affect an assisted fertility cycle?
It is known that stress may be a contributing factor to infertility, but quantifying the effect of stress on an assisted fertility cycle has been difficult. Anything that can be done to reduce stress would be considered possibly beneficial. This would include regular exercise, yoga, getting adequate sleep, and using relaxation techniques. Some have recommended utilizing relaxation or mindfulness apps to reduce anxiety and tension and improve sleep. ASRM has offered the following as some examples of these apps: Ferticalm (for women), FertiStrong (for men), Headspace, MindshiftCBT, and Personal Zen.
Are you advising that clients work with licensed mental health providers during the pandemic?
For anyone who is experiencing stress or emotional distress during this pandemic, consultation with a licensed mental health professional is recommended. These consultations can usually be performed via a telehealth visit, allowing social distancing to be maintained.
What do fertility appointments look like during this time? Are partners allowed to attend appointments?
Not every fertility center is practicing in the exact same way. Many have moved all fertility-related consultations to telehealth visits, while there are some that may still be seeing patients in their offices while using precautions. Although initially, it was deemed adequate to screen patients and staff for symptoms or fever in order to prevent viral transmission, it has been found that many people infected with the novel coronavirus have no symptoms, or are contagious prior to the onset of symptoms, so universal precautions must be taken. However, even these precautions aren’t foolproof and do not guarantee safety. There is no current screening that can eliminate the risk. .As a result, many practices are not having any in-office appointments other than for early pregnancy monitoring for those who have already conceived. Telehealth visits allow for an evaluation of the patient’s medical history and to plan for evaluation and future treatment. Partners are encouraged to participate in telehealth visits.
A lot of people are saying “people shouldn’t get pregnant right now”. That’s obviously hard for a person or couple who’s mentally and emotionally prepared to endure the process. We know this isn’t an arbitrary decision, can you explain the rationale for delaying treatment?
There are numerous reasons why fertility treatments are being delayed right now. Although infertility is a disease, its treatment is considered medically necessary, and no one providing fertility care believes that any fertility treatment is elective, the urgency of treatment is not the same as for surgical emergencies (for instance, a ruptured appendix). Other non-emergent treatments like orthopedic surgery, eye surgery, and dental procedures, are also being postponed as a result of the pandemic. A delay in fertility treatment of a few months has not been demonstrated to lower the ultimate chance of successfully conceiving.
The major reason for the delay in fertility treatments is to limit the risk of viral transmission to patients and staff given the highly contagious nature of the virus and that many of those infected are asymptomatic. Although most who are infected will not have a severe illness, a significant minority will require hospitalization and some will succumb to their disease. Unlike many other medical treatments, fertility treatments usually require frequent visits over several weeks which make it difficult to maintain adequate social distancing, and increase the risk of exposure to the virus.
Many fertility centers have donated their PPE (personal protective equipment) to hospitals on the front line, as a result of the shortage of these materials. Some clinics, especially those associated with a hospital, have loaned their anesthesia equipment (which can be used as ventilators) or even the patient care space (recovery rooms, procedure rooms) to the hospitals that are in dire need of these. Those centers obviously are unable to proceed until they have all of their equipment and space available for their use.
Additionally, there is significant concern about the risk for COVID-19 infection in pregnant women, so delaying fertility treatment, and resultant conception may be warranted. Although very early preliminary data does not indicate major issues in pregnancy, there is very little data to go by. Other similar respiratory viruses have had a worse disease course in pregnant women (higher risk for pneumonia, for instance), and therefore pregnant women may be considered a high risk group. There are also concerns about whether the fetus or newborn could be adversely affected, but it is too early to know for certain.
What can fertility clients look forward to? Are there some resources you love that you’d like to share?
Like everyone else, fertility clients can look forward to a time when we can resume somewhat normal lives. This will include continuing with fertility investigations and treatments. It is unclear at this time when that will occur but the hope is it will be in just a few months. The goal of preventing infections must remain paramount, but it is understood that resumption of fertility care must happen as soon as it is safe to do so.
Some recommendations and resources to consider:
• RESOLVE: The National Infertility Association has resources and various ways to get support. RESOLVE has an online support community, local support groups (now meeting virtually), webinars, and other content to help you connect, get support, and stay informed. RESOLVE is offering its peer-led support groups via virtual technology so that you can connect with others going through the same thing as you
• Limit use of social media and other sources of news so that you are not inundated with information, much of which is inaccurate and anxiety inducing. Maybe set a certain time of each day for news gathering when you are less likely to trigger anxiety (avoid these for at least an hour before bedtime).
• Distract yourself with non-COVID-19 related topics. Read a book, watch a funny movie, take an online course.
• Focus on improving your health. You may want to use this time to focus on improving general health (for instance, quitting smoking, drinking less or losing weight) that may improve future fertility treatment success.
• Stay in touch with others in your support network. Use virtual connections via telephone or video chat to do this. Staying connected with others reduces the sense of isolation.
For more information, please visit WINFertility
Barry Witt, M.D is Medical Director of WINFertility and Greenwich Fertility. He is a board-certified reproductive endocrinologist and OBGYN who has been offering reproductive care for more than 25 years.