Is it safe to get pregnant during the Covid-19 Pandemic?

Covid-19

These are very uncertain times. The medical profession, scientists, politicians and the general public are grappling with how best to manage a new virus and a pandemic like none we have seen before.

Medical and scientific evidence about the virus is accumulating daily, but there is still a lot we don’t know.

The evidence to date on pregnant women who have contracted Covid-19 and delivered babies is very reassuring. International bodies including the Royal College of Obstetricians and Gynaecologists in London are at pains to reassure pregnant women that they do not need to panic but, like the rest of us, they need to take extra precautions, particularly around social distancing and hygiene.

To date we know of nine women in the Chinese city of Wuhan who were diagnosed with Covd-19 in late pregnancy (36-39 weeks). None of these women developed severe respiratory disease; their clinical course was similar to that of non-pregnant women with the disease. All their babies were delivered by Caesarean section; all the babies were well and no virus was found in the amniotic fluid, the infants or breast milk.

Since then, 13 other pregnancies have been reported in Chinese women outside Wuhan. One became critically ill but this incidence is no higher than in the non-pregnant population. Six of these women went into premature labour and there was one stillbirth but we cannot say if these complications were related to the virus. In other reports, two babies have been diagnosed with infection soon after birth, one in the US and one in London, but it seems likely the infection happened after the birth rather than during the pregnancy or birth. This is all very reassuring for pregnant women.

Trying to conceive

But what about those who are not pregnant but are thinking about it or are trying to conceive? Should they be getting pregnant at this moment in time? It is really difficult to give clear advice in this regard, because we just don’t have enough evidence or experience with this virus. The reassuring studies described above involve very small numbers of women and all were in the later stages of pregnancy. There have been no reports yet on the outcomes of women infected in early pregnancy. We don’t know how the virus behaves in early pregnancy.

Because of this uncertainty, three international fertility bodies – the European Society for Human Reproduction and Embryology, the American Society for Reproductive Medicine and the British Fertility Society have in the last few days given guidance to fertility specialists advising them not to provide any treatment which would lead to pregnancy.

Irish fertility clinics – and many others in the US and Europe – have stopped doing treatments that would result in a pregnancy at this time. This includes IVF cycles, intrauterine or artificial insemination (IUI) and the use of fertility drugs to induce ovulation.

For people midway through IVF treatment, it is advised to freeze embryos for future use rather than to transfer them now. It is important to stress that these are very much precautionary measures until we have more data regarding the effects of Covid-19 in early pregnancy. It is undoubtedly extremely stressful for patients, but most agree it is best to be cautious at this time.

Other factors that affect this decision are the need to observe social distancing to reduce spread of the disease and help to “flatten the curve”. We can do this only by minimising the number of people attending clinics. However, many clinics are still open and staffed by nurses, doctors and other support staff who can answer queries and help people through this difficult time.

Concieve naturally

The halting of fertility treatment by clinics raises the question as to whether people who do not have fertility problems should continue to conceive naturally or spontaneously. The short answer is that we just don’t know. There really is no guidance available yet about this.

We know that those with underlying health problems – people who are immune-suppressed or who have diabetes or chronic lung disease – are more at risk of serious illness if infected with the virus. It would seem prudent that this group consider avoiding pregnancy at this time.

Young women who are fit and healthy and have no fertility-related issues may wish to postpone pregnancy for a few months until we have more information. Older women and those with known fertility issues often do not have time on their side, so they may wish to continue trying to conceive – or they may wish to wait a little while too.

Duty of care

Because fertility treatment such as IVF is an elective medical treatment, those working in fertility clinics have a medical duty of care to their patients not to provide a treatment unless there is sufficient evidence that it is safe. However, individuals trying naturally will have to make their own decisions at this time of such uncertainty.

There are conflicting opinions among doctors and scientists as to whether we should reassure or worry the general public at this time. There is a fine balance to be struck.

The aim of this article is to share the current evidence – scanty as it is – in the public domain so that the general public are aware of the pros and cons of conceiving at the present time. The evidence and guidance will be updated over the coming weeks as more pregnancy outcomes are reported. In the meantime, some advice would be to not panic, stay on folic acid and any other recommended medications and use this time to optimise one’s physical and mental health.

Professor Mary Wingfield is clinical director at the Merrion Fertility Clinic and a consultant obstetrician gynaecologist at the National Maternity Hospital

 

Important Covid-19 update for MFC patients

 

 

 

 

 

MFC Policy re services

Monday 16th March 2020

It is with great regret that we are curtailing all our fertility treatments from today, 16th March 2020.

