Need fertility counselling during COVID-19? Dr Duru Shah, Director of Gynaecworld, a reproductive fertility center in Mumbai, answers 8 questions on COVID-19 and fertility.
The unexpected explosion of the COVID-19 outbreak has posed certain challenges for the reproductive healthcare community. The COVID-19 pandemic has become a global concern and all the countries are trying their best to flatten the curve.
Due to limited evidence of the effect of the novel coronavirus virus on pregnancy and fertility, the possibility of the Sars-Cov-2 virus affecting the reproductive system cannot be ruled out.
Various fertility societies including the American, European and even Indian organizations have provided certain specific recommendations regarding fertility treatments and their way forward in these COVID times.
Till recently all fertility treatments were suspended leading to immense disappointment amongst patients. This was necessary as there is still very limited evidence to show how the virus might affect the embryos or early pregnancy.
However, as the initial wave of the pandemic has started to diminish and the government has relaxed certain lockdown measures, fertility hospitals and fertility treatment centers have once again resumed fertility treatments in a phased manner.
But, before you contact the best fertility center or talk to the best fertility doctors to start your fertility treatments and fertility injections, you should understand that there are many things we do not yet know about the effects of COVID-19 on fertility and pregnancy.
8 Questions On COVID-19 And Fertility Treatments
In this article, I’ve outlined 8 common questions on COVID-19 and fertility that we receive during fertility counselling to help you plan your advanced fertility treatments.
Before you plan your medication for IVF treatments, fertility surgery, or any other fertility treatment for women, you must discuss these issues with your fertility specialist or fertility clinic.
1. Which patients classify as priority candidates for fertility treatment?
According to medical recommendations, high-risk patients with associated co-morbidities like hypertension, diabetes or any other medical conditions should delay their treatment till the pandemic curve flattens.
Fertility specialists recommend that third party reproduction including donor and surrogacy cycles should be avoided, at least for the time being.
Patients who are cases of advanced age, who have a decreased number of eggs in their ovary or those who are scheduled to undergo cancer therapy need Assisted Reproductive Technology (ART) and fertility services on a priority basis.
2. Does the coronavirus affect the female reproductive system?
The coronavirus attaches itself to a membrane protein called the ACE2 receptors and gradually makes its way to the target organ. These ACE2 receptors have been found in the human ovaries and the lining of the uterus, i.e. the endometrium.
Normally these receptors help in the maturation and release of an egg every month in a natural cycle and also help in the regeneration of the uterus lining.
Because of the presence of these receptors in the female reproductive tract, there is a possibility of the virus affecting the female reproductive system.
Recent studies have failed to identify any viral RNA in ovarian or uterine tissues, but we need more evidence to establish this fact.
3. Does the coronavirus affect the male reproductive system or disrupt semen parameters?
If you’re under treatment for male fertility problems, you should know that there has been conflicting evidence regarding the presence of the coronavirus in the semen.
A few studies have observed the presence of the same ACE2 receptors in the testicular cells implying a possible effect of the virus on the male reproductive system.
However, other studies have not found the virus in the semen of men who recovered from COVID 19, although a study suggests temporary disruption in semen parameters doing active infection.
This can include a decrease in the sperm count and motility, which tends to occur in other common influenzas as well. Long term consequences and effects on men’s fertility are yet to be studied.
4. Does the COVID-19 coronavirus have an effect on the embryos?
The Indian Council of Medical Research (ICMR) has published a new study suggesting the possible effect of the coronavirus on early embryos due to the presence of ACE2 receptors on them.
The good news is that the embryo can be protected from the effect of the novel coronavirus in its early developmental days, due to a protective covering called the Zona pellucida.
But once the embryo crosses day 5 of its development, it hatches out of its protective covering and can be prone to contamination with the coronavirus during that time.
5. Do I have to undergo COVID-19 testing if I am planning an IVF cycle?
According to recommendations by IVF fertility centers, it is better to get the couple tested before starting any private fertility treatment. This is to ensure that the resulting embryos are not compromised.
Ideally, IVF is performed on day 2 of the cycle. If your fertility blood tests reveal that any partner is positive for COVID-19 or develops symptoms in the initial part of the cycle, it’s better to postpone the IVF cycle.
If the eggs have already been retrieved as a part of an IVF cycle, the embryos can be made and frozen or vitrified; to be implanted in the subsequent cycle once COVID-19 symptoms subside.
6. What’s the risk that the COVID-19 infection will affect my unborn child?
According to WHO, pregnant women do not appear to be at a higher risk of severe COVID-19 infection. But, since pregnancy itself is a state of compromised immunity, there are chances of a pregnant woman contracting the coronavirus.
However, there is no observable difference between the symptoms manifested by a pregnant woman and a non-pregnant woman.
There have been studies in which newborns born to COVID positive mothers have shown no symptoms after birth and have an absolutely normal birth weight.
But there are also some studies in which antibodies to COVID-19 have been detected in newborns after birth, suggesting the possibility of intrauterine transmission of the virus from the mother to the baby.
A few case studies have also shown that severe COVID-19 infection can lead to premature labour or early delivery. So keep these factors in mind when discussing fertility solutions with your fertility doctor.
7. What precautions can I take if I’m already pregnant or trying to conceive?
It is indeed a trying time for all of us, but with certain necessary precautions, pregnant women and women trying to conceive can protect themselves from the infection.
Social distancing and avoiding crowded places or ceremonies can help you avoid contact with an infected person. Frequent hand washing and sanitization of household items and home can ensure a clean and safe environment.
Along with your fertility vitamins and pregnancy vitamins, taking immunity-boosting drugs like vitamin C and Zinc tablets can help too.
As a pregnant woman, you should take full advantage of telemedicine facilities and visit the fertility center only when needed.
8. Is coronavirus detected in breast milk?
Till now, there have been no reports that suggest the presence of the novel coronavirus, Sars-Cov-2, in the breast milk of new mothers.
But if the mother is COVID positive, there is a possibility of the transmission of the virus from mother to child during breastfeeding, due to close contact between the mother and the baby.
Hence, wearing of masks and following proper hand hygiene protocols are of utmost importance while handling the baby, as is proper COVID-19 treatment for mothers who test positive for coronavirus.
For fertility counselling and information about advanced fertility treatments and fertility treatment cost in India, contact our fertility center in Mumbai and learn about your fertility treatment options.
About the author:
Dr Duru Shah is Director, Gynaecworld, the Center for Women’s Health & Fertility in Mumbai, India and a prominent and well-known gynaecologist in India. She is not only known to be the best gynaecologists but also as one of the prominent social activists.
Through her profession, she has contributed towards the girl child and rural women in society. She is the voice of the gynaecological community, for propagating the best practices in her field and for championing multiple social causes pertaining to women’s health.
A consultant to Breach Candy Hospital, Jaslok Hospital and Sir Hurkisondas Hospital, even at the age of 62, Dr Shah is intrinsically engaged in setting new benchmarks for her profession and unflinchingly lends support to an array of social causes through various professional and social organisations.
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