Your Reproductive Health During COVID-19

The situation with coronavirus (COVID-19) is rapidly evolving, and it can be overwhelming to try and keep up with the latest news. As of April 5, 2020, more than one million people have been confirmed to have COVID-19 worldwide. The center of the Pandemic is now the United States.  Here are basic FAQ’s about COVID-19 as it pertains to fertility, pregnancy and breastfeeding.

Background:

Q: What is COVID-19?

A: COVID-19 stands for Coronavirus Disease 2019. COVID-19 is an infectious disease caused by a virus called the coronavirus. COVID-19 is officially caused by a coronavirus called Severe Acute Respiratory Syndrome (SARS)-CoV-2.

COVID-19 causes respiratory illness (like the flu) with symptoms such as a cough, fever, and in more severe cases, difficulty breathing.

Q: Why is COVID-19 concerning?

A: The current spread of this new coronavirus has been rapid and the infection rate has increased exponentially. The virus now has affected almost every continent and has shown itself to be highly contagious. Many people who have been infected with coronavirus have no symptoms and can unknowingly shed the virus, thus infecting those around them.

Symptoms:

Q: What are the symptoms of COVID-19?

A: Common symptoms of COVID-19 infection include fever, respiratory symptoms, cough, and/or shortness of breath, loss of smell or taste. The tricky thing is that many people with allergies or a cold can have the same symptoms. If you have any of these symptoms, please alert your primary care provider so that they can determine if you need to be tested for the coronavirus.  Anyone experiencing symptoms such as difficulty breathing or shortness of breath, persistent pain or pressure in the chest, bluish lips or face or an inability to arouse should seek medical attention immediately.

Q: How does COVID-19 spread?

A: It can be spread person-to-person through respiratory droplets from a cough or sneeze. It can also be spread by touching objects that have been exposed to these droplets.

 Q: Who is considered a more at-risk population?

A: According to the CDC, those at higher risk include older adults (older than 60 years) and those with serious, chronic medical conditions like heart disease, lung disease, and diabetes. Healthy women and men of childbearing age are not as high of a risk however, they can still be affected. At this time, just under half of hospitalized people with this coronavirus are under the age of 50.

Prevention

Q: What is the best way to prevent COVID-19?

A: The CDC recommends that all people follow basic hygiene guidelines to decrease the potential for viral transmission:

  • Washing your hands often with soap and water for at least 20 seconds.
  • Between hand washes, use sanitizer regularly, especially after touching doorknobs and keyboards in public places.
  • Avoid touching your face (nose, eyes, mouth) with unwashed or unsanitized hands.
  • Cover your nose and mouth with a tissue when you cough or sneeze, or cough into your elbow. Throw away any used tissues promptly and wash your hands immediately.
  • Practice Social and Physical Distancing – when you are out in public, deliberately increase the physician space (minimum of six feet or two arm lengths) between you and others
  • If you are sick, please stay home and take care of yourself.

Q: Should I wear a mask?

A: Please be aware that the typical masks we utilize for medical care do not provide protection against the COVID-19 virus. These masks only work to contain your secretions so that you do not infect others. As of March 3, 2020, the CDC now recommends that everyone wear a mask (even a home-made one is OK) if they leave their house.  It is important to sanitize masks after use, this means using your washing machine to clean homemade masks or disposing of paper masks.

Fertility:

Q: Does COVID-19 infection impact fertility?

A: We have limited data on this specific coronavirus and its impact on reproduction and pregnancy. At the current time, infection with this coronavirus does not impact the ability to get pregnant. We do not know if the virus can be spread through semen or with sexual intercourse.

Q: Has COVID-19 been seen in the reproductive system?

A: The COVID-19 virus appears to be isolated to the respiratory and gastrointestinal systems. At the time of writing this statement, it does not appear that the virus resides in the female reproductive tract. There is some evidence that the virus may infect the male reproductive systems based on the large presence of a specific receptor called the Angiotensin Converting Enzyme 2 (ACE2) receptor to which the COVID-19 virus attaches for entry into the human cell. This receptor is rarely, if ever, seen in the female reproductive system.

Q: My fertility treatment has been delayed. What is the impact of delaying my fertility treatment on my overall fertility?

A: For most fertility patients, waiting a period of a few weeks or 1-2 months to begin treatment will not change your overall chance of getting pregnant; having a child through treatment will remain similar. But that’s not true for everyone – for example, those patients who are about to undertake urgent cancer treatment with either chemo- or radiation therapy, may lose their fertility altogether if they don’t undertake fertility preservation.

Pregnancy:

Q: Should I avoid becoming pregnant right now?

