Reproductive health in the age of COVID-19 can be a scary thing to endure. With a virus circulating throughout the world, family planning has paid a price (along with many other things). For expecting families, the arrival of a new baby during a pandemic may be a daunting and nerve-wracking endeavor. There’s still so much to learn about the novel coronavirus and it may be too early to know for sure what the disease can do to a pregnancy. Doctors and OBGYNs alike are ensuring that they are taking the appropriate measures to keep families safe during this time. We asked Amodrn readers to give us any and all questions they may have about reproductive health right now. And we have answers.
Dr. Lucky Sekhon is a reproductive endocrinologist and infertility specialist, a board-certified obstetrician and gynecologist, and an assistant clinical professor in the Mount Sinai Health System. She has particular expertise in fertility preservation (egg freezing), LGBTQ family building, and in-vitro fertilization. While Dr. Sekhon maintains a busy clinical practice, she continues to publish and present cutting edge clinical research in the field of reproductive medicine. She is passionate about educating women about their reproductive health and family building options and often volunteers at various Women’s’ Health outreach events throughout the city. We asked her your most-asked questions about all things reproductive health and COVID-19. She answered. Keep reading for more.
An OBGYN Answers the Most Common Questions Asked About Pregnancy and COVID-19
1) Are your late thirties a risky time to start trying to have children?
Many women are starting their family building journey in their mid to late 30s, oftentimes due to professional demands and other priorities shifting when they are ready to begin trying to conceive several years later than when their mothers’ and grandmothers’ were starting their families. This societal shift poses a challenge to our biology as women. We are all born with a finite number of eggs and we lose these eggs over the course of our lifetime. This loss in egg quantity accelerates as we approach age 35 years and older. This is compounded by the fact that egg quality diminishes over time as well – which means it can be more difficult to get pregnant, and there is a higher risk of miscarriage.
In our 20s, we anticipate that 1/4 pregnancies end in miscarriage, due to the fact that about a quarter of all embryos formed from our eggs may result in genetically abnormal embryos that don’t have what it takes to establish a healthy pregnancy. That figure rises to about 50% by the time we approach age 37-38 years, and to more than 60-70% beyond age 40.
The one ‘workaround’ is to consider freezing eggs or embryos. Once eggs are frozen, themselves, or as embryos (if fertilized by sperm), they are no longer subject to the degradation of quantity and quality over time… and your uterus DOES NOT age. Eggs/embryos can remain frozen indefinitely and be used at any time in the future to conceive a pregnancy Pregnancy risks, in general, do increase with age, particularly over age 40 years – you are more susceptible to high blood pressure, diabetes in pregnancy, requiring a c-section at delivery, and other complications. This is something to keep in mind as you think through your family building goals.
2) Are pregnant women showing classic signs of COVID-19? WHO has classified pregnant women as low risk, what do you think?
The symptoms and manifestations of COVID-19 appear to be similar among pregnant and non-pregnant women. Studies out of NYC are showing that up to a quarter to a third of pregnant patients who test positive for COVID-19 upon admission to labor and delivery are, in fact, completely asymptomatic. The large majority of symptomatic pregnant patients have mild symptoms (~80-90%), with less than 10% of cases being classified as severe, and less than 5% of cases being critical. This is comparable to the breakdown in case severity seen among non-pregnant patients with COVID-19. This likely only applies to low-risk pregnant women – not those with additional risk factors for severe disease with COVID-19 ie. morbid obesity, high blood pressure, underlying cardiac/lung issues.
3) Is trying for a baby safe during this time?
At this time, there are no recommendations coming from any professional medical societies that all women should delay trying to conceive. This is due to the fact that there is a lack of evidence of any glaring risks to mom or unborn baby if COVID-19 is contracting in pregnancy. Given that fertility is a time-sensitive matter and the COVID-19 pandemic is unlikely to become a thing of the past anytime soon, it would be impractical and unfair to advise all women to delay childbearing until further notice. Unlike Zika, which had a very clear link to devastating birth defects in the baby, SARS-CoV2 does not appear to have an obvious impact on miscarriage risk or birth defects.
Of course, we are still learning new information about the virus and its impact every day so it would be wise to exercise an abundance of caution once you are pregnant (ie. avoiding crowds, wearing masks, regular handwashing, etc) as we accumulate more data. Thus far, no major red flags are appearing with regards to COVID-19 and how it impacts pregnancy in the first, second, or third trimester. While there are some limited case reports demonstrating virus has been found in the placenta, the majority of studies have failed to demonstrate that the virus can easily cross the placenta, with no infants testing positive at the time of delivery.
4) For pregnant women right now, is it safe to give birth?
Yes. Of course, entering a hospital, especially in a community with high rates of COVID-19, is a daunting prospect during times like these – even if the reason for visiting the hospital is for an exciting, happy reason ie. delivering your baby. Hospitals have evolved quickly to ensure the safest environment possible for mom and baby at the time of delivery. Most large NYC hospitals are employing universal testing of both mom and their support person who plans to join them during labor and delivery. All staff members and patients are wearing masks to protect themselves and their patients.
5) Are pregnant women more susceptible to COVID-19?
No, it does not appear that pregnancy sensitizes an individual to be more likely to contract COVID-19 or to have more severe disease than what is seen in the non-pregnant population.
6) Should I worry about bringing COVID-19 home from the hospital? Should I go straight home after my birth? Will I wear a face mask during birth?
You will wear a face mask on labor and delivery. I recommend adhering to strict social distancing with a newborn – even pre-COVID-19. A newborn is unvaccinated and vulnerable to a wide array of bacterial and viral infections. Their immune system is naive and susceptible to most bugs. Due to concerns of exposure to COVID-19 in the hospital, strict precautions such as the use of personal protective equipment and regular handwashing are used to mitigate the risk of spread.
7) When is it safe to have visitors after birth during this pandemic?
This is a difficult one – it is hard to know when this will be regarded as safe. It also depends on who the visitors are. For instance, if you were having your parent come to spend time with you during your maternity leave – you could ask that parents or support person to limit their contacts and take extra precautions to avoid exposure for ~14 days or longer prior to the planned trip, to minimize the risk of them contracting COVID-19 and transmitting it to you at home. I would err on the side of caution, and not lift the restrictions against home visitors until broader restrictions can be lifted on society and we are less worried about the rate and spread of infection.
8) Can COVID-19 transmit in the womb? Are there any links between COVID-19 and birth defects?
There are no known links between COVID-19 and birth defects. The majority of studies of women in their third trimester, with COVID-19, who delivered during the pandemic have shown no sign of transmission of the virus into the baby, breast milk, cord blood, amniotic fluid or placenta. Since these initial studies, there have been sporadic case reports of being able to isolate viruses from the placenta. However, no studies have shown convincing data that the virus can be passed directly from mother to baby, while the baby is in utero – as newborns who were tested shortly after delivery are consistently found to be COVID-19 negative.
9) Breastfeeding and COVID? How risky is it? Should I isolate so there’s no chance of catching it?
Breastfeeding is still great to promote healthy bonding between mother and baby. It also optimizes the health and immunity of the newborn.
10) Can I still start/continue fertility treatments during this time?
Yes. Most fertility clinics took a short pause on treatment, at the height of the pandemic. However, in the last 1-2 weeks, we have begun treating patients again. It looks very different nowadays. Everyone who works in the office is wearing a mask, gloves, and sometimes even goggles – to protect themselves and patients. We are staggering our cases so that we have a more even, overall lower volume of patients in the office at any one given time. Although IVF is a low-risk procedure overall, we continue to strive to minimize the potential (mostly rare) risks of complications from ovarian stimulation and egg retrieval by being very conservative with any clinical decisions (ie. taking utmost care to minimize the risk of twins, which are high-risk pregnancies). We are doing many consultations via telemedicine to minimize in-person exposure.
11) Should those who are pregnant return to work when this pandemic has calmed down? What if they work in high-risk environments like schools?
This is a highly personalized decision. Because there is a lack of evidence to suggest that pregnancy, itself, is a risk factor for contracting COVID-19, or having a more severe illness, higher risk of hospitalization and/or mortality, there is no formal recommendation to pregnant women in the U.S. to avoid going to work – whether they are teachers or health care workers, who are more likely to be exposed. However, this is a novel virus and we admittedly are learning new things about it as time passes. Thus far, the data has been reassuring from both the maternal and fetal standpoint regarding safety. But we do not have complete data, particularly on earlier infections that take place in the first trimester. Preliminary data from second-trimester ultrasounds do not suggest an increased risk of fetal malformations or birth defects, which is reassuring.
For any pregnant woman who is concerned and wants to practice an abundance of caution until more time passes. We can then accumulate more data, it might be reasonable to decide to work from home. Some women have taken the decision to take medical leave or go on maternity leave early, to minimize exposure.
12) Should I put a face mask on my child when we go outside?
If your child is 2 years old or older, you can try to have them wear a face mask. This minimizes the risk of exposure outside. I recommend practicing this indoors first. If your toddler is fussing with the mask and more likely to keep touching their face and the mask while wearing it, it may do more harm than good as they will be touching their face while outside, after touching potentially contaminated surfaces. If your toddler isn’t compliant with wearing the mask (as many won’t be) without frequently touching the mask or their face, the best measures are to maintain a distance of 6 feet or more from any other individuals while outside and to avoid enclosed spaces when with your child, if possible. It is also prudent to bring hand sanitizer with you on any outing to periodically clean your toddler’s hands.
13) Is frozen embryo transfer risky right now?
