COVID-19 and fertility: Here's what the experts know so far (February 2021 update)
LAST UPDATED: Feb 19, 2021
12 MIN READ
HERE'S WHAT WE'LL COVER
Over the past year, every other news headline has mentioned COVID-19, or the new strains of the coronavirus infection that are spreading around the world. We’re being told how to wash our hands and when we should consider working from home (if that’s an option for us) — but what effect, if any, does the coronavirus outbreak have on our fertility and reproductive health? Here's what the health experts say.
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The biggest takeaways
Research is still ongoing and there have not been any studies done to see if contracting the COVID-19 infection now will make it harder to get pregnant later.
At this time, pregnant people don’t appear to be at a higher risk for contracting the virus — but data shows they're at a higher risk for severe illness.
It’s possible, though very unlikely, for an infected pregnant person to pass on the coronavirus to the fetus. Current estimates suggest about 3% of infants born to COVID-19+ birthing parents will also test positive for COVID-19.
If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive. In terms of limited access to medical care, we don’t know how long that will last. So, just like during any other time, when to try for kids is totally up to you.
Most fertility clinics that closed at the beginning of the pandemic are now operational, with the proper safety precautions in place. Because clinics close and reopen based on the regional severity of COVID-19, if you are interested in pursuing assisted reproductive technology (ART), you should contact a clinic near you to see what services are currently being offered.
If you meet the diagnostic criteria for COVID-19, it’s recommended that you avoid getting pregnant and wait until the illness subsides before attempting pregnancy or pursuing ART.
Everyone, including pregnant people, should be exercising precautions to avoid infection.
Leading medical bodies agree that all pregnant people should have access to the COVID-19 vaccine — and that there's no evidence linking the vaccine to adverse fertility or pregnancy outcomes.
A refresher on COVID-19
Coronaviruses are a large family of viruses common in people and many animals. In rare cases, animal coronaviruses can infect people and then spread (this happened with MERS-CoV, SARS-CoV, and now with this new virus). The virus is named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019” (abbreviated “COVID-19”).
According to the Centers for Disease Control and Prevention (CDC), the COVID-19 global pandemic (as declared by the World Health Organization on March 11, 2020) we’re witnessing now was first discovered in China, but is now affecting over 200 international locations (including the US).
The CDC reports that your risk of exposure to COVID-19 depends on the rate of community spread in your region, and there’s significant variability in this across the country. For the following groups of people, though, the risk is higher regardless of where you live:
Healthcare professionals in contact with people who have the virus
Close contact with people who have the virus
Travelers coming back from international locations with ongoing community spread
Older people or people with underlying medical illnesses
About 2-14 days after exposure, fever, cough, loss of taste or smell, and shortness of breath might suggest contraction of the virus. If you’re experiencing any of these symptoms, contact your doctor ASAP.
How coronavirus impacts impacts fertility and trying to conceive
Here are the top questions related to COVID-19, fertility, and trying to conceive:
Will contracting COVID-19 now impact fertility later?
Research is still ongoing in this area. There are no studies indicating that the virus has any impact on your fertility. While coronavirus fears have caused some people to seek out egg freezing, there’s no reason to panic — and there is no known medical indication to seek out egg freezing as a “preventive measure.”
Dr. Eva Luo, an OB-GYN at Beth Israel Deaconess Medical Center, says, “Nothing in what we currently know and understand about COVID-19 would justify egg freezing or other ART procedures.”
What about COVID-19 and the fertility of people with sperm?
While there is some data to suggest that indicators of sperm quality and quantity are negatively affected by COVID-19 in the short term, these changes do not appear to be permanent, and these kinds of short-term impacts are seen in other conditions, too.
Another common question: Can you get COVID-19 from sperm? According to the CDC, we don't know quite yet, though reviews of the preliminary data we have suggest that COVID-19 is not sexually transmittable — meaning the virus is unlikely to transmit through seminal or vaginal fluids.
If you're trying to get pregnant, should you stop trying to conceive due to coronavirus?
If you don’t have COVID-19, there is no medical reason to change your plans about trying to conceive, according to recent guidelines from ASRM and SART. However, there may be logistic, psychological, and emotional reasons to modify your plans. Postponing pregnancy is a very personal decision, and you should speak with a doctor for specific recommendations.