On 14th March, ESHRE, the European body which advises on fertility in Europe, issued advice that fertility patients should avoid conceiving at present due to possible risks of COVID-19 in pregnancy. (See full statement below).

This may be an overreaction but we have taken the difficult decision that it is best to be cautious at this point in time. We will be monitoring the situation carefully and will adjust our policy as required.

As of today we are cancelling:

  • All embryo transfers (fresh and frozen cycles unless exceptional circumstances)
  • All ovulation induction and IUI treatments

Our clinic is still staffed and we will be doing as much as possible to keep things going. Please contact us by phone or email if you have any particular concerns. Again, we apologise for any inconvenience and distress that this will undoubtedly cause.

European Society for Human reproduction and Embryology

Coronavirus Covid-19: ESHRE statement on pregnancy and conception,  14 March 2020.

There is no strong evidence of any negative effects of Covid-19 infection on pregnancies, especially those at early stages, as indicated by the latest updates from the Centers for Disease Control and Prevention (CDC) in the USA and others in Europe.(1,2)

There are a few reported cases of women positive for Covid-19 who delivered healthy infants free of the disease.(3) There have been reports of adverse neonatal outcomes (premature rupture of membranes, preterm delivery) in infants born to mothers positive for Covid-19 during their pregnancy, but the reports were based on limited data.(4) Similarly, one case report has been published of an infected infant, but again there was no strong evidence that this was the result of vertical transmission.(5)

These data, although encouraging, only report small numbers and must be interpreted with caution. They refer to pregnancies in their final stages, but we have no information on the possible effect of Covid-19 infection on pregnancies in their initial stages.(6)

However, in view of the above considerations and the maternal and neonatal outcomes reported in cases of other coronavirus infections (such as SARS), ESHRE continues to recommend a precautionary approach.(7) It is also important to note that some of medical treatment given to severely infected patients may indicate the use of drugs which are contraindicated in pregnant women.

 

As a precautionary measure – and in line with the position of other scientific societies in reproductive medicine – we advise that all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid becoming pregnant at this time. For those patients already having treatment, we suggest considering deferred pregnancy with oocyte or embryo freezing for later embryo transfer.

ESHRE further advises that patients who are pregnant or those (men and women) planning or undergoing fertility treatment should avoid travel to known areas of infection and contact with potentially infected individuals.

ESHRE will continue to monitor the scientific literature, especially in relation to ART and pregnancy. And reaffirms the view that all medical professionals have a duty to avoid additional stress to a healthcare system that in many locations is already overloaded.

CORONAVIRUS / COVID-19 UPDATE

Thank you for your patience in these very uncertain times.

We are observing the situation and keeping up to date with national and international recommendations. As you know, this is an evolving situation and advice is changing day by day. See www.hse.ie

Because we are a healthcare facility and our treatments are elective, we are adopting safe but strict procedures in an effort to protect all patients and staff and we will be giving our patients regular updates. We sincerely apologise for any inconvenience caused and please rest assured that we will do everything possible to minimise disruption and stress.

Our current recommendations and policies are as listed below. Please call or email us if you have any concerns.

Please do not enter the clinic if:

– You are known to have the Covid-19 virus, whether well or ill

– You have travelled to or from the affected regions listed below

– If you have been in contact with someone who has the virus

– You have flu like symptoms such as:

  • A cough
  • Shortness of breath
  • Breathing difficulties
  • Fever (high temperature)

If you are unsure, please call us on 01 663 5000 to discuss your situation

Avoid Unnecessary Patient Visits

We are organising telephone consultations to reduce the need to attend the clinic

We cannot allow partners or children to attend for the following:

  • Scans (except pregnancy scans)
  • Blood tests
  • Semen analysis

We have taken the difficult decision to postpone some services. This is in the interests of patient safety and we sincerely regret having to do this. Anyone who has had their treatment cancelled will be given priority when services get back up and running and there will be no financial implications.

How to Prevent

  • Wash your hands well to avoid contamination
  • Avoid touching eyes, nose or mouth with unwashed hands
  • Cover your mouth and nose with a tissue or sleeve when coughing or sneezing and discard used tissue
  • Clean and disinfect frequently touched objects and places
  • Distance yourself from others and avoid crowds/gatherings

What Should I Do?

