Kristy and Brandon Callaway are ready to have a baby. They’ve started setting up their nursery with a crib and bassinet, and like to toss around baby names, though they haven’t found one they agree on yet. They started in vitro fertilization last year, and in mid-March, Kristy was set to begin a monthlong series of daily injections and medications to prepare her body for a frozen embryo transfer initially scheduled to take place this week.
Then the coronavirus began spreading through the U.S. On March 18, Kristy’s fertility doctor called to let her know her treatment would be postponed. Now, the Callaways’ dreams are on hold.
“We were finally taking the biggest step of all toward becoming parents, and it came to a screeching halt,” Kristy said. “With a single phone call, our dreams and plans were on hold again. I cried the entire day. I still cry often.”
Fertility treatments, including IVF, are often physically taxing, emotionally painful, expensive and full of uncertainty. Becoming pregnant can take years, and just one IVF cycle can cost between $10,000 and $15,000, depending on insurance coverage and treatment center costs. Pushing back treatment could mean an individual has a lower likelihood of success or less money to afford the procedures.
But COVID-19 is giving many couples, like the Callaways, no choice but to delay. In order to protect patients, fertility centers have suspended new fertility treatments — including IVF, intrauterine inseminations, and ovulation induction — due to concerns surrounding COVID-19, as recommended by the American Society for Reproductive Medicine.
The ASRM guidelines urge fertility doctors and centers to strongly consider canceling embryo transfers and suspending elective surgeries and nonurgent diagnostic procedures, but allow care to continue for women who are “in-cycle” (meaning treatment is in progress), as well as in cases where women require urgent stimulation and cryopreservation (egg or embryo freezing), such as cancer patients who may soon be starting chemotherapy.
Current research shows it’s not likely that the coronavirus can pass from mother to fetus during pregnancy, labor or delivery, according to the American College of Obstetricians and Gynecologists. The guidelines are more about reducing community transmission of the virus and reducing pressure on overburdened health systems and hospitals, and they fall in line with Centers for Disease Control and Prevention guidelines that suggest canceling elective procedures and using telemedicine when possible.
Many states have issued executive orders that outline which businesses and facilities must close in light of COVID-19, but health care facilities are typically deemed an essential service and permitted to stay open.
Still, some IVF centers have shut down entirely, which means that even patients whose treatment is already in progress have had to cancel fertility treatments, said Meir Olcha, a board-certified obstetrician and gynecologist and the director of preimplantation embryo assessment at New Hope Fertility Center in New York City.
There’s a real urgency to resume treatments when it’s safe to do so, said Amanda Kallen, a board-certified reproductive endocrinologist at the Yale Fertility Center. But pinpointing when that will happen is difficult and will likely be dictated by the progression of the pandemic, ASRM guidelines, and broader state and federal shelter-in-place orders.
“We’re having daily conversations with our practice on how soon can we get started again, when is it safe, and how do we prioritize people who have been waiting or are ready to go,” Kallen said.
In the meantime, she’s working to support panicked and anxious patients and provide reassurance that this pause is temporary and designed to prevent the rapid spread of COVID-19.
“But I don’t think anybody feels that this is an easy decision for us to make or for patients to have to deal with,” Kallen said. “I’ve seen the word elective used to describe fertility treatment and that’s not the right word. It’s not elective and nobody chooses to be infertile and nobody chooses to need to use fertility treatments.”
Postponing treatment three to six months can significantly impact the chance of being pregnant in certain patients. Meir Olcha, New Hope Fertility Center
Since we don’t know how long the pandemic or the current ASRM recommendations will last, fertility experts agree that it’s tough to know whether suspended fertility treatments could eliminate the chance of becoming pregnant for some women. Olcha said it’s a possibility given that fertility and ovarian reserve decline with age and sometimes this decline can be steep.
“Postponing treatment three to six months can significantly impact the chance of being pregnant in certain patients,” Olcha said.
Mark Surrey, a clinical professor in the department of obstetrics and gynecology at the David Geffen School of Medicine at UCLA and associate director at the Southern California Reproductive Center, said determining how halted treatments will affect fertility is tricky and “sort of like trying to predict the future.”
He explained that there are biological markers that help to assess fertility. One is called Anti-Müllerian hormone and helps predict ovarian reserve, which is basically the number and quality of eggs in a woman’s ovaries. A low AMH marker allows fertility specialists to project that an individual’s ability to get pregnant would be affected by time.
But while the hormone marker helps with clinical judgments, “it’s hard to attach that to a specific time,” Surrey said.
Lost time isn’t the only concern for fertility specialists and people trying to get fertility treatment right now. The financial impact of the pandemic is a worry too. As the economy takes a hit and people lose jobs, money set aside to start a family may need to be diverted elsewhere. Kallen said she has patients who have lost their jobs, leaving uncertainty around whether they’ll be able to start or resume fertility treatments once the world gets back to a place where these treatments are even happening.
“I think the longer this goes on, the more you’re going to see that we’re all even more worried and anxious about the effect that it’s going to have on our patients — not only their chance of success, but also their mental and physical well-being,” Kallen said.
If this continues for a while, Kallen thinks discussions will evolve about ways to proceed safely with fertility treatments while still protecting health care workers and preserving personal protective equipment.
Both Kristy and Brandon Callaway have medical issues that affect their fertility, and they learned early on that they would need to pursue IVF to have children. Kristy has already undergone two egg retrieval procedures that each yielded only one viable embryo. The next step, whenever it’s safe to do it, will be to transfer the embryo.
“With every previous delay, there was a pill we could take or a procedure we could go through that would get us closer to our goal of parenthood,” Kristy said. “COVID-19 offered us no solutions other than time. So we wait for the day our doctor calls and tells me to start those injections so we can begin the embryo transfer process.”
Until the situation changes, Kristy and others awaiting fertility treatment can only wait.
“I understand why this had to happen, and I know that the smartest thing we can do for our embryos is to leave them where they are ― frozen in a lab, safe from the outside world,” she said. “But that doesn’t make it any easier.”
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