If you currently have COVID-19, the SART recommends avoiding getting pregnant for now and waiting until you fully recover before attempting conception (either naturally or via assisted reproductive technology).
It’s important to note, though, that there may still be repercussions in the healthcare system that make aspects of pregnancy more difficult. In a briefing from the American College of Obstetricians and Gynecologists (ACOG), the organization acknowledges that community mitigation efforts might impact access to routine prenatal care. Because of this, ACOG recommends that OB-GYNs “continue to provide medically necessary prenatal care, referrals, and consultations, although modifications to healthcare delivery approaches may be necessary,” “consider creating a plan to address the possibility of a decreased healthcare workforce, potential shortage of personal protective equipment, and limited isolation rooms," and "maximize the use of telehealth across as many aspects of prenatal care as possible.”
For example, while prenatal vaccinations, glucose screenings, and blood pressure screenings may have been done at separate appointments in a pre-COVID-19 world, ACOG recommends that these be done in a single in-person visit when possible to reduce the odds of disease transmission.
Contrary to claims that we’ll see a “baby boom” because of people spending more time at home, a June 2020 Guttmacher survey found that 40% of their respondents (all people with ovaries) changed their plans for kids — when to have them and how many to have — because of the pandemic. Data is just starting to come in on how actual birth rates have been affected by this pandemic. A report released in early February 2021 found a 22% decrease in the birth rate in Italy. As we’re coming up one year since COVID-19-related lockdowns and restrictions became widespread in the US, we can expect to soon see reports about how birth rates have been impacted stateside.
If you’re considering or already pursuing in-vitro fertilization (IVF), intrauterine insemination (IUI), or egg freezing, what should you know?
While groups like the American Society for Reproductive Medicine (ASRM) originally recommended that clinics pause the initiation of any new treatment cycles back in March 2020, the recommendation has since changed as we have learned more about the virus and how to minimize transmission. Though fertility treatments are not medical emergencies, they are considered time-sensitive, and in ASRM’s view, medically necessary.
Many fertility clinics that initially closed at the beginning of the pandemic are now up and running, with the necessary precautions in place for both clinicians and patients. Because most regulations have been passed at the state (rather than national) level, the capacity at which fertility clinics near you are operating and what COVID-19 mitigation measures are in place depends on where you live. Keep in mind that just because fertility clinics near you are open, doesn’t mean going to them is completely absent of the risk of transmission.
If you’re freezing eggs or sperm, according to ASRM, there is no evidence of cross-contamination of COVID-19 in ART labs — meaning it’s unlikely that your sperm or eggs would come into contact and be affected by COVID-19 once stored.
But because so many cases of COVID-19 are asymptomatic, it is possible that someone undergoing egg or sperm freezing procedures would unknowingly have the virus at the time of the procedure. Preliminary evidence suggests that gametes (aka sperm and eggs) cannot transmit COVID-19. This likely means that using the frozen sperm or eggs of someone who had COVID-19 during their retrieval won't lead to infection.
The SART recommends that anyone who’s actively pursuing ART and meets the diagnostic criteria for the COVID-19 infection consider freezing all eggs or embryos and waiting until they’re disease-free to do an embryo transfer. The American Society for Reproductive Medicine (ASRM) put out a bulletin on March 12, 2020 echoing this sentiment, stating:
"Out of an abundance of caution, patients who have high likelihood of having COVID-19 (fever and/or cough, shortness of breath, and either exposure within 6 feet of a confirmed COVID-19 patient and within 14 days of onset of symptoms, or a positive COVID-19 test result), including those planning to use oocyte donors, sperm donors, or gestational carriers, should strive to avoid a pregnancy. If these patients are undergoing active infertility treatment, we suggest that they consider freezing all oocytes or embryos and avoid an embryo transfer until they are disease-free. Please note this recommendation does not necessarily apply when there solely is a suspicion of COVID-19, because symptoms of COVID-19 are very similar to other more common forms of respiratory illnesses."
If you are actively pursuing ART and have been diagnosed with COVID-19 (or you haven’t undergone the definitive test yet but have symptoms that might meet the diagnostic criteria for COVID-19), you should call your fertility doctor’s office ASAP and follow their recommendations.
How coronavirus impacts pregnancy, birth, and children
Here are the top questions related to COVID-19, pregnancy, birth, and children:
What happens if you get COVID-19 while pregnant?
