COVID-19 Vaccination: Pre-Conceptual Counseling, Pregnancy, and Fertility Treatments
From Dr. Paul Gindoff of Chelsea Fertility NYC:
At Chelsea Fertility NYC, we are at the crossroads of the COVID-19 epidemic and finding safe, procreative efforts to maintain our way of life. These are challenging times and one hot-button issue is whether pregnant women and women trying to conceive should get vaccinated for COVID-19.
At Chelsea Fertility NYC, we are at the crossroads of the COVID-19 epidemic and finding safe, procreative efforts to maintain our way of life. These are challenging times and one hot-button issue is whether pregnant women and women trying to conceive should get vaccinated for COVID-19.
Expectant mothers face a difficult decision as COVID-19 vaccines become available: whether to take one. This is also affecting our patients that are experiencing conception delays as to whether to vaccinate or not. Eligibility and supply are, indeed, further confounding the issue, which makes the opportunity to vaccinate, even if the patient wants to, logistically challenging.
The answer may depend on the woman’s risk of getting COVID-19 and her underlying health issues, just as it is for everyone, but there isn’t enough data yet to make a definitive recommendation. Guidance from health agencies is far from conclusive due to the lack of any evidence-based research. It seems that pregnancy puts people at an increased risk of more severe disease, but it’s not clear if this is due to pregnancy per se or the risk of developing predisposing risks from pregnancy, such as diabetes, hypertension, and clotting diseases. It appears to be more likely the latter.
Healthy young people, whether pregnant or not, seem to have relatively milder disease. Much research and epidemiological studies need to be done globally to get a true assessment of this very important issue. After all, we cannot stop having families!
After many years of debate, the regular flu vaccine is now officially endorsed as safe in pregnancy but the novel COVID-19 vaccines, with their new technologies, begs the question. Scientists still don’t know if the mRNA vaccine can cross the placenta and, if it can, whether it would harm maternal and fetal health. This type of vaccine has never been used in pregnancy. The Pfizer and Moderna vaccines use a gene-based technology called messenger RNA, which had never been cleared for use before this pandemic. Talk about uncertainty!
Generally, patients would like a firm recommendation from their health care provider but, to be fair, the decision must be made by the patient after a detailed discussion about the risks and benefits. Right now, they appear to be the same critical problem-solving decision that a non-pregnant patient faces.
However, the patient undergoing fertility treatments trying to conceive has a distinct advantage. Taking the vaccine shots (whether the series is one or two) would seem to be safest before actual implantation and embryogenesis. The vaccination works fast and patients produce antibodies within two to four weeks.
If an older woman feels that may be too long to put off attempting pregnancy, then they could freeze embryos. Indeed, embryo freezing, with or without PGT-A, is very popular now, as it turns conception into a two-step process that takes two to three months, with a frozen-thawed embryo transfer in the following month after egg retrieval and fertilization. That would leave a window of opportunity to vaccinate before the critical period of organ development (embryogenesis) in the first trimester, which poses the greatest theoretical concern.
