All our lives have been upended in the last month. Many of us have canceled trips, lost our jobs, and been forced to learned new "homeschooling techniques" – but what about the women who were hoping to get pregnant this year?
Many of my patients are in this situation: the forty-year-old patient who finally met Mr. Right and is trying to beat her biological clock; the patient who has struggled to conceive for years and hangs her hope on every new month; the woman who has experienced pregnancy loss multiple times but keeps trying. These women worry about preventing pregnancy for even a cycle just in case this is the magic month where it finally happens for them.
But, with so many unknowns about COVID-19, is it even safe to try get pregnant right now? Should women put their pregnancy attempts on hold – and if so, for how long?
It is impossible to predict what the state of health system will be 9 months from now. We do know that COVID-19 is likely here to stay, but with time, medical supplies will be replenished, and the number of cases will begin to drop. The question of how much time this will take is not one that I can answer and is entirely dependent on the ability of our nation to flatten the curve.
What we do know is that medical supplies are currently limited. The American Society of Reproductive Medicine has recommended to hold IVF cycles and fertility treatments to conserve supplies and reduce possible viral exposures. If you are already seeing a fertility specialist then your treatments are likely on hold already. The decision to restart treatments will likely be based on the availability of personal protective equipment (PPE) for health care workers over the next months and the projected course of the peak of the virus.
If you do conceive, the current research on COVID-19 pregnancy is limited, but what data we do have is reassuring. We have not seen an increased risk of miscarriage or birth defects in women who get sick with COVID-19 during pregnancy. Pregnancy can weaken a women's immune system, so there is concern that pregnant women might be at increased risk of contracting COVID-19; however, while they may be more likely to contract COVID-19, the data doesn't show an increased risk of complications in pregnant compared to non-pregnant women.
What is possibly concerning is that prolonged fever in early pregnancy can be associated with birth defects like spina bifida. This can occur with any sickness that causes fever, so it could very well be associated with the prolonged fever seen with COVID-19. Additionally, many pregnant women need frequent doctor visits in early pregnancy, and issues like vaginal bleeding and dehydration can result in in hospital admissions and ER visits. With medical resources stretched thin over the next few months, this is not the best time for avoidable ER visits or hospital admissions.
The decision to get pregnant is obviously a very personal choice, but if you are young (<32) and healthy, it does makes sense to wait a few months until after the peak of the viral infections occur before trying to conceive. What better time to work on getting healthier with improved diet and exercise than while you are sheltering in place? If you older or have history of infertility or miscarriage, you should discuss your specific risks and benefits with your provider. Visits for preconception counseling and contraception can both be accomplished with telehealth, which most offices are currently making readily available during the pandemic.