On March 17, 2020, the American Society for Reproductive Medicine (ASRM) released a statement recommending the suspension of all new fertility treatments during the coronavirus COVID-19 pandemic. This decision was made to ensure that fertility clinics were doing their part in reducing the spread of coronavirus and to preserve healthcare resources for the many critical cases; it was also made in light of the “paucity of data surrounding the impact and potential risk of COVID-19 on pregnancy, the fetus and child well-being.”
The lack of concrete data is due to the fact that SARS-CoV-2, the technical name for the coronavirus that causes COVID-19, is a novel virus, meaning it’s new to humans. Experts have a few places to look for guidance on COVID-19 infection during pregnancy: the limited studies that have been 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.
Here, we’ll go over everything we know (and everything we don’t) about coronavirus and COVID-19’s potential effect on pregnancy and fertility.
COVID-19 and pregnancy
The short answer as to whether pregnant people are more at-risk in this pandemic—and whether a COVID-19 infection could affect a pregnancy or fetal health—is a big “maybe.” There isn’t a lot of evidence of adverse outcomes for mothers or babies, but the possibility has to be considered, based on what we know about viruses like the novel coronavirus.
Will being pregnant put me at risk for a more severe COVID-19 infection?
The Center for Disease Control (CDC) reports that we don’t “currently know if pregnant women have a greater chance of getting sick from COVID-19… nor whether they are more likely to have serious illness as a result.” We do know that pregnancy alters the immune system (as well as the heart, lungs, and other organs), and that if pregnant people get other respiratory infections—such as the flu—they’re more likely to experience severe illness.
A small 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 report by the World Health Organization (WHO) that looked at the outcomes of 147 pregnant women diagnosed with COVID-19, 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.”
However, the American College of Obstetricians and Gynecologists (ACOG) is still advising caution based on the impact of other respiratory illnesses (including influenza and the SARS outbreak of 2002–2003), stating that “pregnant women should be considered an at-risk population for COVID-19.”
Can COVID-19 impact pregnancy or fetal health?
First, it’s important to know that 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 coronavirus infection was the cause—and again, data is very limited.
When we look at the effects of related coronaviruses, such as those that caused SARS and MERS (studies: 1, 2), on pregnancy, we find that these illnesses can lead to miscarriage and premature delivery. And, a 2015 study looking at the role of infection (not coronaviruses, but flu and other illnesses) in pregnancy loss suggested that up to 15% of early and up to 66% of late miscarriages may be caused by an infection.
One of COVID-19’s largest potential risks for fetal health is the high fever often associated with the illness. One of the reasons that experts recommend that pregnant people get the flu vaccine—in addition to the increased risk of illness for the parent—is that a high fever while pregnant may be associated with birth defects in the developing baby. (To be more clear, while some studies have not found an increased instance of birth defects in babies born after maternal fever, others have found a significant increase.)
We’re speaking here about potential risks, not actual statistics. In the previously mentioned study of nine pregnant women with COVID-19, all nine babies were born healthy.
Can a pregnant person pass coronavirus to their baby?
The passing of an illness from the pregnant person to their 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, vertical transmission may be rare, but the possibility can’t be completely ruled out.
In the aforementioned small study of pregnant women who tested positive for the coronavirus, researchers also tested the amniotic fluid (the fluid that surrounds the fetus during pregnancy), the umbilical cords, swabs from the infants’ throats, and samples of the mothers’ breast milk—all samples tested negative for the presence of SARS-CoV-2.
However, there have since been several cases of newborns with coronavirus infections soon after birth. 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 coronavirus 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 study (once again, a small one) 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.
The good news: in all of the above studies, the 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 coronavirus 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.
COVID-19 and fertility
Will a COVID-19 infection affect female fertility?
When it comes to the impact of infections similar to coronavirus—such as influenza—on female fertility, the evidence is few and far between.
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 protocol 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 higher doses 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.” So, the data we currently have does not suggest that COVID-19 will impact fertility.
Will a COVID-19 infection affect male fertility?
Unlike female fertility, there’s good evidence that illnesses that cause fevers—such as influenza or COVID-19—affect male fertility in the short term. As reported by male fertility company Legacy, “seasonal flus are known to reduce male fertility… due to the fever associated with the illness.” Dr. Paul Turek, Legacy advisor, explains that, “currently, it is believed that the [novel coronavirus] is similar to a common seasonal flu virus regarding its impact on male fertility.”
There’s good evidence that that impact is only 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.
There’s no evidence at the moment that COVID-19 can impact male fertility permanently. Some researchers have raised the concern, 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). Dr. Allan Pacey advises that, while it’s important to consider the possibility, “it is premature to conclude [that] COVID-19 will definitely affect male fertility.”
So, should I stop trying to conceive during the coronavirus pandemic?
Fertility treatments are currently off the table. But should everyone stop trying to conceive altogether?
Honestly, this is a very personal decision. As you can gather from the information above, data is limited, and recommendations are being guided by an abundance of caution. 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. One big factor is the potential that there may be less access to healthcare resources, such as the regular prenatal care that’s important for pregnant people, as the crisis grows. Many hospitals and doctors’ offices have begun to 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.
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. It 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.
The impact of a delay
For many whose plans to conceive (whether naturally or via fertility treatments) have been postponed by the pandemic, a big question looms: will this delay affect my chances of getting pregnant?
The short answer is no. As Dr. Bat-Sheva Maslow explains, “when we’re talking about the decline of fertility with age, we’re talking in terms of years, not months.” There’s no evidence that a brief delay—one to three months, for example—has an impact on success rates, so don’t let that fear be a factor in your decision to wait (or not).
And, there are things you can do to prepare for this next step, even as you wait: