After nearly two years of trying to have a baby, Karen Rzonca, 32, was hoping that this would be the month she finally got pregnant.
When other reproductive medical treatments didn’t work, she and her husband, who live in New York City, decided to try in vitro fertilization, embarking on a path that thousands of women take each year, according to the Society for Assisted Reproductive Technology. First came the injections to stimulate egg production, then a surgical egg retrieval and embryo fertilization with her husband’s sperm.
On March 16, three days before one of the embryos would be inserted into her uterus, her doctor called with some bad news: The embryo transfer was canceled. If she were to contract the coronavirus it was unclear how it might affect her pregnancy or her baby, the doctor explained. And nobody knew when it would be safe to move forward.
“I definitely appreciated, I guess, the concern that the office had …” Rzonca said on March 19, her voice trailing off, leading to tears. “I pretty much took the phone call like a champ, hung up, and then cried my eyes out for two hours.”
As the coronavirus pandemic worsened, the American Society for Reproductive Medicine (A.S.R.M.) issued new guidelines on March 17, advising its more than 8,000 members to avoid starting new treatment cycles for I.V.F., IUI and egg freezing; consider canceling embryo transfers; and suspend all nonemergency surgeries. It made an exception for patients who have an urgent need to freeze their eggs or sperm, as might be the case with someone about to undergo chemotherapy, as well as patients who were midtreatment and had taken ovarian-stimulating drugs.
Some fertility centers, including Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery in Boston and Weill Cornell Medicine’s Center for Reproductive Medicine in New York City, had already stopped treating new patients, even before the guidelines were issued, citing the urgent need to protect the well-being of its current patients, among other concerns.
The A.S.R.M. will re-evaluate its guidelines at the end of March at the latest. But given how quickly the coronavirus is spreading, it’s unclear if the recommendations will be reversed then.
Within days of the A.S.R.M. announcement, Beverly Reed, M.D., a fertility doctor at IVFMD, near Dallas, had created an online petition to protest the new guidelines.
“Many fertility physicians and patients are against this decision and feel that this is a women’s rights violation,” Dr. Reed said in an email on March 22. “American women in general are not being told to avoid pregnancy. So, why are infertility patients being told not to? In addition, it unfairly prevents same sex couples and single mothers by choice from getting pregnant.”
Much is still unknown about how the new coronavirus affects pregnancy. The good news: There is no evidence yet that pregnant women are at a higher risk of developing the disease, and limited studies of women in late stages of pregnancy indicate the virus is not transmitted by a mother before the baby is born, during birth or via breast milk. But experts do not know what effects the coronavirus might have on a fetus, particularly in the early stages of development, or how severely it could sicken pregnant women.
“We really are in unprecedented times,” said Catherine Racowsky, Ph.D., the president of A.S.R.M. and the director of the Assisted Reproductive Technology Laboratory at Brigham and Women’s Hospital. “We feel this is the safe way to move forward for now.”
While many fertility doctors are canceling appointments and temporarily halting new cycles, the New Hope Fertility Center in New York is having conversations with each patient and deciding on a course of treatment on a case-by-case basis, said Dr. John Zhang, M.D., Ph.D., the founder, director and chief executive of the center.
The U.S. government has called for hospitals to suspend elective surgeries to slow the spread of the coronavirus, and because most fertility procedures are considered elective, some doctors have argued that non-urgent fertility surgeries should be suspended to conserve the already dwindling supply of medical equipment and personnel who might be called on to fight the coronavirus.
Fertility clinic officials who have suspended or canceled treatments say they recognize how difficult this is for patients who have been struggling to conceive.
“These procedures, as elective as they may be, they are very much time-sensitive to our patients, there is no question,” said Dr. Antonio R. Gargiulo, M.D., a reproductive endocrinology and infertility specialist at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital. “To them, every month counts — every week counts.”
The new coronavirus is “very aggressive,” he added, and spreading quickly. “We know nothing as to how this may affect the early development of the fetus, the risk of miscarriage, the risk of malformation, the risk of long-term viability of the baby.”
“I don’t know that it’s a great idea to have an attempted pregnancy right now,” he said.
Caroline Haugen, 36, who lives in Traverse City, Mich., tried “for quite some time” to conceive her first child. She visited The Fertility Center in Grand Rapids, Mich., where she received medicated IUIs and eventually became pregnant with a girl, who was born in December 2016. She and her husband decided to expand their family this year and planned to return in April for another IUI.
On March 16 she had an ultrasound to examine her uterine lining and the next day a nurse called to tell her that she was cleared to start a new IUI cycle. Haugen called back on March 20, a couple of days before her medications were expected to arrive, to check back in with the nurse. It was then that she found out her clinic would not be starting any new cycles out of concern over the potential ramifications of coronavirus.
“I cried,” she said. “Because it feels like a negative all over again. Except we didn’t even try.”
Haugen acknowledged that her clinic is “just doing what’s recommended.” Even so, she added, “You want to say, ‘No! Do it to me anyways!’”
The coronavirus adds another layer of worry for fertility patients, adding to the mental and physical stressors of struggling to get pregnant. Fertility treatments can also present a large financial burden.
If a patient were to fall ill during a treatment cycle, she might need to stop treatment after having already spent a great deal of money. That’s a very real concern for patients in most states, including Washington, where insurers are not mandated to cover fertility treatments. The UW Medicine Reproductive Care clinic is adapting the latest guidelines but will make exceptions for urgent cases like cancer patients or other unique circumstances.
Canceling a treatment cycle can mean wasted medication, which is often costly and typically cannot be reimbursed.
Rzonca and her husband had already spent thousands out of pocket for the procedure, including genetic testing, but because she has three normal, frozen embryos they can reschedule the embryo transfer when it’s safe to do so.
In contrast, many women who hadn’t yet started medically assisted fertility treatments this year will need to wait to harvest their eggs, including older women who might be nearing the end of their reproductive years.
The waiting, such an omnipresent part of the process, is one of the hardest parts, Rzonca said.
She and her husband have decided to try on their own, at home, where they are both working for at least several more weeks.
“Yes, of course, this is a terrible, risky time to become a pregnant person for the first time and not know the effect of the virus,” she said. “But we’re definitely not going to hold back.”