Fertility clinics in the US, UK and Europe are now open, or due to open, after a temporary pause on non-urgent treatments due to the coronavirus pandemic.
The ASRM issued new recommendations at the end of April on how to safely start care, with updated guidelines on how clinics can do their work safely.
Similarly, the UK's HFEA has announced that clinics can apply to reopen as of 11 May, and the ESHRE has updated its recommendations to state that the pandemic is stabilising and “the return to normal daily life will also see the need to restart the provision of ART [assisted reproductive technology] treatments”.
Fertility treatment is often a time sensitive process, with age playing a role in egg and sperm quality and quantity and multiple interventions often required, so this will be welcome news to the growing numbers of people distressed over delays, which the majority of clinics were observing in line with industry recommendations.
One patient told the BBC: "Next year I would have been 39, and that sits with you heavy...The difference between being able to conceive in the next couple of months compared to next year… that could be the difference."
Despite fertility clinics reopening, sociologist Dr. Zeynep Gurtin writes in the Guardian, "for many patients this won't end the anxiety."
That's because it is clear that social distancing means that it can’t be a case of 'treatment as usual' – and additional medical and emotional support will be necessary. In some areas clinics are not yet operating at full capacity, or having to adapt to the "new normal" social distancing by managing changes to care.
The charity Fertility Network said it fears some patients could be "stuck in limbo." This is because they may not be able to undergo the tests needed in order to be referred to a fertility clinic. Whilst patients can in many cases contact clinics themselves without referral, often insurance (or in the case of the UK, NHS guidelines) may require them to seek consultations and tests from primary care physicians or OBGYNs first.
In a letter to the Guardian newspaper, Lucy, a fertility patient from London, said: "in reality, fertility services remain firmly in the grey area created by coronavirus. The situation brings a new dynamic to the already swirling questions that consume most of us dealing with fertility issues..."
What can you expect from fertility care as health systems and societies gradually re-open and adjust?
Here’s how fertility care might change
Clinics are changing the way they operate in coming months to manage the risk of coronavirus transmission, protect patients and staff, and to limit the use of personal protective equipment and other resources that might be required in other parts of the health system helping patients fight the virus.
New guidelines that aim to minimize contact and maintain social distancing include:
Telehealth consultations with doctors, nurses, counsellors and other staff
Physical distancing where possible
Staggered appointment times
Possible requests to wear a mask
Fewer visits to the clinic throughout treatment overall
There might also be:
Questions about potential coronavirus symptoms such as fever and cough.
Some clinics may limit the number of people allowed into the waiting room and consultation rooms, and so partners or others may not be able to accompany patients to appointments.
The ticking clock
Coronavirus-related family planning concerns also extend to single people worried about ticking biological clocks, currently unable to freely date in person (read about the rise in sales of at-home sperm freezing kits), as well as those who had been planning to try to conceive unassisted in the near future.
"As much as pregnancy plans are often tied to weddings, money and financial benefits like paid maternity leave are also huge factors. Getting everything to line up just right is a delicate process—and COVID-19 is taking a wrecking ball to it. Ewa, 34, a Ph.D. student, planned to get married, find a new job, and start trying to get pregnant. The pandemic upended these plans and created a domino effect: While she's postponed her wedding and job search amidst economic uncertainty, she and her fiancé have fast-tracked their baby-making efforts in order to take advantage of the maternity benefits offered by her current job." - Glamour
“My biggest fear is not making the right life decisions.” - Ewa, 34
Is it safe to try to get pregnant now?
There is no definitive evidence on fertility, pregnancy and COVID-19, as it is a relatively new virus. However, it appears that pregnant women are not more likely to get infected, or be at higher risk for severe symptoms.
A recent study of 43 pregnant women in the USA who had been admitted to hospital and tested positive for COVID-19 found nearly nine out of 10 had mild disease.
"All available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus." - Royal College of Gynaecologists
There is no evidence to suggest an increased risk of miscarriage.
Despite this, there are some things to be aware of:
Fever associated with COVID-19 can affect sperm quality for about three months, so may temporarily reduce fertility.
Data from the UKOSS study of 427 pregnant women in May 2020 found the majority of women who have become severely ill were in their third trimester of pregnancy, emphasising the importance of social distancing from 28 weeks of pregnancy.
The study also found pregnant women from black, Asian and minority ethnic (BAME) backgrounds are more likely than other women to be admitted to hospital for coronavirus.
Pregnant women over the age of 35, those who are overweight or obese, and those women who have pre-existing medical problems, such as high blood pressure and diabetes, also appear to be at higher risk of developing severe illness.
Emerging evidence suggests that transmission from a woman to her baby during pregnancy or birth (vertical transmission) is probable. However, the RCOG says: "It is important to emphasise that in all reported cases of newborn babies developing coronavirus very soon after birth, the babies were well."
Pregnant women are considered in the "vulnerable" group. As RCOG advises:
"Pregnancy in a small proportion of women can alter how your body handles severe viral infections."
Caution has driven the decisions made by officials to place pregnant women in the vulnerable category, as some viral infections are worse in pregnant women; however, all available evidence suggests that pregnant women are at no greater risk of becoming seriously unwell than other healthy adults if they develop coronavirus.
Why were clinics not treating patients?
In mid March, the American Society for Reproductive Medicine (ASRM) published guidelines that recommended fertility clinics suspend non-urgent treatments in the United States, including IVF and egg freezing, in order to protect patients and clinic workers through social distancing, as well as to reduce access to the healthcare system and to conserve medical supplies.
Similarly in Europe the UK fertility clinic regulator, the HFEA, and the main European body overseeing fertility care, ESHRE, released guidelines recommending clinics pause non-essential treatments.
Advice from fertility doctors
Fertility doctors ELANZA Wellness has spoken to encourage patients to contact a clinic as a first step, as they can arrange for a consultation (in clinic or via telehealth) to help plan options and advise on fertility.