Fertility during the pandemic: OBGYN and reproductive endocrinologist available for interviews

Several states are reporting significant drops in birth rates over the past year and a June study from Guttmacher Institute found that more than 40 percent of women reported that COVID-19 changed their conception plans.

In light of the trend to postpone pregnancy, members of Yale New Haven Health’s obstetrics and reproductive endocrinology team discuss fertility in the time of COVID-19.

Biological clock

For decades literature highlighted that women over 35 struggle to get pregnant. A few years ago the science behind this dramatic fertility decline came into question.

One of the largest studies found that 78 percent of women aged 35 to 40 will conceive within a year of trying, compared with 84 percent of women aged 20 to 34. Male fertility generally starts to decline around age 40 to 45 when sperm quality decreases.

“Fertility is like weight gain,” said Sandra Ann Carson, MD, director, Reproductive Endocrinology and Infertility, Yale Medicine. “Just as you don’t gain weight overnight. You don’t lose fertility overnight. Instead there is a gentle decline at age 30 and that decline is a little more rapid after age 35 and even more rapid after age 40.”

Assessing fertility

“When assessing fertility we look at a variety of factors,” said Dr. Carson. “We ensure that sperm is present in a partner, that the fallopian tubes are not blocked, and we check to see if the patient is ovulating. We also remind couples to have regular sex and that means more than once per week.”

Hugh Taylor, MD, chief, Obstetrics and Gynecology, Yale New Haven Hospital, has focused on fertility for the last 30 years. Dr. Taylor said, “There is tremendous variability when it comes to fertility, which makes guessing how many reproductive years someone might have left difficult.”

Conception during COVID-19

The pandemic has led to questions regarding whether people should postpone pregnancy because of potential virus-related risks.

Studies from the CDC have shown that pregnant women who contract the disease are at higher risk for severe illness, but most pregnant women who get infected with COVID-19 do well,” said Dr. Taylor.

Jean Tornatore, MD, medical director of Labor and Delivery at Bridgeport Hospital said, “We are now delivering babies conceived during the pandemic. Data about COVID-19 transmission to the baby looks reassuring. We are not telling people to wait to get pregnant if it is something on their mind for the immediate future.”

Yale Fertility Center of New Haven published a study in June 2020 which detailed a case where the COVID-19 virus crossed the placenta, an organ that serves as a barrier between the fetus and mother’s body. For viruses to infect the fetus they have to cross that barrier.

Even with the results of this study, Dr. Taylor states, “We are not telling people to avoid pregnancy because of the virus. All the standard things we tell people to do with masking, hand washing and distancing – pregnant people should be even more diligent.”

Dr. Taylor adds, “The virus crossing the placenta seems to be the exception not the rule for COVID-19 and when it happens we thankfully aren’t seeing birth defects like with Zika, a virus transmitted by some mosquitos that can cause serious problems during pregnancy.”

COVID-19 vaccines and fertility

“The way the vaccine works should not impact fertility, pregnancy or a developing fetus,” said Dr. Taylor.

The U.S. professional societies including the American Society for Reproductive Medicine (for which Dr. Taylor is the president) along with the Society for Maternal Fetal Medicine and the American College of Obstetrics and Gynecology have all recommended that pregnant people be offered the vaccine.

“We think the benefits far outweigh any potential risks,” said Dr. Taylor. “We know that the complications of COVID-19 infection can be more severe when a woman is pregnant.  When considering the vaccine, women should have a conversation with their doctor and weigh factors such as other health conditions and their personal exposure.”

Read here for more information on the COVID-19 vaccine and pregnancy.

Preserving fertility

“Fertility preservation starts with a healthy lifestyle,” said Dr. Carson.  “Tobacco avoidance is one of the best things people can do to protect their fertility. Moderate exercise and limiting alcohol are also recommended.”

Dr. Taylor adds freezing eggs is a good insurance policy, especially for people undergoing certain medical treatments. “The pregnancy rate with frozen eggs is about 5 percent, so we need to collect a large number. The fertility rate with embryos (an egg that has been fertilized) is more like 30-50 percent, so if you have a partner, freezing embryos makes a lot more sense.”

If you have questions about COVID-19 risks and fertility, it may be helpful to speak with a specialist to learn your options.