This Couple Had to Delay IVF Due to Coronavirus, Putting Dreams on Hold
Here's how Covid-19 has influenced infertility treatment guidelines, causing some people to have to halt or delay in vitro fertilization (IVF) cycles
Elise Adams and her husband have been on a two and half year journey to try to get pregnant. After three rounds of in vitro fertilization (IVF), they finally had some good news: A baby was on the way.
For many like Adams, IVF treatment is an involved, expensive, and complicated process, that requires careful timing, pricey medications, and multiple doctor’s visits. It requires hormonal injections, egg retrieval, the transfer of an embryo to the uterus, and the freezing and storage of extra embryos for future use, among other things. Approximately 1.9 percent of births in the U.S. are due to assisted reproductive technology, like IVF, reports the Centers for Disease Control and Prevention (CDC).
“We were super excited and so happy to finally start our family,” Adams recalls. But about six weeks into the pregnancy, in the beginning of March, Adams had a miscarriage.
At the same time in early March, the novel coronavirus and the disease it causes, Covid-19, started to spread rapidly throughout the country, calling for social distancing and stay-at-home mandates in many states. For five weeks, Adams and her husband were not able to get a hold of their doctor after her miscarriage to discuss when they could try again. This is an important step for the couple, as they have a single embryo remaining in storage. “We have one more embryo, so one more shot at this,” Adams says. “We’re just ready to see how the book ends, close the chapter, and move on either way with our lives, but we can’t do that.”
Courtesy Elise & Michael Adams
Infertility treatments during Covid-19
Adams and her husband, along with many other couples and individuals, are currently in a holding pattern in regards to their fertility treatment due to new guidelines from the American Society for Reproductive Medicine (ASRM). Effectively immediately on March 17, the group recommended that most fertility treatments be suspended as a means to help manage the spread of coronavirus. The ASRM is reevaluating the situation on a two-week basis, according to Sara Twogood, MD, an OB/GYN in Los Angeles and co-founder of the health education resource FemEd. The next update is expected on April 27.
“ASRM recommended continuing to care for patients who are “in-cycle” but not initiating new treatment cycles,” says Dr. Twogood. “This essentially means that patients who were already actively taking medications for the purpose of a fertility treatment would continue that cycle as planned. Patients who are not in the middle of an active cycle would be postponed.” This includes procedures like fertility testing, intrauterine insemination (IUI), egg retrievals and freezing, IVF, and other infertility treatments.
In some states, IVF is considered an essential service
When the ASRM issued these recommendations a few weeks ago, it caught not only the patients by surprise, but the doctors, too. “Although the ASRM isn’t a regulatory body [so there’s no punishment for not abiding by its guidelines] when you get a message from an organization, as a whole it makes everyone pause,” says James Grifo MD, PhD, who specializes in reproductive endocrinology, IVF, infertility, and obstetrics and gynecology at NYU Langone Medical Center. “A lot of patients weren’t happy, and I don’t blame them.”
The ASRM’s recommendations follow that of many other medical specialties—postponing any non-urgent procedures and office visits. The initial phrasing of the guidelines suggests fertility treatments were elective. To help clear this up, Dr. Grifo (who is also a member of the ASRM) and several other doctors got together to urge the ASRM to rethink its messaging as to not confuse the public.
“For someone who is mid-cycle in their fertility treatment, it’s not elective to not do her egg retrieval and leave her with swollen ovaries; that’s not good medicine,” says Dr. Grifo. “The ASRM wasn’t suggesting that, but the message needed to be clearer.” He says the ASRM has adjusted its messaging. Since then, many states such as New York have classified fertility treatments as essential services. Meanwhile, other states that are not as impacted by Covid-19, have left treatment plans up to the doctor and patient.
Currently, no major changes have occurred from its original guidelines. However, it’s important for patients to stay in touch with their doctors regarding next steps in this is an evolving situation, adds Dr. Twogood.
The effect of Covid-19 on fertility treatments
Adams understands the precautions that need to be taken during this time. She is following social distancing as well as the other CDC guidelines, but practicing these safety measures can take a toll on mental health. “Having a miscarriage and then having to be locked in your house for six weeks has been really hard,” she says. “You want to be able to go to lunch with your friends or just walk around Target to get your mind off things.” (Here’s how to keep loneliness and isolation from hurting your health during quarantine.)
There’s also a significant financial strain to consider for those postponing any treatment. “We have medicine that we’ve already bought that could expire if we’re not able to get treatment in time,” says Adams. This is on top of fertility insurance coverage Adams was able to get for this final round (all the other rounds were paid for out-of-pocket) that would go to waste if treatment doesn’t happen by the end of the calendar year.
If you’re getting ready to start a new treatment and haven’t had to pay any medical costs yet this could still lead to a financial strain. Many people are dealing with a lay-off or other financial hardship due to coronavirus that could put a halt on family planning, says Dr. Twogood. This may put people back to the beginning of the lengthy process, waiting for circumstances to change. “Delaying someone’s embryo transfer for a month or two is not a terrible thing,” says Dr. Grifo. “But for people who need to get embryos that aren’t given a chance, and they’re getting older, it could present a bigger problem.”
Courtesy Elise & Michael Adams
How to deal with fertility treatment delays during Covid-19
The best thing you can do as a patient is to be as informed as possible during this time, say both Dr. Grifo and Dr. Twogood. “Everyone wants a healthy staff, healthy patients, and a good outcome,” says Dr. Grifo. Talk to your doctor about your specific treatment. Together you can weigh the risks and benefits of either going forward or delaying treatments (with the understanding it may need to get canceled mid-treatment should you get sick). If you do choose to delay treatment, they recommend practicing all the self-care you can.
“Continue to maintain a lifestyle that optimizes fertility,” says Dr. Twogood. “Make sure you’re eating well, exercising, decreasing stress to the extent it’s possible, avoiding alcohol, smoking, and drugs, and continuing to take any recommended vitamins, supplements, and prescription medication (for non-fertility purposes).”
Although Adams and her husband have been through so much over the last two and a half years, she’s still able to find the silver lining in her own situation. “Of course a part of me wants [the procedure] to be done and hopefully get some good news as a result, but the other part of me is OK with waiting,” she says. Adams explains that it’s still unclear what impact Covid-19 has on a pregnant woman or her fetus. Also, she adds, those who are pregnant aren’t able to have their partner come to ultrasound appointments with them or participate in a baby shower. (Here’s what pregnancy is like during coronavirus, according to 10 women.)
Adams recognizes that “It’s small stuff in comparison to what’s going on in the world, but when you’ve waited as long as we have, you want your pregnancy to be the most special it could possibly be when if it does happen.
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- Medline Plus: "In vitro fertilization"
- Centers for Disease Control and Prevention: "ART Success Rates"
- American Society for Reproductive Medicine: "ASRM Issues New Guidance on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments"
- Sara Twogood, MD, OB/GYN at Cedars-Sinai and co-founder of the health education resource FemEd, Los Angeles
- James Grifo MD, PhD, reproductive endocrinology, IVF, infertility, and obstetrics and gynecology at NYU Langone Medical Center, New York City
- CDC: "How to Protect Yourself & Others"