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

 

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

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.

IVF Add-Ons: Do à La Carte Menus Serve Infertility Patients?

IVF Add-Ons

“Add-on” treatments and medications in IVF are highly controversial in the infertility field. At Merrion Fertility Clinic, we believe that strong evidence from clinical trials is needed before add-on treatments should be offered as part of the IVF cycle. These experimental techniques are expensive and poorly regulated, meaning that they can be introduced into routine practice before they have been shown to improve live birth rate.

In some cases, they may even have adverse effects on patients. A recent series of articles by specialists in the field, published in the journal Fertility and Sterility, looked at add-on treatments used by fertility clinics. All concluded that there is still not sufficient evidence to show that these techniques work or what their long term effects are for patients and their babies.

To read more, please follow the link below:

https://www.fertstert.org/article/S0015-0282(19)32454-9/fulltext

 

Dr Nita Adnan – new member of the MFC Clinical Team

Dr Nita Adnan

We would like to extend a very warm welcome to a new member of the MFC Clinical Team.  Dr Adnan has been working as a Consultant Obstetrician and Gynaecologist in National Maternity Hospital since 2017 and recently joined Merrion Fertility Clinic.   You can find out more about Nita and the MFC Clinical Team on the following link:

https://merrionfertility.ie/about/why-mfc/clinic/our-clinical-team/

 

What is the IVF Process?

ivf process The IVF process is emotionally intense, physically draining and  expensive. But advanced medical knowledge and pioneering lab techniques are making the ‘take-home baby rate’ for women and couples better than ever, writes Danielle Barron.

Merrion Fertility Clinic featured in the Sunday Business Post and answered the most common fertility questions.

Keep reading to see full article.

 

 

The IVF Process

Whether it’s Intracytoplasmic sperm injection (ICSI) or standard In Vitro Fertilisation (IVF), the procedure is the same for the couple. Professor Mary Wingfield, a consultant obstetrician and gynaecologist at the National Maternity  Hospital, and clinical director of Merrion Fertility Clinic, outlines what a typical IVF cycle involves. “We try to get between ten and 15 eggs, and to achieve this the woman has to go on fertility drugs that she self-injects for ten to 15 days.”

The eggs are removed vaginally, and on the same day the man produces a sperm sample. The eggs and sperm are placed in culture, and by the following day, it will be obvious which eggs have been fertilised and are on their way to forming embryos.

Three to five days later, all proceeding well, an embryo is selected to be put back into the woman’s womb. Any extra viable embryos are frozen to be used in the future.

ivf process - newborn

IVF Success Rates

The good news is that there have been a number of incremental improvements in IVF over the years, which has seen the “take-home baby rate” soar from 10 per cent to 30 per cent on average, says Wingfield.

“It’s much better than it used to be. If the woman is under 35, then with one treatment it is 50 per cent – you can compare that to couples with peak fertility who will only get pregnant every third time they try.”

To get pregnant naturally, around 15 million healthy sperm are needed, but for IVF you need about 100,000. Of course, just one sperm and one egg make a baby, but understandably with an IVF cycle they like to maximise your chances.

For more common causes of poor sperm production and motility (the movement and swimming of the sperm), urologists have a range of strategies and interventions that can help improve sperm quantity and quality.

Continue Reading the Full Article Here

IVF Clinics Face New Crackdown on add-on treatments

Add Ons

As a not-for-profit clinic, we at Merrion Fertility Clinic and the National Maternity Hospital are passionate about fairness and making our treatment as affordable as possible for all our patients. We urge patients and the general public to carefully consider all the information regarding different treatments and pricing.

And we encourage you to write to the Minister for Health advocating for public funding of IVF for all Irish patients.

https://www.theguardian.com/society/2019/sep/10/ivf-clinics-face-new-crackdown-on-add-on-treatments

Children and Family Relationships Act 2015

We are delighted to say that we received confirmation from the Department of Health yesterday that the Children and Family Relationships Act 2015 will now not commence until the 5th May 2020.  This is good news as it gives us, the fertility clinics, and the Department of Health time to ensure that all the necessary arrangements are in place before the Act is commenced.  It also means that patients have more time to discuss and plan their options.

We will be very happy to discuss this further with you at your next appointment at the clinic.

 

Concern as IVF funding still not in place

funding

Despite the official government announcement last year that €1 million would be allocated for public IVF funding, these funds have still not been released. Those awaiting the much-needed financial and legal supports around assisted reproduction, as promised by the then Health Minister Leo Varadkar three years ago, continue to face uncertainty about when these funds will be made available and what criteria will be required to qualify for assistance.

The Government approved the IVF financial aid plans in October 2017 and a specific €1m fund was then announced by the Taoiseach last December.

In a statement, the Department of Health said a model of care for infertility, tied to long-awaited assisted human reproduction (AHR) legislation and the provision of financial assistance, was still being worked on by officials.

MFC continue to advocate for public funding of IVF for all Irish patients.

To read the Irish Examiner article, please see below:

https://www.irishexaminer.com/breakingnews/ireland/concern-as-ivf-funding-still-not-in-place-922418.html