Coronavirus: How Does The State of Alarm Affect Assisted Reproduction?

By (embryologin), (gynecologist) and (invitra staff).
Last Update: 03/18/2020

The corona crisis is causing a state of emergency in various countries worldwide. The virus, which puts people world wide into quarantine because of its high rate of infection, has changed the way we live and work and the way we socialize in the coming days.

Despite the discovery of this virus a few months ago, every day we know a little more about how the corona virus and quarantine will affect pregnant women and patients undergoing assisted reproduction treatment.

Nevertheless, it is still unclear how things internationally will develop in the future which is why we currently recommend not to start right now with your family planning.

In the following article, we are going to examine the situation for U.K and U.S. fertility patients who are in the middle of a treatment or who are thinking about starting a IVF cycle.

Below you have an index with the 7 points we are going to deal with in this article.

What is the coronavirus??

Nowadays, pretty much everyone has heard the word corona virus. However, only few know that the real name of this virus is SARS-CoV-2.

Corona virus is the name of viruses that mainly infect animals. Some of them have developed the ability to be transmitted from animals to humans.This ability to jump from animals to people is known as zoonosis.

The name corona virus was invented in the 1960s when these virus types were first observed under the microscope. The characteristic figure of the virus showed a crown surrounding it. This halo reminds us of the solar corona we see when we look at the stars.

The new corona virus was first discovered in December 2019 in Wuhan, China. The virus has spread throughout Asia and into Europe, particularly in Italy and Spain, which are particularly affected by the virus.

The excessive daily increase in COVID-19 cases in Spain has prompted governments worldwide to take drastic measures to stop the spread of the virus.
The disease that causes SARS-CoV-2 is called COVID-19 and has a very characteristic clinical manifestation, which we will see below.

Symptoms of COVID-19

First of all, it should be noted that this virus can be asymptomatic or present with small symptoms in a certain part of the population, as is the case with the vast majority of children and even part of the adult population. This population is not susceptible to the test that detects the coronavirus. That is why the data on the symptoms of this disease are from those people who have been tested for COVID-19.

According to data published by the Ministry of Health, 80% of patients who are ill and diagnosed with COVID-19 have mild symptoms. However, the other 20% may have serious complications. Some of the most common symptoms are:

  • Fever
  • Cough
  • Fatigue
  • Dyspnea

In that most vulnerable patients, there may be a risk of certain pulmonary complications, such as bilateral pneumonia. This respiratory disease affects both lungs and causes difficulties in breathing normally.

How is the coronavirus transmitted?

COVID-19 is transmitted by contact with respiratory secretions that patients give off when they cough or sneeze. This secretion would infect a healthy person if it came into contact with their mucous membranes, i.e. nose, eyes or mouth.

It should be noted that this new coronavirus is highly contagious and that the authorities recommend keeping a distance of at least 2 meters from infected people or people with symptoms of it to prevent it from spreading.

incubation period of the coronavirus

Official data from the Ministry of Health report that the incubation period of coronavirus can reach 14 days after exposure.

This is because of the virus' ability to survive on inert surfaces. The coronavirus can be active on an inert surface for up to 9 days after it has been deposited there. This makes it easier for the coronavirus to survive for several days on metal surfaces, such as doorknobs or stair railings, while waiting to be transmitted to a new host that has its hand on the surface.

Treatment of coronavirus

There is no treatment for this virus. Currently, pharmaceutical companies have started a race to develop an effective vaccine against SARS-CoV-2.

The treatments that are usually used are to palliate and control the symptoms that cause COVID-19.

Antibiotics should not be used to treat this disease, since this infection is caused by a virus, not bacteria

Prevention

In order to prevent the coronavirus from spreading, it is important that the population knows how to protect themselves from the coronavirus. Compliance with the hygiene rules will therefore help us to prevent this disease and prevent it from spreading:

  • Frequent hand washing
  • Avoid touching the face
  • Coughing and sneezing in the elbows
  • Use disposable tissues
  • Isolation when presenting symptoms

Coronavirus and fertility treatments in the U.K.

Although the British Government had declared not to undertake any steps against the battle of the corona virus earlier, it has shut down the country now, and its citizens have to abide to safety measures to in order to combat the further spread of the virus.

The new stance of the British Government will also influence the activities of U.K. fertility centers in the long run.

However, it is still left to the decision of each fertility clinic, whether to stick to the guidance of the British Fertility Society and the Association of Reproductive and Clinical Scientists.

