Tens of thousands of women across the country trying to have a baby through fertility treatments are in limbo because of COVID-19: They've had to postpone their appointments indefinitely due to coronavirus recommendations recently issued by the American Society for Reproductive Medicine. But now some fertility specialists and their patients are pushing back.
Among them is Amy Schmidt Zook, whose bathroom cabinet in her Fort Worth, Texas, home is a miniature pharmacy of medicine and medical equipment — syringes, needles, alcohol swabs, cotton pads, medications for stimulating her ovaries and follicles and for preventing premature ovulation.
Zook is 43 years old and wants to have a third child — she has a five-year-old son and two-year-old daughter — but her doctors say her chances are slim. So she and her husband have been trying in vitro fertilization, or IVF, in which an egg and sperm are combined in a lab. 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 suspending new treatments, with no restart date given, so it was canceling her upcoming appointments. Many other clinics nationwide have done the same.
"I was like, wait a second — they're flat-out telling us we can't do IVF?" Zook recalled. "I was shocked."
The U.S. guidelines, issued March 17, are similar to recommendations by fertility groups in Europe and Canada. The task force that wrote them said they're meant to address not just the unknown impact of COVID-19 on pregnancy and fertility, but to encourage social distancing and reduce demand on the health care system. The guidelines do 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 those apply to relatively few patients.
"I've never felt so old in my life," said Zook, an emergency room physician who is now a stay-at-home mom. "At 43, I'm really falling off the cliff of fertility, and it's just like, oh my gosh, this really could be the end of it."
She said it frustrates her that despite the widespread mandatory closures nationwide due to COVID-19, "you can still get Starbucks and McDonald's because that's considered essential," but fertility treatments — which 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, these are the guidelines. I've just got to follow them...My patients were sad. I was sad."
But as she fielded patient inquiries, she began to question the validity of that guidance.
"One of the questions from my patients was, 'Does coronavirus cause birth defects? Is that why we are being told we can't have treatment?'" recalled Reed, who works at IVFMD, a fertility center near Dallas. "And I said...we don't know for sure at this point, but the early data we have does not seem to show any increased risk for birth defects."
"The next question was, 'Are all American women being told not to get pregnant right now?' I said, 'Well, no.' And that's when they said, 'Why am I being told I can't get pregnant right now?' And I said, 'You know what? That's a really good question.'"
So Reed is circulating a petition protesting the guidelines, and about 15,000 people nationwide have signed it so far.
Reed said the guidelines unfairly discriminate against fertility patients, especially same-sex couples and single people, who have fewer options to get pregnant on their own. She also believes they harm women who may lose their chance to have a biological child. And although the risks of COVID-19 are still being studied, Reed thinks patients should be able to decide for themselves if they want to continue treatments.
"I have patients who are willing to take that risk — who say, yes, I understand it may be dangerous, but I'm OK with that because I still want to try to build my family," Reed said. "And if I don't get to do it now, I may never get to do it."
But Dr. David Adamson, a former president of the American Society for Reproductive Medicine, said so little is known about how the new coronavirus could affect unborn babies that patients cannot make an educated decision about the wisdom of continuing treatments.
"My assessment personally is that I think they've made the right decision," he said of the recommendations.
Adamson, a clinical professor at Stanford University School of Medicine, noted that suspending treatments reduces the current burden on the health care system by encouraging patients to stay home, and helps conserve scarce medical resources, such as masks and gowns.
"But make no mistake: There are definitely women and men who are being harmed by 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 it's OK to go ahead right now."
Dr. Eve Feinberg, a member of the task force that wrote the recommendations, said it isn't just COVID-19's unknown health risks that prompted them.
"It was really much more about the public health concern of viral transmission," meaning the spread of the virus, said Feinberg, an 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, that helps stop the virus from being transmitted, she said.
"Data really has shown from other widespread pandemics that sheltering in place is the most effective strategy for suppression of new transmission," Feinberg added. "If we were to have patients staying at home in the large field of infertility, collectively we can make a huge difference in risk of new transmission."
She noted that when patients make repeat visits to a fertility clinic over weeks or months, they can come in contact with dozens of people — doctors, nurses, phlebotomists, ultrasound technicians, and so on — potentially spreading the coronavirus widely.
Whereas "when you're trying to get pregnant naturally," she added, "you typically have sexual intercourse with one person and you have the risk of exposing [only] one person."
Of clinics that have remained open despite the recommendations, Feinberg said: "I'm not happy about it. I think it's going to prolong the [pandemic]...and I think anyone who's continuing to run business as usual... ultimately is going to be doing a disservice in that this is a community effort, this is a country effort...and we all need to adhere to the same public health standards."
'Every month feels like an egg wasted'
"A shame" is how Shelly Kudrov described the impact of the new guidelines. She's single, lives in Redwood City, Calif., and dearly wants to have a child.
"It's a lifelong dream of mine," she said. "I just didn't find the right partner in time."
Kudrov started fertility treatments in December and said she wasn't surprised when her appointments were canceled last month, considering that there was a national emergency due to COVID-19.
"I'm upset about it and I'm disappointed...but I am in large part in agreement with it," she added. "There is a whole world of us out there wanting to get fertility treatments. That's a lot of people to be continuing to go out and be exposed and exposing other people. And if they got [the virus], God forbid, from their doctor and then brought it home, all their family members could get it."
Still, Kudrov said, "I'm not going to lie — being 44 and still wanting to get pregnant with my own biological baby, using my own eggs, this timing is critical. Every month feels like an egg wasted."
Texas resident and educator Elissa Sheppard has been undergoing fertility treatments for about a year, but said she doesn't have that same sense of a ticking clock. She is 32 years old, married to a woman, and has been pregnant before, although she ultimately had a miscarriage. She learned about the new guidelines when she received a phone call from her fertility clinic shortly before she had an appointment.
"Now we're in a holding pattern of waiting to see when they're going to reopen so that we can restart treatment," Sheppard said.
"It's like my brain agrees, but emotionally I feel very devastated or heartbroken," she said of the recommendations, "...because I had this tragic miscarriage...and then I went through multiple cycles of trying to heal and get to a point where we could start again. And then to have them tell me two hours before my appointment that it was canceled!"
Dr. Reed, the Dallas-area OB/GYN who started the petition protesting the guidelines, acknowledged that younger women will be less affected by the temporary suspension of fertility treatments.
"If you're 25 years old and you have normal ovarian reserve [a woman's egg supply], then do I think waiting three months will have a significant impact on your chance to have a baby? No, I don't," Reed said. "But if you are 43 years old and you have diminished ovarian reserve or you're running out of eggs, do I think three months could have a significant impact on their chances to have a baby? Absolutely."
The American Society for Reproductive Medicine task force that wrote the recommendations says it is meeting every two weeks to consider updating them, and its next update is due April 14.
"As the pandemic evolves, we will be re-evaluating what is considered to be an emergency" exception to the guidelines, Feinberg said, "and we may escalate diminished ovarian reserve into that category."
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