Causes & Treatment
Fertility Help – Clinica Tambre Answers your Questions on Covid-19 and Fertility
Eloise Edington | 5 Apr 2020
Covid-19 is, disturbingly but understandably, the topic of nearly every headline and the worry of the moment, to use an under-statement. Here at Fertility Help Hub urge you to stay strong, stay positive and to heed your government’s and the World Health Organisation’s advice. The virus is having a huge and distressing impact on wide areas of people’s lives. However, in this IVF blog article we will be addressing, through renowned fertility clinic Clinica Tambre, some of the questions that you have been asking us specifically regarding the implications of Covid-19 for fertility treatment.
These questions were kindly answered for us on 27/03/20 by Clinica Tambre in Madrid, where there is presently rigorous lockdown and where, at the time of writing, attending health centers is one of the few reasons that citizens are allowed to leave their homes. If you have already sought help and begun fertility treatment, you should consult with your own fertility clinic to discuss the implications of Covid on your treatment. As you know, the situation is changing daily everywhere.
Over to the experts at Clinica Tambre…
www.clinicatambre.co.uk | @clinicatambre
Is It Advisable to Continue Treatment (Ovulation Induction) During the Pandemic?
Answered by Dr. Marta Zermiani
There are a few reported cases of women positive for Covid-19 who delivered healthy infants free of the disease. We experts have no further information on the possible effect of Covid-19 infection on pregnancies in their initial stages, however, it’s important to note that some medical treatment given to severely infected patients may indicate the use of drugs, which are contraindicated in pregnant women.
As a precautionary measure, all the scientific societies in reproductive medicine advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid trying to conceive during this time. It is a difficult situation, but as a pioneer clinic we are here to plan again all your treatment when all this is over 🙂
Related Article – Fertility Clinic Support During the Covid Era
Does the Treatment Put Your Immune System Under Pressure, Giving You a Higher Risk of Serious Illness From the Virus?
Answered by Dr. Esther Marbán
No, they don´t. Fertility treatments have no significant effect on the immune system that may increase the risk of having a more severe medical condition from Covid-19.
How Much is an Otherwise Healthy Woman’s Immune System Compromised or Weakened by Pregnancy and Do you Have Any Advice for Pregnant Women to Improve their Immune System?
Answered by Dr. Elena Santiago
Immune systems during pregnancy can be different due to all the changes in the body that need to occur to “accept” the implantation and development of the embryo and foetus. This doesn’t ́t mean that a pregnant women is vulnerable to all types of diseases or that, if she has any illness, this will be more severe because of her condition. Some can be more dangerous during pregnancy but not all of them. There is no recommendation at all to improve the immune system, as this could be self-defeating for the pregnancy. The only advice is to follow the vaccine recommendations such as for flu during autumn and winter, as taking care of your gut health is even more important during this time.
Have Clinics Been Advised or Told To Delay Treatment if it Hasn’t Started Yet? If Treatment is Having to be Delayed, is There an Estimated Time When Clinics Might Feel Happy to Resume IUI and IVF Cycles?
Answered by Inge Kormelink, CEO of Tambre
Clinica Tambre is following the strict guidelines of ESHRE and the SEF, to be able to ensure safety and continuity to all our patients. Consequently, many actions will depend on the protocols given by these organisations. We are supporting our patients wherever they are. We have done that in the past, we are doing this right now and will do so in the future. Tambre is a high-end boutique clinic that in record time has proactively implemented all the measures needed to be ready for when we can start again helping out patients on their road to parenthood. Although at the moment it is not possible to resume face-to-face appointments with our international patients, we are doing our best to strengthen communication with them so that, even though we are far away, they feel us closer than ever.
Related Article – Fertility Clinics Reopening: ASRM Release Updated Guidelines
If There is Considerable Delay, Can Egg Quality Decrease Much Over, For Example, 4 to 5 Months?
Answered by Dr. Elena Santiago
It ́s true that time has a negative impact on egg quality and ovarian reserve, but we really don’t know if 4-5 months can really be an important consequence…It obviously depends on the basis of the situation of each woman, but normally less than 6 months shouldn’t change the situation so much that it won’t work anymore or even be worse than a few months ago.
