This question was the centre of a discussion we had in early March 2020 with a 45 year old couple under IVF treatment for the past few months at Yash IVF. This elderly couple has undergone over 10 IVF cycles and even a couple of Surrogacy cycles over the last 10+ traumatic years years at a reputed IVF Clinic in Pune. The question now was, when clinically things were looking good, whether to stop the treatment or continue and take the risk posed by the Corona Virus.
After a single prolonged but successful cycle at our centre they were given the happy tidings of a positive Beta HCG test recently.
We had counselled them as per the advisory by the health authorities, which recommends that fertility medications be stopped and the number of pregnancies be restricted during the pandemic. We also approved them of the fact that while we don’t yet have sufficient data about the effect of COVID-19 on pregnant ladies and their babies, guidelines have been issued by the state and national level Obstetrics and Gynaecological Societies (FOGSI at national level and AMOGS in Maharashtra). These deal with all the aspects of Pregnancy and Covid-19 with the objective of ensuring a safe and successful delivery.
While we had advised them to think deeply and consider all the risks before approving the embryo transfer, their decision of the elderly couple was very clear – to proceed with the ET. “Given our age, if God wants us to have a child, nothing can stop it. If he doesn’t, no one can make it happen. Let’s do what is in our hands and be patient”, was how the husband put it, also confirming this would be their final attempt at parenthood.
They were also very clear about selecting Yash IVF as their provider – combination of a high quality IVF service and a safe, reputed Nursing Home, both NABH certified by the Quality Council Of India, New Delhi.
According to the recommendations published by the Federation of Obstetric & Gynecological Societies of India (Version 1, 28-03-2020), related to Pregnancy With Covid-19 Infection –
- Pregnant women infected with COVID-19 do not appear to be more likely to be severely unwell than other healthy adults.
- only moderate to mild cold or Flu-like symptoms will bother most pregnant women
- If the pregnant woman has co-morbid conditions such as diabetes, hypertension, obesity, respiratory disease or is of advanced age, she is more likely to have a severe form of respiratory disease
- Preliminary research suggests that the infection is neither likely to be transmitted from the mother to child nor secreted via the breast milk
- According to 2 documented reports in 18 pregnant women with suspected or conrmed COVID-19 pneumonia, none of the newborns, delivered via cesarean section, tested positive for the corona virus, at birth
- The reports further stated that there were no traces of the virus in either the mother’s amniotic uid, cord blood or breast milk
Under the circumstances, continuation of treatment or completing part of it (Fertilization and Cryopreservation of the embryo), may be an option exercised by the more elderly patients, individuals with a decreased ovarian reserve and patients with diseases like cancer, etc. in whom clearance for an emergency IVF cycle may be warranted. Most of the facilities are shut however, for the other category of infertile couples and the impacts of a postponement in treatment will probably be felt in the coming months.
A few patients will have the opportunities for their own biologic children diminished by the postponement, and for them this is a lamentable fallout of COVID-19 that must be added to the societal burden of this pandemic.
The silver lining is that while women undergoing fertility treatments like IVF will be forced to wait for a frozen embryo transfer vs undergoing a fresh transfer, their meaningful chances for a healthy baby will not be compromised. There are no clinically significant differences with frozen embryo transfers (FET), and there may even be some advantages, including significantly better pregnancy outcomes.