Marina Dimitraki, Assisted Reproduction Gynecologist, MSc, MHA, PhD, EFOG EBCOG, EFRM ESHRE / EBCOG

For days now, we are experiencing the spread of SARS-CoV-19, as well as a significant adoption of measures, aiming to limit its spread. In the face of this new reality and threat to public health, the scientific organizations for human reproduction ESHRE (European Society of Human Re-production and Embryology), ASRM (American Society of Re-productive Medicine), ISUOG (International Society of Ultrasound in Obstetrics-Gynecology), EMGE (Hellenic Obstetrics and Gynecology Society) have published official instructions and counseling approaches. The guidelines are based on recent scientific and clinical data. Thus, we can get answers to questions that inevitably concern us.

Should I stop trying to conceive naturally because of the COVID-19?
This is a personal decision. If you have not been infected by the coronavirus, there is no medical reason to stop trying. However, you should keep in mind that there is no data on the infection with COVID-19 in the first trimester of pregnancy. In addition, due to the isolation measures, there is a restriction on the access for medical care.

We are ready to start treatment for IVF. Should we continue during this period of the pandemic?
Both ESHRE and ASRM have issued clear instructions since the pandemic began. So they recommend:
1. The postponement of any adjuvant therapy (induction of ovulation, intrauterine insemination, in vitro fertilization).
2. The cancellation of all embryo transfers.
3. The completion of treatments for fertility preservation only in people with malignancies.
4. The postponement of all non-emergency and diagnostic procedures.
5. All communication between the doctor and the couples/ women to be done through the internet and telephone conversations, as well as to avoid all meetings in assisted reproduction clinics.

Is it possible that if I get infected with coronavirus, it may affect my fertility in the future?
There is no scientific evidence that the virus has a negative effect on fertility.

Can sperm, eggs or embryos be infected by the coronavirus?
Sperm, eggs and embryos cannot be infected by the coronavirus as they do not have receptors where the virus could attach. In addition, laboratory procedures and laboratory manipulations, as well as the structural elements of the oocyte and, consequently, of the fetus possess a high level of protective barrier and make it impossible to infect them.

Do pregnant women belong to the high-risk group for coronavirus?
As pregnant women do rate greater morbidity and mortality, if they are infected with other viruses of the same family, such as SARS-CoV and influenza, they should also be considered a high-risk group for coronavirus. In addition, it should be taken into consideration that if pregnant women get infected, they may not be able to receive effective treatment as many antiviral drugs are forbidden to not be used during pregnancy. However, according to the World Health Organization (WHO), pregnant women do not appear to be at a greater risk of COVID-19, while the vast majority of pregnant women who develop coronavirus will only have mild symptoms of respiratory / influenza infection.

If I get coronavirus during pregnancy can my baby get it too?
COVID-19, as with SARS and MERS viruses, does not appear to be transmitted through the endometrium and the placenta from the infected mother to the fetus. Coronavirus was also not detected in the placenta, amniotic fluid, umbilical cord blood, breast milk, and the oral smear of newborns from infected mothers. However, the above observations derived from studies to a small number of infected pregnant women and three cases of vertical transmission from the mother to the newborn. The last ones concerned the infection of the newborn in the period just before and after childbirth. Therefore, more data are needed for safe conclusions.

What could happen when a pregnant woman becomes infected with COVID-19 in the early stages of pregnancy?
There are no clinical data on its effect on the 1st and beginning of the 2nd trimester of pregnancy. Experience with the SARS and MERS viruses shows that the risk of miscarriage in the first or second trimester as well as congenital malformations in the fetus, do not increase. Therefore, close monitoring after treatment and recovery from COVID-19 are required, in case a woman is infected during the 1st or 2nd trimester of pregnancy.

Can coronavirus disease affect pregnancy?
Infection from this virus in the 3rd trimester of pregnancy has been associated with an increased risk of premature rupture of fetal membranes and preterm birth, in most cases iatrogenic, due to the clinical picture of the mother or due to possible disturbing indications from the cardiotocography interpretation. However, right after childbirth, immediate ligation of the umbilical cord and immediate, thorough wiping and cleaning of the newborn is recommended.

If I get infected with coronavirus, am I allowed to breastfeed?
Breastfeeding is not contraindicated, as the virus has not been detected in breast milk (additional data are needed). However, close contact with the affected mother is the greater risk factor for the newborn’s exposure to the virus.

For all of the above, let us emphasize that our experience is still small to draw safe conclusions and that additional clinical data are needed for the repercussion of COVID-19, at all stages of pregnancy.

Among the measures to prevent the transmission of the disease, in the era of home isolation, it is recommended to limit scheduled visits to assisted reproduction clinics and obstetric care.

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