What Can We be Doing in the Meantime to Prepare, Ready For When Treatment Becomes Available Again?
Answered by Dr. Marta Zermiani
On the one hand, we must be patient and remain calm, even if it is not easy. Fertility clinics have the mission of informing their patients at times like this and giving them the assurance that the treatments will be adapted to the situation. On the other hand, we have to be firm about following preventive measures regarding hygiene. Men and women planning or undergoing fertility treatment should avoid travel to known areas of infection and contact with potentially infected individuals and, if they live in these areas, they have to comply with all safety measures in order to avoid Covid-19 infection. We must take great care of ourselves, like for e.g. our gut health.
Related Article – Mask Inspiration to Prepare You for Your Fertility Appointments
If you are Pregnant, How Concerned Should you be About Any Adverse Effect of Covid-19 on your Pregnancy, Whether in First, Second or Third Trimester?
Answered by Dr. Esther Marbán
The current information and data available at the moment show that pregnant women’s medical condition doesn´t seem to be worse than the rest of the young and healthy population.
There are few reported cases of women positive for Covid -19 who delivered healthy babies and there have been some reports of adverse neonatal outcomes such as preterm delivery, premature rupture of membranes, respiratory distress, liver function alteration or thombocytopenia.
According to the latest ESHRE (European Society of Human Reproduction and Embryology) information, there is no strong evidence of any negative effect of Covid-19 infection on pregnancies, especially at early stages but due to the lack of information currently available of the possible effect of the infection on pregnancy in the initial stages, this data should be interpreted with caution.
Related Article – 3 Top Strategies to Use this Pandemic Down-time to Your Advantage
How Soon do you Think We’ll see Robust Data on Covid-19 Pregnancy Outcomes?
Dr. Marta Zermiani
We have to wait for more data on the effect of Covid19 infection on pregnant women and the foetus. Basically, we need more time, maybe one year or more.
Now for some more general fertility questions…
1. Is there a Way to Improve the Thickness of Your Uterine Lining for IUI?
Answered by Dr. Marta Zermiani
Usually it is not necessary to perform any treatment in order to implement endometrial lining thickness in a IUI cycle because in women with regular periods the endometrium reaches the correct thickness and characteristics (it should be trilaminar) in a natural way or with small doses of ovarian stimulation. In some patients with very irregular periods, which normally have non-ovulatory cycles, it is sometimes difficult to achieve the desired follicular growth and, at the same time, an adequate endometrial development. In such cases an estrogen treatment can be added (usually estradiol valerate), orally or vaginally, with the aim of improving endometrial lining thickness.
2. Do you have Advice on how to Improve Egg/Embryo Quality and Numbers?
Answered by Dr. Elena Santiago
A) Quality:
Egg quality normally depends on a woman´s age, so the older she is, the poorer the quality. There is nothing we can do about this, but obviously we try our best during ovarian stimulation. In women older than 35 years, we use protocols that include hMG or LHr, basically to have either FSH or LH hormones participating during the process. This is always controversial depending on different scientific studies, but there are no negative side effects. If we achieve the best egg quality, we will also be able to improve embryo quality.
Embryo quality depends not only on the egg, but also on sperm quality. For this reason, we will try to decrease DNA fragmentation during sperm selection using different techniques at the lab. Afterwards, embryologists will try to pick the best spermatozoa using the microscope before ICSI.
For embryo culture, we have the possibility of using last generation incubators with “Time Lapse” technology. In this way, the constant environment conditions will also improve embryo quality.
Related Article – Fertility Springboard Podcast: Everything You Need to Know about Embryo Transfers
B) Number:
One of the challenges in reproduction is to try and have a good response to ovarian stimulation in women with a low ovarian reserve, meaning that the response is not as high as we would like. In this case, we follow a high dose stimulation protocol to try and have the maximum number of eggs as possible and therefore the highest number of embryos too.
Another fertility help option to improve the number of follicles is to do pre-treatment before stimulation with different substances such as testosterone, melatonin or DHEA. Unfortunately none of these has proven to really increase the response in women with low ovarian reserve or poor responders.
Hopefully this IVF blog article has helped to answer some of your questions during this unprecedented time, and provided you with some help, comfort and hope for your fertility journey.