According to the CDC, pregnant people are likely at a greater risk for severe illness related to COVID-19. Specifically, their analysis of epidemiological surveillance data has found that compared to non-pregnant people with symptomatic COVID-19, pregnant people with symptomatic COVID-19 are more likely to be admitted to the ICU, need a ventilator, and ultimately, are less likely to survive.
One study from January 2021 followed 240 pregnant people between the months of March and June of 2020 and found that mortality from COVID-19 was higher in pregnant people with the virus as compared to nonpregnant people with the virus (and at similar ages as the participants). These are the biggest takeaways from the study:
Pregnant people with COVID-19 were 3.5x more likely to be hospitalized than their nonpregnant peers.
The mortality rate of pregnant people with COVID-19 was 13x in those who were pregnant than those who were not — though most of the pregnant participants were asymptomatic or had mild infections and went on to have healthy pregnancies.
In terms of COVID-19 symptoms and potential birth outcomes, a February 2021 systematic review looked at 136 cases of infected pregnant people and found that:
63% of women experienced fever
37% experienced coughing
16% experienced diarrhea
23% experienced a sore throat
76% of the women delivered via cesarean (as a comparison point, as of 2017 the average C-section rate in America was 32%, according to the CDC)
On pregnant people with fevers: Though fevers in early pregnancy (because of COVID-19 or other illnesses) have been linked to neural tube defects in some studies, one large study that followed 100,000 women in Denmark over time didn’t find a connection.
Race may play a role in which pregnant people are most exposed to the virus. Data collected from nearly 1,300 people with ovaries in Philadelphia points to Black and Latino pregnant people having 5x the risk of coronavirus exposure than white pregnant people. More recent data from other parts of the country confirms this pattern, which mirrors what we see in non-pregnant people, too: There are big racial and ethnic disparities in COVID-19.
If you’re pregnant, Dr. Jane van Dis, MD, FACOG, an OB-GYN and Medical Director at OB Hospitalist Group, recommends, “Wear a mask, wash hands, and socially distance. Get in to see your provider right away so that you can address any medical conditions, medications, or prenatal care testing."
As we get more detailed epidemiological data, and more data from individual clinics, a clearer picture of whether pregnant people are disproportionately affected by severe COVID-19 infection will emerge. To help fill some of these gaps, doctors at California universities are filling them with new research (like UCSF ASPIRE and a nationwide registry).
Can a pregnant person with COVID-19 pass the virus on before, during, or after birth?
The CDC says we’re still finding that out. But, so far, here’s what we know:
In-utero parent-to-child transmission of COVID-19 during pregnancy itself is unlikely. In the few studied cases of children testing positive for COVID-19 at birth, there’s been no evidence of COVID-19 in the amniotic fluid, umbilical cord, or placenta.
Up to 3% of infants born to birthing parents that are COVID-19 positive at the time of delivery will also have COVID-19. While we can’t be positive about the time of transmission in these cases, it seems most likely that they contracted the virus after birth, through contact with an infected person.
Infants testing positive for COVID-19 at birth almost universally recover and don't exhibit severe symptoms.
While there's only limited evidence that vertical transmission could be possible (and if so, incredibly rare), there are new studies (here and here) showing that antibodies can be transmitted in-utero — meaning COVID-19 infections during pregnancy (or possibly antibodies developed post-vaccination) might reach the infant. Whether these are protective against the virus is still being studied.
Are pregnancy outcomes different in people with COVID-19?
Based on the currently available data, we can start making some inferences about associations between COVID-19 during the third trimester of pregnancy and pregnancy outcomes. (We don’t yet have enough data on pregnancy outcomes from people who had COVID-19 earlier on in their pregnancies).
CDC data and systematic reviews suggest higher rates of preterm births (i.e., when an infant is born before 37 weeks) in people who were COVID-19 during delivery. These people are also more likely to deliver via C-section. Other large studies and reviews find no other differences in pregnancy complications or outcomes in people who do and don’t have COVID-19 during the third trimester.
What happens during and after childbirth for people who test positive for COVID-19?
As we’ve learned more about COVID-19, hospitals have changed their policies on post-birth protocols for mothers and infants. While the American Academy of Pediatrics (AAP) initially suggested separating infants from mothers with confirmed or suspected COVID-19, their revised suggestions now support keeping birthing parents and infants in the same room after birth, with everyone taking the necessary precautions (such as wearing masks and washing hands).