It is expected for clinics to follow the advice from both associations. This means that fertility treatments, that are not urgent, should be delayed.

The British Fertility Society sets the following guidelines for U.K. licenced fertility centers:

  • Not starting new treatments such as In-Vitro fertilization, embryo transfer, surgical sperm retrieval, insemination and ovulation induction
  • Consultations are to be carried out by phone or video calls
  • It is reasonable for non-infected Fertility patients who have already commenced a fertility treatment to complete their cycle.

Coronavirus and fertility treatments in the U.S.

Although generally speaking, the United States is currently at the initiation phase, there are already various states in which the COVID-19 has massively been spreading.

Governors in various U.S. states have therefore begun, to implement strict measures to encourage its citizens to stay at home. This means, among others, that in the respective regions, a ban on gatherings of people, travel restrictions and the closing of leisure facilities will be ordered.

The new virus has not only an impact on areas of daily life though. It also effects the U.S. health sector, including fertility clinics.The American Society for Reproductive Medicine therefore suggests avoid getting pregnant for those who presumably or are confirmed COVID-19 infected.

This also includes gestational carriers and both egg and sperm donors.

Gestational carriers and egg donors are recommended to freeze their oocytes or embryos and delaying their embryo transfer until they are desease-free.

As the U.S. administration has not implemented a shutdown on fertility clinics yet, there are still various U.S. fertility centers that keep on treating infertility patients always keeping in mind the recommendations of the CDC:

  • Practice good hygiene such as disinfection, avoiding physical contact and washing hands.
  • Provide video conference whenever possible.
  • Isolate oneself when suspecting infection or presenting symptoms.

Coronavirus and pregnancy

Fortunately, it has not been described that women infected with corona virus can transmit the disease to their babies.

Studies during the epidemic in China showed that babies born to infected mothers were born free of the virus. In addition, the virus was not found in amniotic fluid, umbilical cord or breast milk.

This is why the WHO maintains that pregnant women do not appear to have a greater risk than other patients of developing complications from COVD-19.

Patients who are currently pregnant should be reassured that no teratogenic or malignant effect on the baby has been seen. This means that the coronavirus does not cause malformations in the babies of infected pregnant mothers.

Although data on pregnant women and women infected with corona virus are very promising, they need to continue to be protected in the same way as the rest of the population. Therefore, it is recommended precaution in this situation if the woman is pregnant.

FAQs from users

As Medical Director of Ginemed, could you explain to us what the coronavirus is and how it can affect us?

By Dr. Pascual Sánchez Martín (gynecologist).

COVID-19 is highly contagious and spreads easily through the population, but behaves similarly to the flu virus. 90% of people infected with COVID-19 will be asymptomatic. However, of the remaining 10% who will develop the disease.

Of 10 patients who will have symptoms of COVID-19, 8 will develop a fever, cough, malaise and flu-like muscle pain, and 2 will develop respiratory complications, such as pneumonia, and need hospital care. Only less than one person, or 0.5% of cases, will develop pulmonary fibrosis and the patient will need a ventilator.

In those patients whose defence system is weaker than normal, death may occur.
Read more

What message do you want to send to patients who are already in treatment?

By Dr. Pascual Sánchez Martín (gynecologist).

The coronavirus presents a symptomatology very similar to the seasonal flu. Every year we are faced with patients who catch the flu and are in the midst of the assisted reproduction process.

Faced with this situation we must differentiate the recommendations that would be made to the general population, in which there is no need not to continue with in assisted reproduction treatment.

But in particular cases we must study the needs and characteristics that involve each individual to determine whether it is necessary to postpone treatment.
Read more

What should I do if I am about to start assisted reproduction treatment and I have symptoms of COVID-19 disease?

By Dr. Pascual Sánchez Martín (gynecologist).

When we have a patient under treatment who develops the symptomatology of COVID-19, i.e. fever, cough and generalized discomfort, the wise thing to do would be to stop the fertility treatment treatment, in the same way as any other type of illness.

This is because an ill person who undergoes fertility treatment, when he or she is found to have fever and discomfort, will have worse results than if he or she were in full form.

It should be clarified that it is not that this patient cannot get pregnant, but the results will be worse. Therefore, there is no reason to treat a patient who is sick, whether it is due to COVID-19 or any other type of illness.

What do patients and donors need to know to protect themselves and avoid getting COVID-19?

By Dr. Pascual Sánchez Martín (gynecologist).

Assisted reproduction patients and donors are required to follow the same medications for the general population.