Frozen embryo transfer is a relatively low-risk procedure. It is a very simple procedure that does not require anesthesia. The procedure involves using a long, thin, flexible catheter to drop the embryo off a few centimeters from the top of the uterine cavity. It is done under ultrasound guidance in most clinics, so we are always aware of where the embryo is being deposited. The main risks of a frozen embryo transfer cycle are that the embryo may not implant (and you aren’t pregnant and have to try again), it could implant and result in a later miscarriage, or it could implant in the wrong place (ie. the fallopian tube) and result in an ectopic pregnancy that would need potential medical and/or surgical treatment.
With close monitoring of any pregnancy achieved from a frozen embryo transfer, your doctor will be aware of the pregnancy. It will appear normal vs. abnormal from an early stage and can monitor the situation accordingly.
Try different measures until you find what soothes your morning sickness. Everybody is different and will have different triggers. For many, hunger will exacerbate morning sickness. Eating carbs or something salty will help to keep morning sickness at bay. If morning sickness progresses to frequent vomiting and inability to keep food and/or water down, it is important to consult your doctor. This ensures you aren’t getting to the point of dehydration or weight loss in early pregnancy. If it is severe enough, you may require observation at the hospital and IV fluid hydration. In this case, small doses of medication can work to control nausea and vomiting of pregnancy.
15) How long after a C-Section is it safe to try getting pregnant again?
In general, we strongly recommend a minimum of 6 months to start trying to conceive again. This allows your uterus adequate time to heal. The incision is a scar that needs adequate strength to promote a healthy pregnancy. It also minimizes the risk of uterine rupture as the uterus expands and grows during the pregnancy. It is ideal to have an interpregnancy interval of at least 18 months.
16) Tips for those transitioning from birth control to attempting to have a child?
If on a long term birth control pill, you may need to be patient. It can take anywhere from 3-6 months for a normal ovulation pattern to be restored. If you haven’t gotten a period for 3-6 months or longer after stopping the pill, consult your OBGYN or a reproductive endocrinologist to investigate further. When using an IUD, it’s different. This is a quickly reversible form of contraception with effects that should cease as soon as the IUD is pulled out.
Once you are off birth control it is a good idea to keep a menstrual diary and keep track of when you get the first day of your period each cycle and to also note when you think you are ovulating based on physical signs/symptoms or the results of ovulation predictor kits. This will help you monitor whether your cycles have restored to a regular pattern and frequency, and to identify any potential gynecologic issues which may have arisen that could have been masked by long term contraception that either stopped your period altogether or produced a fake or synthetic period.
17) Best prenatal vitamins to take to get pregnant and when to do it?
Any prenatal vitamin will do the trick. As long as it has 400mg of folic acid to prevent neural tube defects such as spina bifida. Ideally, you should start prenatal vitamins 2-3 months preconception.
18) If I have previously had retained placenta and hemorrhage after giving birth, am I at risk again?
It depends on what the cause of the retained placenta and hemorrhage was. Will the placenta have a history of scarring of the uterus or prior c-section? You are definitely at risk of a repeat event and should be monitored closely in future pregnancies. Your OBGYN should be reminded of this history when you are admitted for labor and delivery so that they can be prepared in case of a repeat event and have all the necessary tools ready should you experience another hemorrhage.
19) Diagnosed with PCOS, both ovaries with 30 cysts. Any tips on how to get pregnant with PCOS?
=Polycystic ovary syndrome (PCOS) is most relevant to fertility when it causes cycles to be irregular. This indicates that you are not ovulating regularly. This can make it very difficult to time when to have sex and try to conceive each cycle. Also, it can make your attempts very inefficient as you may have long periods of time between each cycle/ovulation. So, over time, you have fewer chances than the average person who normally ovulates every 28-30 days. It is important to seek the help of a reproductive endocrinologist and infertility specialist. They can prescribe medications to help get your cycle on track. And also get you to ovulate more regularly and in a predictable manner. We can also help you time when to have sex by more accurately detecting when you will ovulate.
Ovulation predictor kits often give false-positive results. Sometimes, patients with PCOS tend to have high baseline levels of the main hormone.
20) How to deal with hormonal anxiety?
It depends on how severe it is. For some women with mild symptoms, recognizing that the anxiety is stemming from hormones and premenstrual syndrome is often enough to help alleviate it -once you acknowledge it, it may dissipate. It is also helpful to keep a journal documenting how you are feeling so that you can recognize patterns and understand the triggers better. Explore different coping mechanisms- whether it be calling a friend or family member and leaning on them for support, or using exercise/meditation/acupuncture to help work through the anxiety. Some women have more severe symptoms of anxiety/depression that seems to be related to their menstrual cycle. They may have something more serious than just plain old PMS.
PMDD (premenstrual dysphoric disorder) is an actual diagnosis. There are many medical interventions as well as non-pharmacologic therapies that can help with this.
While you’re here, check out this Amodrn article on our founder Bianca May Cheah’s birth story.