A: It is important to point out that the COVID-19 virus is not like the Zika virus. At this time, there is no definitive evidence that the COVID-19 virus will have an ill-effect on pregnancy. That being said, women who are infected with COVID-19 have a higher chance of having a miscarriage and having pre-term labor. Most women will not have this happen. All of the information that is currently available is from a small case series (fewer than 20 patients) with women exposed in the third trimester of pregnancy. We don’t have much knowledge of what happens if a pregnant woman is exposed in the first or second trimester.

Q: If I am pregnant, what is COVID-19’s impact on pregnancy?

A: Very little is known about COVID-19 related to its effect on pregnant women and infants, and there are currently no recommendations specific to pregnant women regarding the testing or management of COVID-19. We do not have much information from published scientific reports about the susceptibility of pregnant women to COVID-19. In general, pregnant women experience immunologic and physiologic changes that make them more susceptible to viral respiratory infections. It is reasonable to predict that pregnant women will be more susceptible based on prior coronavirus infections such as SARS and MERS.

The only data that we currently have is based on third trimester infections with COVID-19. There is little, if any, data on first or second trimester exposures. Currently, there are 2 case series totaling only 18 women which have shown reassuring outcomes of COVID-19 infection and pregnancy – only one woman experienced severe respiratory morbidity which required intubation and ventilation.

In general (not specific to COVID-19), there is mixed data regarding congenital malformations in the setting of maternal fever. Data from SARS infection is reassuring, suggesting that there is no increased risk of fetal loss of congenital abnormalities.

There have been a small number of reported problems with preterm delivery in babies born to mothers who tested positive for COVID-19 during their pregnancy, however it is not clear that these outcomes were related to maternal infection. Many of these early deliveries were thought to be iatrogenic, meaning due to medical decisions being made by the physicians.

Q: Can COVID-19 be passed from a pregnant woman to her fetus or newborn?

A: There is no evidence of the COVID-19 virus being found in either amniotic fluid or in umbilical cord blood. Lack of vertical transmission (from mother to fetus/newborn) is similar to what’s seen in other respiratory viral illnesses. We do not know if COVID-19 can cross the placenta during pregnancy, but there have not been any new cases of newborns screening positive for COVID-19. Please see more information on the CDC’s Pregnancy & Breastfeeding page.

Q: Can COVID-19 be transmitted through breastmilk?

A: There is no evidence of this coronavirus being found in breastmilk. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and health care practitioners. Currently, the primary concern is not whether the virus can be transmitted through breastmilk, but rather whether an infected mother can transmit the virus through respiratory droplets, given how close mother’s faces are to their infants, during the period of breastfeeding.

Gynecologic Care:

Q: Should I continue to schedule elective surgeries?

A: Federal, as well as many local, regional, state and hospital mandates, have led to the suspension of all elective or non-urgent surgery in order to preserve critical resources (including personal protective equipment (PPEs), ventilators, and trained staff) for more urgent needs. An enormous surge in affected individuals needing advanced respiratory care is expected within the coming weeks. The purpose of these mandates is the goal of flattening the transmission curve for COVID-19 and minimizing the use of resources that are needed on the front lines for addressing this pandemic.

For many patients with symptomatic surgical issues, including fibroids/polyps, endometriosis, ovarian cysts, and other benign conditions who have surgeries already scheduled, it is recommended that these procedures be rescheduled. National and local health department guidelines should be followed in scheduling these surgeries, recognizing that the pandemic is evolving at different rates in different locations.

Q: Should I go and get my annual exam and PAP smear done?

A: At this time, physician offices have been encouraged to conduct Telehealth consultations in order to limit the number of in-person interactions. This is due to the fact that anyone who goes to see a doctor can be inadvertently exposed to COVID-19, whether it is riding with others in an elevator, sitting in waiting room, touching a door handle or using a pen. For these reasons, it is strongly recommended not to undertake any elective procedures or have any elective visits occur at this time; this includes annual examinations/PAP smears. Physicians are strongly encouraging patients to reschedule these important, but not emergent, visits.

Q: Where should I go for additional information?

A: If you have any additional questions, we encourage you to reach out to us. You can also find more information online at these trusted resources:

  1. Missouri Department of Health & Senior Services (MDHSS)
  2. Center for Disease Control/Public Health (CDC)
  3. Food and Drug Administration (FDA)
  4. American Society of Reproductive Medicine (ASRM)/SART
  5. American College of Obstetrics and Gynecology (ACOG)

The team at SIRM® St. Louis has launched All Things Fertility podcast.  Join Drs. Molina Dayal and Maureen Schulte as they look to educate and inspire listeners to take control of their fertility health, including our latest episode on COVID-19 and its impact on fertility health.  Visit stlouisfertilitycenter.com/podcasts