|Year : 2020 | Volume
| Issue : 4 | Page : 213-215
Perspective: COVID-19 and its effect on patients undergoing infertility treatment
Mini Mol Padmini, Rafiya S H Sangameshwari
Department of Clinical Embryology, MGM School of Biomedical Sciences, MGM Institute of Health Sciences, (Deemed to be University), Navi Mumbai, Maharashtra, India
|Date of Submission||25-May-2020|
|Date of Decision||04-Jun-2020|
|Date of Acceptance||04-Jun-2020|
|Date of Web Publication||09-Dec-2020|
Dr. Mini Mol Padmini
Department of Clinical Embryology, MGM School of Biomedical Sciences, MGM Institute of Health Sciences (Deemed to be University), Sector 1, Kamothe, Kalamboli, Navi Mumbai 410209, Maharashtra.
Source of Support: None, Conflict of Interest: None
The sudden pause in infertility following an outbreak of the coronavirus disease-2019 (COVID-19) pandemic felt like another loss for those who were trying to conceive. Infertility can also be classified as a disease and as such, not all infertility care procedures should be considered elective. There is complexity in defining essential versus nonessential treatment. Therefore, for all of those who were about to start IVF (in vitro fertilization) cycle after years of trying to conceive, frozen embryo transfer (FET) could be a possible solution. FET has the potential of separating fertilization from pregnancy. It means that the IVF cycle without “embryo transfer” (ET) can be carried out and the resultant embryo can be frozen. These frozen embryos could be transferred to the patient after COVID-19 pandemic subsides. This way, the patient can avoid the adverse effects of the virus on the pregnancy. A sudden pause in the fertility cycle may lead to a feeling of hopelessness among patients, with certain thoughts that “they will never be able to conceive or that their life will never be happy.” Indeed, short delays may not compromise fertility. Patients as well as their doctors should be prepared for a stress-free post-pandemic period for pregnancy. Thus, assisted reproductive technology (ART) may ensure that the virus spoils do not spoil their life expectations.
Keywords: Assisted reproductive technology, COVID-19 and fertility treatment, fertility pause, frozen embryo transfer
|How to cite this article:|
Padmini MM, Sangameshwari RS. Perspective: COVID-19 and its effect on patients undergoing infertility treatment. MGM J Med Sci 2020;7:213-5
|How to cite this URL:|
Padmini MM, Sangameshwari RS. Perspective: COVID-19 and its effect on patients undergoing infertility treatment. MGM J Med Sci [serial online] 2020 [cited 2021 Jan 23];7:213-5. Available from: http://www.mgmjms.com/text.asp?2020/7/4/213/302800
| Introduction|| |
The rapid spread of coronavirus disease-2019 (COVID-19) has taken the world by surprise. Despite conflicting hypotheses about the origin of this virus, its natural evolution has been recently proved. It is well known that coronaviruses undergo genetic recombination, which can lead to new genotypes and outbreaks. The emergence of horseshoe bats in a large reservoir of severe acute respiratory syndrome coronavirus (SARS-CoV)––like viruses along with the tradition of eating exotic mammals in southern China is a time bomb. On March 11, 2020, the World Health Organization (WHO) declared the outbreak of novel coronavirus disease (COVID-19) a pandemic and reinforced its call for countries to take urgent action and step up their response to minimize transmission to save people’s lives. The first case of the coronavirus pandemic in India was registered on January 30, 2020. India is now at a critical stage. As of May 7, 2020, the Ministry of Health and Family Welfare has confirmed that a total of 35,902 active cases, 15,266 cured/discharged, and 1783 deaths in the country. Since the outbreak of COVID-19 pandemic, the American Society for Reproductive Medicine (ASRM) on March 17, 2020 gave out a notification to suspend all infertility treatment and sighted two reasons for the same: to reduce the spread of COVID-19 pandemic and to redirect health-care resources to critical care.