  1. I have been to an affected region in the last 14 days and

HAVE symptoms

  • Stay away from other people
  • Phone your GP without delay
  • If you do not have a GP, phone 112 or 999

DO NOT HAVE symptoms

For advice see www.hse.ie

  1. I have been in close contact with a confirmed or probable case of COVID-19 in the last 14 days and

HAVE symptoms

  • Stay away from other people
  • Phone your GP without delay
  • If you do not have a GP, phone 112 or 999

DO NOT HAVE symptoms

For advice see www.hse.ie

Affected Regions

  • China
  • Hong Kong
  • Singapore
  • South Korea
  • Iran
  • Japan
  • the following regions in Italy – Lombardy, Veneto, Emilia-Romagna or Piedmont
  • Spain

 

 

 

Tackling Fertility in Endometriosis

Endometriosis Awareness Month

What is endometriosis?

Endometriosis is a chronic inflammatory condition that affects up to 1 in 10 women of reproductive age, and typically causes pelvic pain, painful periods and reduced fertility. In clinical terms, endometriosis means the growth of endometrial tissue (i.e. internal lining of the uterus or womb) outside the uterus. This can occur anywhere in the pelvis, most commonly behind the uterus, on the ovaries or in front of the uterus, and very rarely in regions distant from the pelvis, such as the lungs. Just like the endometrial lining of the uterus, these endometriosis lesions also release blood and inflammatory factors into the pelvis during menstruation. Over time, this can cause scarring, cysts and adhesions in some women, increasing pain around periods and even throughout the menstrual cycle. The presence of endometriosis can only be confirmed by laparoscopic (keyhole) surgery. Depending on the amount, location and type of endometriosis lesions observed by the clinician during laparoscopy, the disease is graded as minimal (Stage I), mild (stage II), moderate (stage III) and severe (Stage IV).

 

What causes endometriosis?

Despite being recognized since the 1800s, its high prevalence in the global female population and the significant economic and medical impacts it imposes, the exact cause of endometriosis remains poorly understood. The leading theory is that of ‘retrograde menstruation’, i.e. that during menstruation, blood can reflux back through the Fallopian tubes and into the pelvis, carrying small fragments of endometrial lining. It is thought that these fragments can either implant and themselves cause endometriosis, or stimulate the lining of the pelvis to develop into endometriosis. In support of a role for retrograde menstrual bleeding, it is very unusual for endometriosis to occur in women who are not menstruating, and it is more common in women who have long, heavy and frequent periods. However, retrograde menstruation is estimated to occur in up to 90% of women, while only 10% of women will develop endometriosis, so this is clearly not the whole story. We know that there is a genetic predisposition for endometriosis, particularly the severe forms of the disease. Women who have a first-degree relative (i.e. mother or sister) with endometriosis are six times more likely to develop it themselves, but as yet there is no genetic test to determine endometriosis risk. No major differences have been found in the actual menstrual blood of women with or without endometriosis, but a number of studies have shown distinct changes in the endometrial lining of the uterus itself. Differences have also been found in the pelvic fluid of women with endometriosis, but whether these changes are a cause or result of the disease remains unknown.

 

How does endometriosis affect fertility?

Endometriosis is a leading cause of reduced fertility in women, occurring in  30-50% of women attending fertility clinics for assisted reproduction. However, up to two-thirds of women with endometriosis will have no difficulty conceiving, and it is not yet clear what distinguishes those women who will struggle from those who will not. In severe endometriosis, distortion of the ovaries and Fallopian tubes can impede fertilization and pregnancy establishment, while ovarian cysts (called endometriomas or chocolate cysts) can interfere with ovulation and the ability of the ovary to produce good quality eggs. In milder grades of endometriosis, where the pelvis is not significantly distorted, the reasons for subfertility are less obvious. Many studies have indicated that the immune system of women with endometriosis-associated infertility may be different to that of healthy fertile women. For instance, studies have revealed increased inflammatory factors in the fluid of the peritoneal cavity and in the endometrium of women with endometriosis, which are likely to impact ovulation, egg development and embryo implantation. Research from Merrion Fertility Clinic, in collaboration with Trinity College Dublin, found differences in uterine immune cells in women with endometriosis-associated infertility who had a successful cycle of IVF compared to women who were unsuccessful. While there is compelling research evidence of immune dysfunction, it is important to note that, as yet, there are no  immune tests or treatments that are of value. Neither is there any international consensus on the cause or mechanism of subfertility in endometriosis.