Guidelines from both AAP and CDC suggest the risk of mother-to-child transmission from breast milk/chest milk is very low. People with COVID-19 who decide to start direct breastfeeding/chestfeeding should take the necessary precautions, like mask wearing, to decrease the risk of transmission to the infant.
How does coronavirus affect children?
According to the CDC, children don’t seem to be at a higher risk for contracting the virus. They’re also more likely than adults to be completely asymptomatic, and to not experience severe symptoms. Similar to what we see in adults, children with certain underlying conditions may be at higher risk of experiencing severe symptoms if they were to catch COVID-19. Babies under one year old may also be at higher risk of severe symptoms. There are also certain rare conditions, like multisystem inflammatory syndrome in children (MIS-C) and Kawasaki syndrome that might be caused by COVID-19 in children.
Even though most children who contract COVID-19 will not exhibit significant symptoms, there are children who have died from COVID-19, and children who do get infected are able to pass it along to adults, for whom COVID-19 presents greater risks.
What to know about the COVID-19 vaccine
While we have very little data about the vaccine right now, its effects in people who are pregnant or breast/chestfeeding, and long-term effects on fertility — and despite pregnant and breast/chestfeeding people being excluded from trials — recommendations from the Food and Drug Administration (FDA), CDC, ACOG, ASRM, the Society for Maternal-Fetal Medicine (SMFM), and the Academy of Breastfeeding Medicine (ABM) all suggest that those who are trying to conceive, pregnant, or breastfeeding have the option of getting the COVID-19 vaccine.
On February 5 2021, ACOG, ASRM, and the Society for Maternal-Fetal Medicine (SMFM) released a statement reaffirming their recommendation that all pregnant people have access to the COVID-19 vaccine. They also point to clinical trial data that shows the fertility of trial participants was not impacted by the vaccine — and suggest that they haven't seen adverse fertility outcomes in the millions of people who've gotten the vaccine.
There are no studies that have specifically studied the effect of the vaccine on chances of conception, and fetal or infant outcomes. But based on observational data in humans and animals, the chance that there is a harmful impact is low to absent.
How to limit risk of exposure to COVID-19
The CDC recommends that these precautions be taken to limit the risk of exposure to COVID-19:
1. Wash your hands (often): This might sound pretty basic, but clean your hands with soap and water for at least 20 seconds after you’ve been outside, or if you’ve been coughing, sneezing, or blowing your nose. Don’t forget to wash the tops of your hands! In between hand washes, use hand sanitizer with at least 60% alcohol. (If you need some inspo, sing along to this hand-washing song that went viral.)
2. Stop touching your face. Most people touch their face a few times every minute – which adds up. Avoid touching your eyes, nose, or mouth while you're at it.
3. Practice social distancing, aka avoid close contact with others: Keep your distance from sick people who are exhibiting signs of the virus or in communities where the virus is spreading. This means refraining from hugs, handshakes, and other embraces. This article in The Atlantic will give you a helpful framework of what types of social gatherings and interactions you should consider avoiding.
4. This is a no-brainer, but stay home if you’re feeling sick: This isn’t the time to stay quiet about symptoms — if you’re feeling sick, tell your boss that you’re working from home or taking the day off. (Some companies are even asking all employees to stay home to limit exposure, and some are working out paid-time-off policies for hourly workers.)
5. Cover your coughs and your sneezes: Use a tissue or the inside of your elbow — and be sure to dispose of any tissues you use and wash your hands after.
6. Wear a face mask: If you’re at a location where social distancing isn’t possible, wear a cloth covering over your nose and mouth to prevent the spread of possible infection (not everyone shows symptoms!).
7. Become a cleaning/disinfecting machine: Clean and disinfect whatever surfaces you touch daily. If they’re dirty, clean them with detergent or soap and water before disinfecting.
8. Avoid all unnecessary travel: The CDC also suggests that we refrain from traveling to the countries listed on their site.
9. Consider getting the vaccine if you’re eligible. Two highly effective vaccines have received FDA approval in the US, and others will likely get approval soon. Based on what we know so far, the impacts of the vaccine on fertility are similar to the impacts of COVID-19 infection on fertility (aka, probably not much of an impact).
As we learn more about the new strains of coronavirus’ impact on fertility, pregnancy, and ART, we’ll keep you updated. In the meantime, check back in with the CDC for the latest facts and figures.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.