| Infertility not to be considered as an elective|| |
It was a sensible decision by ASRM at the outbreak of pandemic to put a pause on all the fertility treatment at this life and death situation of the COVID-19 outbreak. Infertility is a disease for some and a time-sensitive issue for many. This means that all in vitro fertilization (IVF) treatments should not have been termed as “elective treatment” and by doing so; the complexity has been elevated in defining elective and nonelective procedures. Such postponing time-bound procedures such as IVF can be devastating for those involved. The overall chance of conceiving will not be compromised for a few months but for older patients with reduced ovarian reserve and patients in need of immediate gonadotoxic oncology treatment will suffer.
| CORONAVIRUS DISEASE-2019 AND FERTILITY|| |
At present, the impact of COVID-19 on reproduction and pregnancy is not clear and whether this pandemic has any adverse impact on fetal health is also a big question mark. Though there is not much evidence on adverse outcomes for mothers or babies, the possibility must be considered. Nevertheless, according to earlier reports, newborns can get affected with COVID-19 infections as a “vertical transmission” from the mother shortly after birth,, so the possibility of vertical transmission of the virus from mother to baby cannot be excluded. The American College of Obstetricians and Gynecologists (ACOG) has indeed been briefed that pregnant women who have COVID-19 may be at higher risk for certain complications based on the above details. According to it, it is sensible to postpone pregnancy as the health-care resources may be less and not easily assessable. In addition, as this pandemic of COVID-19 requires social distancing and self-isolation, the close ones such as family and friends may not be able to be with a pregnant patient or couple to celebrate this milestone of their life. Also, there will not be any helping hands such as home nurses and domestic help available at this point in time which can further aggravate tension, stress, and anxiety.
| ASSISTED REPRODUCTIVE TECHNIQUE: A SENSIBLE SOLUTION|| |
One of the most remarkable advantages of the assisted reproductive technique (ART) is the flexibility to put the time the factor between fertilization and conception and this ability of separation can be bliss during this extended fertility due to the pandemic outbreak. Weiet al. in their study on fresh versus frozen embryo transfer (FET) in ovarian stimulation cycles concluded that FET has an advantage over using fresh embryos.
FET is thus an optimal option for those who cannot postpone their ovarian stimulation procedure, those with exceptionally low ovarian reserve and/or advanced age, or those waiting for anticancer therapy but wants to retain fertility. For women with poor ovarian reserve where ART treatment lasts for several months, as in the case of customized protocols, ART with FET remains a good choice.
On March 30, 2020, ASRM affirmed a recommendation that a new treatment cycle should not be initiated, all embryo transfers should be canceled, continue caring for people who are in the cycle for having urgent needs of stimulation for cryopreservation, they also recommended postponing elective surgeries, and any nonurgent diagnostic procedures and to prioritize telehealth over personal interaction. The European Society for Human Reproduction and Embryology (ESHRE) has recommended guidance on recommencing ART treatment, which states that all high-risk patients (e.g., diabetes, hypertension, use immunosuppressant therapy, past transplant patients, lung, liver, or renal disease) should not start ART treatment until it is advised safe by the relevant health-care professionals. All patients should be given a choice to proceed with or postponing their ART treatment. All patients with a previously confirmed COVID-19 infection should have a medical certificate of clearance to be eligible for treatment. If patients have been on respiratory support during the COVID-19 infection, they should additionally provide a medical specialist report. All staff members with positive test results for SARS-CoV-2 immunoglobulin M (IgM) or immunoglobulin G (IgG), irrespective of symptoms, should receive health-care advice and resume work only after the infection is cleared with a negative reverse transcription polymerase chain reaction (RT-PCR) test result or equivalent. It was also advised to use telemedicine for all treatment steps that do not require the physical presence of patients at the center to reduce staff–patient contact.
Who should be accessed when on pause?
When health-care facilities are feared, they are avoided. There must be consistent messaging and talks which will help women and their families to seek early advice and make timely decisions. This is particularly important for women with infertility, in the hold of fertility cycles, quarantine, and self-isolation. Infertility has been a disease for some while it is also time-sensitive. Thus, they need to focus on the issues that need to be addressed during this period of waiting, to prepare to conceive postpandemic. Short delays will not compromise fertility.
