IVF Guidelines During The Pandemic Puts Pregnancy On Hold
Milissa Solemina-McConnell and her husband always knew their path to pregnancy wouldn't involve candles and romantic music but rather a clinic visits and hormone injections.
He has a genetic condition he doesn't want to pass down. Over the years, she's learned she has a chromosome deletion and other reproductive issues that make conceiving naturally risky.
But while the couple, who live in Boston, expected to need medical help, they didn't expect their journey to parenthood to involve five egg retrieval cycles, five embryo transfers, one miscarriage, maxed out insurance plans, multiple specialists and fertility clinics, and four years — but no baby.
They were supposed to give it another shot this week, with Solemina-McConnell set to have one of their frozen embryos transferred to her uterus. But because of the novel coronavirus pandemic, that expectation is dashed too.
"It's not just about, 'They want a baby, they can wait.' It's not that simple," Solemina-McConnell, 37, told Business Insider. She and others on similar journeys feel they've waited long enough. "At this point," she said, "I can't imagine a future without a child."
On March 17, the American Society for Reproductive Medicine issued guidelines for clinicians to postpone "new, nonurgent treatments" for infertility in light of what remains unknown about how the novel coronavirus affects pregnant women and their babies. The move, which some clinics and couples had already taken, can also spare supplies and space for COVID-19 patients.
The New Guidelines Include:
- The American Society for Reproductive Medicine recommends people undergoing fertility treatments postpone "new, nonurgent treatments" in light of the novel coronavirus.
- The guidelines are intended to spare medical resources and to protect families from what remains unknown about how COVID-19 could affect pregnant women and their future children.
- Some women and families fear postponing their procedures means missing their last chance to have children and others find the guidelines discriminatory.
- Doctors encourage patients to view postponements as a time to manage their mental health and get their bodies in optimal shape to conceive.
But while most understood, some women and couples say their family planning dreams are now dashed, and others, like single women or same-sex couples, see the guidelines as discriminatory toward people who can't get pregnant on their own.
"The lay public thinks fertility treatment is optional, and these patients are really passionate about building families," Julie Lamb, an OB-GYN and adviser to Modern Fertility, told Business Insider. "No one sees it as optional."
The Guidelines Say New, Nonurgent Treatments Should Be Postponed
The ASRM guidelines, which are set to be revisited on March 30, recommend that clinics and providers don't start any new fertility treatments, including IUI (when sperm is directly injected into the uterus), IVF (when an egg and sperm are merged in a lab before being transferred to the uterus), and egg freezing for people who don't need it urgently.
People already in the middle of fertility treatment — for instance, women who are already on a course of medications to prompt their ovaries to produce more eggs, which then need to be "retrieved" — can continue care, as can people such as cancer patients who want their eggs frozen to before undergoing chemotherapy.
The guidelines also encourage practices to use telehealth services with patients when possible.
"This will not be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are unwilling to add, in any way, to that burden," ASRM CEO Ricardo Azziz said in a press release, noting it's also tough on clinicians and staff members who may now be out of a job.
"But the fact is that given what we know and what we don't, suspending nonurgent fertility care is really the most prudent course of action."
Some Women Say They May Miss Their Chance To Start A Family
The ASRM guidelines are controversial because they imply that fertility treatments are elective when infertility is classified as a disease. "We didn't choose this," Solemina-McConnell said.
They also hit particularly hard among women who feel this year or even month may be their last chance to conceive a child before they age out of the possibility.
"The human window of fertility is limited; if they wait until the outbreak is over to resume treatment, it will be too late for some patients to qualify for continued treatment," states a Change.org petition urging ASRM to reconsider. As of March 30, it had just under 500 signatures. By April 2, another petition with the same aim had nearly 12,400.
Recommendations to pause fertility treatments also unfairly limit same-sex couples, who need fertility treatments to conceive, while couples who can conceive naturally aren't as of yet discouraged from proceeding with their family plan.
"It wasn't intended to target vulnerable populations, but it does," said Lamb, who's had at least one patient have panic attacks in her clinic when she learned she had to postpone treatments.
And while doctors say most women have understood and supported the recommendations, the most challenging part may be wondering if all the time, money, physical discomfort and pain, and emotions poured into their fertility journeys were worth it.
Lauren Sancton, a consultant in Houston who was set to undergo an embryo transfer in mid-April, told Business Insider that hearing she'd need to delay her procedure "was like a gut punch."
"From the shots to the financial portion of it to the doctor's appointments — there are ultrasounds, there's blood draws, you have to follow a calendar, and then there's the emotional side," she said. "You are doing all this because you have that one goal of wanting a child."
Talk To Your Doctor
Brian Levine, MD, founding partner of CCRM Fertility in New York and an advisor to the telehealth service Maven, told Business Insider that no patients had fought him on delaying fertility treatments once he walks them through the reasoning behind the guidelines — which, he reminds, are just that, not law.
"I don't view it as a draconian 'you must stop' [any new treatments]. I view it as a cautious, thoughtful approach saying, 'We don't know what's happening yet, so let's not tax the system while we figure out what's going on," Levine said.
He explains that some of the ASRM measures, like encouraging telehealth and postponing non-urgent procedures, are the case for patients with all kinds of conditions, not just infertility.
He doesn't want them to spend their whole pregnancy anxious and look back in a year wishing they had waited another month or two. While most evidence is encouraging to pregnant women and their children, some studies suggest moms can pass COVID-19 to their babies in utero, and another has shown that infants are more at risk of severe infection than older kids.
To cope, Lamb encourages patients to reach out for mental health support through their clinics or telemedicine services.
Levine helps patients reframe the moment as an opportunity to get their bodies in optimal condition to conceive, like by limiting their news consumption to manage stress and by eating a Mediterranean-style diet, which has been shown to improve pregnancy and birth outcomes.
"The silver lining is this is pause and not a stop," he said, "and now you have the opportunity to get your body ready to run this marathon."