UPDATED WITH NEW RESEARCH—JULY 24, 2020
Here, we’ll go over everything we know (and everything we don’t) about COVID-19’s potential affect on pregnancy and fertility.
SARS-CoV-2, the technical name for the coronavirus that causes COVID-19, is a novel virus, meaning it’s new to humans. In March, experts had just two places to look for guidance on COVID-19 infection during pregnancy: the limited studies published examining the consequences of COVID-19 during pregnancy in China and the known impact of related illnesses, such as MERS and SARS (others in the coronavirus family) as well as influenza.
But today, we have a little bit more data to guide family planning decisions.
Ongoing research into COVID-19, pregnancy, and fertility
There are several large studies being conducted right now to better understand the pregnancy during the pandemic. We don’t yet have the results from this research, but they promise to give us much clearer data on pregnancy and fertility during this pandemic.
A National Institute of Health-funded study will examine the medical records of over 20,000 pregnant people at their Maternal-Fetal Medicine Units (MFMU) Network, a group of 12 centers nationwide. They’ll also track the pregnancies of 1,500 patients with confirmed COVID-19 infections. Their aim is to understand not only how COVID-19 affects maternal health and pregnancy, but also how changes to healthcare accessibility—implemented as a result of the pandemic—may have affected pregnancy-related complications and C-sections.
The PRIORITY study, spearheaded by UCSF, aims to create a nationwide registry of pregnant or recently pregnant people who are either believed to have COVID-19 or have a confirmed COVID-19 infection. The hope is to help patients and healthcare providers better understand how COVID-19 impacts pregnant people and their newborns.
There’s also the ASPIRE study, which will track pregnancies during their first trimester, when all of a baby’s organ systems form, and the placenta, the crucial connection between mom and fetus, develops. This study, also run by UCSF, hopes to understand the impact of COVID-19 on this critical, vulnerable period of fetal development. To ensure they’re able to track pregnancies from the earliest days, this study is partnering with fertility clinics, including our team at Extend Fertility.
COVID-19 and pregnancy
Will being pregnant put me at risk for a more severe COVID-19 infection?
Thus far, it appears that pregnant people with COVID-19 infections are at a slightly higher risk of serious illness, though not more likely to die, than non-pregnant people. The overall risk is still low for those of childbearing age.
According to a CDC Morbidity and Mortality Weekly Report examining COVID-19 cases from January–June, pregnant people with COVID-19 are more likely to be hospitalized and more likely to be admitted to the ICU than non-pregnant people of the same age, especially Black and Hispanic pregnant people. In this report, the death rate for pregnant people with COVID-19 was not higher than that of non-pregnant people. Unfortunately, much is missing from the CDC data, including whether hospitalizations were due to COVID-19 symptoms or pregnancy complications. The data also did not look at the hospitalization or ICU admittance rates of non-infected pregnant people as a comparison.
In response to this report by the CDC, the American College of Obstetricians and Gynecologists (ACOG) advises caution, but reminds the public that “while this report suggests an increase in risk of severe outcomes in pregnant women with SARS-CoV-2 infection… the overall risk to pregnant women is still low.”
Other research has had mixed results. A small, early study of nine pregnant women in Wuhan, China, where the novel coronavirus was first discovered, concluded that the subjects didn’t experience more severe pneumonia than non-pregnant patients. And in a February report by the World Health Organization (WHO) that looked at the outcomes of 147 pregnant women diagnosed with COVID-19 in China, it was determined that they weren’t more likely than non-pregnant people to develop life-threatening illness: 8% had what the WHO classified as “severe disease” and 1% were “critical.”
More recent studies include one from the UK that analyzed the outcome of all pregnant people admitted to the hospital with confirmed COVID-19 infection in March/April 2020, a total of 427. About 10% of these women became so ill they required respiratory support; though five women died (a number consistent with the death rates of non-pregnant people in the UK), most had good outcomes. The results suggested that COVID-19 was not impacting mothers-to-be as significantly as previous outbreaks like H1N1 flu or SARS.
And a small study from Sweden published in July examined the health outcomes of 53 women with COVID-19 infections, 13 of whom were either pregnant or up to one week postpartum. Like the CDC report, the results of this review suggest that the risk of being admitted to ICU may be higher in pregnant and postpartum women with COVID-19, compared with non-pregnant women in the same age group.
Can COVID-19 impact pregnancy or fetal health?
Note: the novel coronavirus is not related to the Zika virus, a mosquito-borne illness with known adverse effects on the health of a baby in utero.
ACOG reports that, while preterm birth and other negative health outcomes have been reported for some infants born to mothers with COVID-19, it’s not clear that the COVID-19 infection was the cause—and again, data is very limited. There’s no evidence right now that COVID-19 causes problems with a baby’s development or an increased risk of miscarriage.
In the previously mentioned study of nine pregnant women with COVID-19, all nine babies were born healthy.
Can a pregnant person pass COVID-19 to their baby?
Passing an illness from the pregnant person to the baby is known as “vertical transmission,” referring to infection that happens during pregnancy, labor/delivery, or soon after birth (such as via breastfeeding).
In the case of the novel coronavirus, it’s now believed that vertical transmission is probable, if uncommon. A baby in London tested positive for the virus—which its mother also had—just minutes after birth. And in a study of 33 infants born to mothers with COVID-19, three were diagnosed with COVID-19 infections. In both cases, doctors concluded that, while the exact method of spread wasn’t clear, vertical transmission during pregnancy or delivery couldn’t be completely ruled out.
The most recent available study looked at the presence of immune antibodies, developed to fight the virus, in six infants born to mothers with COVID-19 infections. Because these antibodies are too large to be passed from the mother through the placenta, it’s believed they were developed independently, suggesting that the infants had contracted the novel coronavirus from their mothers in utero.