It is the perfect time to think about reproductive goals, as to how the patient wants their family to look, how many children they want and their spacing, and if they have enough time to give to their family. Tracking the menstrual cycle when on pause can be helpful as it provides lots of data that will be useful for fertility specialists when treatment is resumed. The tracking gives the idea of “fertile window,” the days before and after ovulation when a woman may be able to conceive naturally, there are numerous free apps available online to keep track of menstrual cycles
Schedule a virtual consultation with a fertility specialist so that women can share any relevant medical records and information about their cycle. It is time for fertility specialists to start thinking about their case, reviewing their history, and making recommendations about what to do next. Women need to address lifestyle changes such as their exercise routine and to quit smoking which may hamper their fertility treatment. They may be advised to start fertility supplements such as dehydroepiandrosterone (DHEA) and co (coenzyme) q10 and prenatal vitamins such as folic acid, vitamin D, and docosahexaenoic acid (DHA), a type of omega-3 fat.
It is the most important to plan out their expenses during this pause, as planning and working on finances is of prime concern so that they are ready when fertility specialists are ready to resume the cycles
| Conclusion|| |
This pause in infertility has been a feeling of sadness, fear, anger, stress, and isolation. For an infertile couple, it is an added emotional burden with further stress adding to it. It is hard and life-altering as they are fighting like the warriors in this pandemic, but everyone has their own unique journey. It does not really work, when we say “just relax and it will happen.” Waiting for just a few months can feel like a lifetime to someone who had already been waiting too long. FET may be an ideal solution for some of the infertile couples. If the couple knows that they have their own embryos in frozen form and these embryos can be used at a convenient time, they may feel more relaxed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF The proximal origin of SARS-CoV-2. Nat Med 2020;26:450-2.
Cheng VC, Lau SK, Woo PC, Yuen KY Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin Microbiol Rev 2007;20:660-94.
Cucinotta D, Vanelli M WHO declares COVID-19 a pandemic. Acta Biomed 2020;91:157-60.
Ministry of Health & Family Welfare, India. MoHFW | Home. Updated regularly. Available from: https://www.mohfw.gov.in/. [Last accessed on 2020 May 7].
American Society for Reproductive Medicine (ASRM): Impacting Reproductive Care Worldwide. Patient Management and Clinical Recommendations during the Coronavirus (COVID-19) Pandemic as of March 17, 2020. Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforce.pdf. [Last accessed on 2020 May 7].
Oliveira N Coronavirus: Baby diagnosed with virus 30 hours after birth. February 5, 2020. Available from: https://www.nydailynews.com/news/world/ny-coronavirus-baby-diagnosed-with-virus-thirty-hours-after-birth-20200205-yeernq5jhbe2hn42a3zg4thgpu-story.html.Published. [Last accessed on 2020 May 25].
New-born British baby tests positive for coronavirus. 2020. Available from: https://www.aa.com.tr/en/europe/new-born-british-baby-tests-positive-for-coronavirus/1766234. [Last accessed on 2020 May 25].
Wei D, Liu JY, Sun Y, Shi Y, Zhang B, et al
Frozen versus fresh single blastocyst transfer in ovulatory women: a multicentre, randomised controlled trial. Lancet 2019;393:1310-8. Doi: https://doi.org/10.1016/S0140-6736(18)32843-5.
Jan T Customized assisted reproduction enhancement (CARE) for women with extremely poor ovarian reserve (EPOR). J Gynecol Women’s Health 2017;3:555625.
Assisted reproduction and COVID-19: A statement from ESHRE for Phase 2. April 23, 2020. Available from: https://www.eshre.eu/Home/COVID19WG. [Last accessed on 2020 May 7].
Vitamins for fertility and healthy pregnancy. April 2, 2018. Available from: https://www.shadygrovefertility.com/blog/fertility-health/vitamins-for-fertility-and-healthy-pregnancy/. [Last accessed on 2020 May 25].