 

What are the options to treat infertility in endometriosis?

For women with endometriosis who are trying to conceive, it is generally recommended that they seek help after 6 months of trying. If a woman is unsuccessful after a year of trying, it is very likely that she will need assistance to conceive. The two main options are surgery or assisted reproduction, most commonly IVF. For women with mild forms of endometriosis, there is evidence that surgical removal or destruction of the lesions can improve fertility, possibly by reducing pelvic inflammation. Surgery has also been shown to improve fertility in severe endometriosis. If the pelvis is restored to a near normal state, around 30-50% of women will conceive in the 12 months following surgery. For this reason, for young women with no other significant infertility factors (e.g. partner’s sperm quality), laparoscopic surgery is typically the first option. In women over 35, the benefits of surgery as opposed to proceeding directly to assisted reproduction need to be carefully weighed. IUI is a viable option only for women with mild disease (Stages I and II), but not for those with significant scarring or inflammation. IVF is a very effective treatment for the majority of women with endometriosis. For young women with severe endometriosis, who are not yet in a position to conceive and may require major surgery and/or removal of an ovary, egg freezing (oocyte vitrification) should be considered as an option to preserve their future fertility.

 

 

For further reading, please see:

The Fertility Handbook (Gill Press), Professor Mary Wingfield

https://merrionfertility.ie/patient-information/causes-of-female-infertility/endometriosis/

http://endometriosis.org/

 

Is Fertility Law in Ireland set to change?

Fertility Law

Legislation regarding assisted reproduction in Ireland has yet to be implemented, and while we await formation of our new government, it is not clear when this will proceed. Parts of the Children and Family Relationships Act 2015 (CFRA) that deal specifically with donor-assisted human reproduction (excluding surrogacy) are due to take effect on 4 May 2020. This will leave a number of important issues unresolved, including parentage of children born to LGBT families using donor assisted technologies, the legal position of their parents, and the status of donor gametes currently in storage.

Solicitor Fiona Duffy, partner at Patrick F O’Reilly & Co., discusses the current legislative and regulatory concerns surrounding ART in Ireland in the article below:

https://www.bionews.org.uk/page_147640

First baby born from In Vitro Matured (IVM) frozen eggs

Frozen EggsThe world’s first successful pregnancy resulting from immature eggs that were matured in the lab before being frozen has been reported. This is an important breakthrough for fertility preservation in cancer, where patients may not have time to undergo traditional egg freezing before starting chemotherapy.   To read more click on the link below:

https://www.breakingnews.ie/world/first-baby-in-world-born-from-eggs-matured-in-lab-and-frozen-say-scientists-982599.html

 

Pre-Implantation Genetic Testing

Pre-Implantation Genetic Testing:

 

PGD (Pre-implantation genetic diagnosis) was developed several years ago and is an excellent technique for diagnosing embryos that have a specific genetic disease such as cystic fibrosis or muscular dystrophy.  This helps people who have a strong family history of such conditions to consider only using embryos that are not affected by these conditions.

PGS (Pre-implantation genetic screening) on the other hand is a similar technique applied to embryos  in the hope of identifying changes in the numbers of chromosomes in the embryo.    Embryos with a normal pattern of chromosomes (euploid) have the best chance of developing into a healthy baby, whereas aneuploid  embryos, that do not have the correct number of chromosomes, are less likely to implant and, if they do, the pregnancy is more likely to end in miscarriage or the birth of a baby with a genetic condition.

In recent times, more and more clinics are offering PGS for couples undergoing fertility treatment.     The exact place of PGS has yet to be determined as there are still many questions to be answered about the technique.    While it can reduce the number of miscarriages and failed pregnancies, it has not yet been shown to increase the number of live births from an IVF or ICSI treatment.    There are no studies on the long term effects of this technique as it has just not been around long enough.     In addition, the results are not always straight forward.   A significant problem is mosaicism, where some cells have a normal number of chromosomes and others don’t.  In these cases, it can be difficult for geneticists to determine the likely outcome of such pregnancies.  There have also been cases of false positive and false negative test results.

For all these reasons, Merrion Fertility Clinic’s policy at present is to recommend PGS for certain of our patients but not for all couples undergoing IVF.   However, we are cognisant that this is an evolving issue and that, as more studies are done, hopefully, the true role of PGS and its place in fertility treatment will be established.