In all of the above studies, the three infants cleared the virus quickly—and in general, COVID-19 deaths among babies and children are rare.
How can pregnant people protect themselves and their babies?
The best recommendations for pregnant people are also the general CDC recommendations for avoiding COVID-19 infection: maintain self-isolation and social distance (meaning stay home if you can, and keep away from others if you have to go out), avoid touching your face, and wash, wash, wash your hands. (Don’t skip prenatal visits, though! They’re very important to monitor the health of the baby and the parent.)
COVID-19 and fertility
Will a COVID-19 infection affect female fertility?
It’s possible, though far from proven, that infections that cause a fever could interfere with fertility treatments. One small study reported that, for women undergoing ovarian stimulation (the medication used during IVF and egg freezing), having a fever during their cycle was associated with a lower number of eggs retrieved, a longer cycle, and a higher level of required medication.
However, even if it were true that fevers could impact IVF or egg freezing cycles temporarily, there’s no good reason to believe they’d have a long-term effect on female fertility. According to Dr. Joshua Klein, there’s no evidence that “a high fever should have a measurable or significant impact on a woman’s future fertility.”
Some researchers have raised theoretical questions around what’s known as ACE2, the protein enzyme to which the novel coronavirus binds; ACE2 provides a sort of “entryway” for the virus to infect cells. ACE2 is on the surface of many cells in the lungs, heart, blood vessels, kidneys, liver, gastrointestinal tract, and reproductive organs, where the enzyme helps regulate the development of ovarian follicles and the uterine lining. Therefore, there has been a concern that the coronavirus could interfere with female reproductive functions.
However, a recent study suggests that there’s actually a low concentration of ACE2 in the female reproductive system; those researchers conclude that these organs are unlikely to be susceptible to coronavirus infection, and that COVID-19 is unlikely to have a negative impact on female fertility.
Will a COVID-19 infection affect male fertility?
Reports indicate a decrease in sperm concentration and motility (movement) for up to 90 days post-COVID infection. This is likely due to fever associated with the virus, which raises the body temperature above the optimal temperature for producing sperm. Many illnesses that cause fevers affect male fertility; as reported by male fertility company Legacy, “seasonal flus are known to reduce male fertility… due to the fever associated with the illness.”
But, there’s evidence, from looking at the effect of other illnesses, that this impact will be temporary. In one case study, a patient recovering from influenza produced normal sperm again 45 days post-fever, and in another, sperm count, motility, and genetic health began to improve in the 50–70 days after the patient’s fever resolved. Dr. Paul Turek, Legacy advisor, explains that “currently, it is believed that [COVID-19] is similar to a common seasonal flu virus regarding its impact on male fertility.”
Some researchers have raised the concern that male fertility could be permanently impacted by COVID-19 infection, based on the rare yet serious effects of viral infections like mumps and SARS (which can cause orchitis, or severe inflammation in the testicles that may damage fertility). A small study revealed that, while the coronavirus was not found in the testes in the majority of subjects, COVID-19 patients exhibited significant injury and inflammation in the testicles. However, there’s no evidence as of yet that this injury is permanent.
As with female fertility, there is the possibility that the presence of ACE2 in the testicles, and the enzyme’s role in the production of sperm, could mean that an infection will affect reproductive function. But again, this connection is theoretical and has not been demonstrated in clinical practice or research.
So, should I stop trying to conceive during the COVID-19 pandemic?
Honestly, this is a very personal decision. There’s a high likelihood that—if you are pregnant now or get pregnant during this pandemic—you and your baby will be just fine.
But there are other, non-health-related factors to consider if you’re trying to decide if now’s a good time to conceive. Many hospitals and doctors’ offices still prohibit visitors other than the patient themselves, including partners, family, or support people like doulas, in an effort to reduce the amount of close contact in their spaces. Currently, many pregnant people are being asked by their healthcare providers to practice a strict quarantine after the 37-week mark, to reduce the chance that the virus could be contracted and potentially transmitted to others during the delivery.
It’s also important to consider that the need for social distancing and self-isolation may interfere with the ability of family and friends to help a pregnant person or couple prepare for or celebrate this milestone in their lives, and may mean loved ones aren’t able to assist hands-on in the tiring weeks right after the baby’s birth.
All of this may add to the stress experienced during the pregnancy—on top of the anxiety already experienced by so many in response to the pandemic, and the very normal stress of being pregnant.
Fertility treatment during the pandemic
For a period after COVID-19 was declared a pandemic, the American Society for Reproductive Medicine (ASRM) recommended that fertility clinics pause treatment as we waited for more data about the virus, including its effect on pregnant people and babies. Then, on April 24, ASRM offered guidance for safely resuming fertility care. Extend Fertility reopened on May 1 with strict protocols to keep our patients, and our team, safe and healthy. We are currently offering all fertility services, including IVF and fertility preservation.
Is fertility treatment safe at this time? Evidence points to yes. Importantly, there is a very low probability that sperm, eggs, or embryos can be contaminated by coronavirus. First of all, washing, culture, and freezing protocols in embryology labs appear to reduce the potential for transmission. And secondly, sperm, eggs, and embryos may actually lack the necessary receptors for this virus.
Fertility preservation during the pandemic
We currently don’t know when life will return to “normal,” and many couples are putting off trying to conceive. Some experts believe that, because of these uncertainties, this pandemic may be a never-before-seen indication for fertility preservation like egg freezing or embryo freezing.
If you are concerned about your fertility or family planning during this pandemic, we are currently offering egg and embryo freezing services with free virtual consultations. Learn more about our COVID-19 services and protocols.