As COVID-19 is a virus that affects the respiratory tract, it is transmitted by small droplets emitted by infected patients. If we come into contact with one of these droplets we can become infected. It is therefore advisable to keep a safe distance between people.

These drops emitted by infected people can be deposited on the surface of objects that are susceptible to being touched by hand. Therefore it is very important to wash our hands frequently with soap to eliminate the virus.

In addition, we must remember to avoid touching our eyes, nose and mouth. These are the places where the virus enters our bodies,
Read more

Once a person is infected with a coronavirus, how can it affect pregnancy?

By Dr. Pascual Sánchez Martín (gynecologist).

To date, we can say that there has been no case of transmission of the virus from the mother to the fetus. Furthermore, there is no transmission through breast milk. Therefore, this virus cannot produce malformations that could damage the baby.

Neither has this virus been found in eggs, embryos, semen or sexual fluids. Fortunately, this is a respiratory disease and not a sexually transmitted disease.

In addition, all the studies that come to us from China about pregnant mothers are very encouraging. It should be remembered that this disease has more than 80,000 patients in China and they are publishing data on it. Among their investigations we can highlight that pregnant women have not been seen to present a greater risk or severity to COVID-19.
Read more

What measures are taken in the Ginemed Centers to ensure the safety of patients and the professional team itself?

By Dr. Pascual Sánchez Martín (gynecologist).

As in all crowded places, we have had to take a number of measures to exercise extreme caution.

We have increased the number of consultations by videoconference to solve questions, give results and ultimately those cases where there is no physical presence of the patient.

In cases where the patient must go to the tilt to perform some kind of test in person, they will do so safely as we have reduced the number of consultations per hour so that patients do not have to wait.

In the consultations we have always kept the safety rules by not shaking hands and maintaining a prudent distance between people. We also have aerosols for patients to disinfect their hands and we have eliminated objects, such as magazines, that could serve as a vehicle for transmitting the virus.
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References

Government Response to Coronavirus: Link

Guidance for the care of fertility patients during the COVID-19 pandemic Link

Human Fertilisation & Embryology Authority: HFEA Coronavirus guidance- current status as of 18 March 2020 Link)

Centers for Disease Control and Prevention. Guidelines to keep workplaces safe: Link)

American Society for Reproductive Medicine. Suggestions on Managing Patients who Are Undergoing Infertility Therapy or Deriring pregnancy. Link)

Liu Y, Chen H, Tang K, Guo Y. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. J Infect. 2020 Mar 4. pii: S0163-4453(20)30109-2.

Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know. Am J Obstet Gynecol. 2020 Feb 24. pii: S0002-9378(20)30197-6.

Wei-jie Guan, Ph.D., Zheng-yi Ni, M.D., Yu Hu, M.D., Wen-hua Liang, Ph.D., Chun-quan Ou, Ph.D., Jian-xing He, M.D., Lei Liu, M.D., Hong Shan, M.D., Chun-liang Lei, M.D., David S.C. Hui, M.D., Bin Du, M.D., Lan-juan Li, M.D., et al. Clinical Characteristics of Coronavirus Disease 2019 in China. DOI: 10.1056/NEJMoa2002032

FAQs from users: 'As Medical Director of Ginemed, could you explain to us what the coronavirus is and how it can affect us?', 'What message do you want to send to patients who are already in treatment?', 'What should I do if I am about to start assisted reproduction treatment and I have symptoms of COVID-19 disease?', 'What do patients and donors need to know to protect themselves and avoid getting COVID-19?', 'Once a person is infected with a coronavirus, how can it affect pregnancy?' and 'What measures are taken in the Ginemed Centers to ensure the safety of patients and the professional team itself?'.

Read more

Authors and contributors

 Laura Parra Villar
Laura Parra Villar
Embryologin
Graduate in Biology from the University of Valencia (UV) and embryologist with a Master's degree in Biotechnology of Human Reproduction from the University of Valencia in collaboration with the Valencian Institute of Infertility (IVI). More information about Laura Parra Villar
Licence number: 3325-CV
Dr. Pascual Sánchez Martín
Dr. Pascual Sánchez Martín
Gynecologist
Dr. Pascual Sánchez Martín has a degree in Medicine from the University of Salamanca and specialized in Obstetrics and Gynecology at the Virgen del Rocío University Hospital. More information about Dr. Pascual Sánchez Martín
Licence number: 414110807
 Romina Packan
Romina Packan
inviTRA Staff
Editor and translator for the English and German edition of inviTRA. More information about Romina Packan

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