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Tens of thousands of women across the country trying to have a baby through fertility treatments are in limbo because of COVID-19: they had to postpone their appointment indefinitely due to recently issued coronavirus recommendations by the American Society for Reproductive Medicine. But now some fertility specialists and their patients are growing back.
Among them, Amy Schmidt Zook, whose bathroom cabinet in Fort Worth, Texas, houses a miniature pharmacy for drugs and medical equipment – syringes, needles, alcohol swabs, cotton swabs, drugs to stimulate her ovaries and follicles and to prevent premature ovulation.
Zook is 43 and wants to have a third child – she has a five-year-old son and a two-year-old daughter – but her doctors say her chances are slim. She and her husband therefore tried in vitro fertilization, or IVF, in which an egg and sperm are combined in a laboratory. If successful, the resulting embryo is transferred to a woman’s uterus.
But in mid-March, Zook’s fertility clinic told her that the American Society for Reproductive Medicine had recommended stopping new treatments, with no restart date, so she canceled her next appointments. Many other clinics across the country have done the same.
“I was like, wait a second – are they telling us we can’t do IVF? Zook remembered. ” I was shocked. “
The US guidelines, released March 17, are similar to the recommendations of fertility groups in Europe and Canada. The task force that wrote them said they were supposed to tackle not only the unknown impact of COVID-19 on pregnancy and fertility, but also to encourage social distancing and reduce demand on the system. health. The guidelines include some exceptions, such as for people with cancer who want to freeze eggs or sperm before starting chemotherapy, and women who had already started a treatment cycle when the recommendations were announced – but these apply to relatively few patients.
“I have never felt so old in my life,” said Zook, a former emergency room doctor who is now a stay-at-home mom. “At 43, I’m really falling from the fertility cliff, and it’s like, oh my god, that could really be the end. “
She said it frustrated her that despite the nationwide widespread mandatory closings due to COVID-19, “you can still get Starbucks and McDonald’s because it is considered essential,” but fertility treatments – that she considers essential – are prohibited.
Zook’s fertility specialist Dr. Beverly Reed said that when she first saw the recommendations, “I was shocked, and then I said, OK, well, here are the guidelines . I just have to follow them … My patients were sad. I was sad. ”
But as she responded to patient requests, she began to question the validity of this advice.
“One of my patients’ questions was:” Does the coronavirus cause birth defects? Is this why we are told that we cannot receive treatment? “”, Recalls Reed, who works at IVFMD, a fertility center near Dallas. “And I said … we don’t know for sure at this point, but the first data we have doesn’t seem to show an increased risk of birth defects. “
“The next question was,” Are all American women told not to get pregnant now? I said, “Well, no. And that’s when they said, “Why am I told that I can’t get pregnant right now?” And I said, “You know what? That’s a very good question. “”
Reed is therefore circulating a petition protesting the guidelines, and about 15,000 people across the country have signed it so far.
Reed said the guidelines unfairly discriminate against fertile patients, especially same-sex couples and singles, who have fewer options for getting pregnant on their own. She also believes that they harm women who may lose their chance of having a biological child. And although the risks of COVID-19 are still being studied, Reed believes that patients should be able to decide for themselves whether they want to continue treatment.
“I have patients who are willing to take this risk – who say, yes, I understand that it can be dangerous, but I agree with that because I always want to try to build my family,” said Reed . “And if I don’t do it now, I can never do it.” “
But Dr. David Adamson, former president of the American Society for Reproductive Medicine, said that so little is known about how the new coronavirus could affect unborn babies that patients cannot make a decision. enlightened on the wisdom of further treatment.
“My personal assessment is that I think they made the right decision,” he said of the recommendations.
Adamson, clinical professor at Stanford University School of Medicine, noted that suspending treatment reduces the current burden on the health care system by encouraging patients to stay at home and helps conserve scarce medical resources, such as masks and the blouses.
“But make no mistake: there are certainly women and men who suffer from not being able to do IVF,” he added. “But we have to look at the greater good of society, and there are still … too many unanswered questions to say that it’s okay to move on now. “
Dr. Eve Feinberg, member of the task force that drafted the recommendations, said that it was not only the unknown health risks of COVID-19 that prompted them.
“It really was much more about the public health problem of viral transmission,” which means the spread of the virus, said Feinberg, associate professor of obstetrics and gynecology at Northwestern University and president of the Society for Reproductive Endocrinology and Infertility.
By reducing the number of patients going to and from fertility appointments, it helps prevent transmission of the virus, she said.
“Data from other widespread pandemics has really shown that sheltering in place is the most effective strategy for suppressing the new transmission,” added Feinberg. “If we were to keep patients at home in the vast field of infertility, collectively, we can make a huge difference in the risk of new transmission. “
She noted that when patients repeatedly visit a fertility clinic for weeks or months, they can come into contact with dozens of people – doctors, nurses, phlebotomists, ultrasound technicians, etc. – which could widely spread the coronavirus.
While “when you are trying to get pregnant naturally,” she added, “you usually have sex with someone and you risk exposing yourself [only] one person. “
Clinics that have remained open despite recommendations, Feinberg said, “I’m not happy. I think it will extend [pandemic]… And I think that anyone who continues to do business as usual… will ultimately do a disservice in the sense that it is a community effort, it is a national effort… and we must all adhere to the same standards public health. ”
“Every month is like a wasted egg”
“A shame” is how Shelly Kudrov described the impact of the new guidelines. She is single, lives in Redwood City, California, and really wants to have a child.
“This is one of my dreams for life,” she said. “I just couldn’t find the right partner in time. “
Kudrov started fertility treatments in December and said she was not surprised when her appointments were canceled last month, given that there was a national emergency due to COVID-19.
“I am upset and disappointed … but I largely agree with that,” she added. “There is a whole world among us who wants to receive fertility treatments. Many people continue to go out and be exposed and expose other people. And if they got [the virus], God forbid, from their doctor, and then they brought him home, all of their family members got it. ”
Still, Kudrov said, “I’m not going to lie – being 44 and still wanting to get pregnant with my own organic baby, using my own eggs, this moment is critical. Every month it feels like an egg is wasted. “
Texas resident and educator Elissa Sheppard has been undergoing fertility treatments for about a year, but said she doesn’t have the same sense of time. She is 32 years old, married to a woman and has already been pregnant, although she eventually miscarried. She learned about the new guidelines when she received a phone call from her fertility clinic shortly before her appointment.
“Now we are waiting to see when they will reopen so we can start treatment again,” said Sheppard.
“It feels like my brain is okay, but emotionally I feel very devastated or brokenhearted,” she said of the recommendations, “… because I had this tragic miscarriage. … And then I went through several cycles of trying to heal and get to a point where we could start again. And so that they tell me two hours before my appointment that it has been canceled! “
Dallas Area OB / GYN, Dr Reed, who launched the petition to protest the guidelines, recognized that young women will be less affected by the temporary suspension of fertility treatments.
“If you are 25 years old and have a normal ovarian reserve [a woman’s egg supply], so do I think waiting three months will have a significant impact on your chance of having a baby? No, I don’t, “said Reed. But if you are 43 and have a reduced ovarian reserve or have a lack of eggs, I think three months could have a significant impact on their chances of having a baby? Absolutely. “
The American Society for Reproductive Medicine task force that drafted the recommendations says it meets every two weeks to consider updating them, and its next update is scheduled for April 14.
“As the pandemic evolves, we will reassess what is considered an” emergency “exception to the guidelines, said Feinberg,” and we could push up the diminished ovarian reserve in this category. “