Recently the HFEA, the official regulatory body for Assisted Reproduction in the UK,  determined that PGS should be classified as a ‘red status IVF treatment add on’ i.e. that ‘there is no evidence that the treatment is effective and safe’.  This decision is controversial.  It certainly has merit but others in the field disagree.    For that reason Merrion Fertility Clinic, as described above, takes an individualised approach to patients when discussing the benefits and risks of PGS.

 

For more reading:

https://www.hfea.gov.uk/about-us/news-and-press-releases/2019-news-and-press-releases/pgs-rating-now-red-following-review/

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/pre-implantation-genetic-screening-pgs/

Merrion Fertility Clinic’s Top Ten Highlights of the Past Decade

No. 1: Expanded Facility

2010: We moved into our current facility in no.60 Lower Mount Street which gave us the space we needed to grow and expand our services, while still being part of the National Maternity Hospital complex. We also had a state-of-the-art laboratory built.

No. 2: Donor Egg Service Launched

April 2015: We announced that we had established a satellite service to support appropriate patients requiring donor egg treatments. Our satellite service comprises pre-pregnancy medical advice and counselling, psychological support, arrangement of pre-requisite tests and prescriptions, provision of necessary ultrasound scans and tests during treatment, and relay of results to overseas clinic.   READ MORE

 

 

No. 3 Launch of MFC Support Group

August 2015: We began our support group which runs every month and is facilitated by our very experienced fertility counsellor, Kay Duff. This allows our patients to share their feelings and stories. The fertility journey can be emotionally demanding and many couples and individuals have benefited from the support of this group.   READ MORE

 

 

No. 4 Awarded Guaranteed Irish Membership

June 2017: We are a not-for-profit, Irish clinic. Not all fertility clinics are Irish-owned; some are owned by foreign corporations, which are answerable to shareholders. Our partnership with Guaranteed Irish reflects our MFC values of quality in patient services and care, and our commitment through education, research and training. As Ireland’s only fertility clinic with ‘Guaranteed Irish’ membership, we take great pride in reflecting the Guaranteed Irish beliefs of Provenance, Quality and Trust.   READ MORE

 

 

No. 5 Prof Mary Wingfield Launches ‘The Fertility Handbook’

June 2017: This comprehensive, research-based book provides excellent guidance on the fertility journey. Proceeds go to the Merrion Fertility Foundation, our sister charity which provides financial support to those who cannot afford fertility treatment.   READ MORE

 

Fertility

 

 

 

No. 6 Prestigious Grant for Fertility Innovation Received

July 2018: We received the highly competitive grant for fertility innovation for our research on the role of endometrium (lining of the womb) in embryo implantation at the 34th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE). Dr. Louise Glover, Research and Development Coordinator at MFC, was awarded the Merck GFI (Grant for Fertility Innovation) for this project. Dr. Glover is pictured below with Louise Brown, the first child born through IVF at the award ceremony.   READ MORE

 

 

 

 

No. 7 Certified as Complying with ISO 9001:2015 

November 2018: We are regularly audited by the Health Products Regulatory Authority (HPRA) to ensure compliance with the highest standards in relation to the Tissues and Cells legislation. We decided to transition to ISO 9001:2015 from the 2008 version of the quality management standard, which ensures that all processes are governed by Standard Operating Procedures and that any non-conformances result in corrective action so that our system is continuously improving.

 

No. 8 First Baby Born from Frozen Eggs

December 2018: We were delighted to announce the arrival of our first baby born through our egg freezing program. Egg freezing or ‘oocyte vitrification’ was first introduced in MFC in September 2016, so this successful pregnancy and birth within only 26 months of establishing the service was a testament to the expertise, hard work and outstanding dedication of the MFC team.

READ MORE

 

 

No. 9 First Baby Born through the Donor Sperm Program

December 2018: We were delighted to welcome our first baby conceived using the donor sperm service at our clinic. This successful pregnancy and birth occurred less than one year after introduction of the donor sperm program in MFC in 2017.   READ MORE

 

 

No. 10 MFC Patients

We are delighted to have been able to help thousands of patients achieve their dreams over the last decade.  We help patients through our various services, some of which are Ovulation Induction, IUI, IVF, ICSI, Egg Freezing, Donor Sperm Services and SSR.  One of our patients shared the following story on her IVF journey:    READ MORE

 

 

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Also, if you ever wish to consider fertility treatment, you can self-refer to our clinic by clicking here.