Everything you want to ask about COVID-19 and IVF

Laura Garcia de Miguel, MD
Medical Director at Clinica Tambre, Clinica Tambre

Category:
COVID-19, IVF Abroad

Everything you want to ask about COVID-19 #OnlinePatientMeetings
From this video you will find out:
  • how can COVID-19 influence IVF treatment, pregnancy and future outcome
  • if fertility treatments weaken the immune system and make you more prone to COVID-19
  • whether it is recommended to postpone your hormonal stimulation now
  • if COVID-19 can affect embryo implantation
   

All you need to know about IVF and COVID-19

Everything you wanted to know about COVID-19, IVF and pregnancy from a reliable source. During this Online Patient Meeting patients’ questions were answered by Dr. Laura García, Medical Director at Clínica Tambre in Madrid, Spain.

 

All you need to know about IVF and COVID-19 - Questions and Answers

How can COVID-19 influence patients’ treatment and the effectiveness of future treatment?

The most significant impact is that recently all these treatments were postponed. By contrast, the effectiveness will not be lower because of it. We will continue with all our standards with high technology and with COVID-19-free laboratories that are 100% under control. There is the same effectiveness as before this whole situation.

Since my embryos have been frozen, will my chances of success decrease when I resume my IVF treatment?

Some protocols recommend freezing all embryos and do a frozen embryo transfer. It controls the endometrium receptivity much better. I understand some patients can be frustrated because they cannot go for a fresh cycle. We have a lot of experience and receive very good results in terms of ongoing pregnancy with frozen embryo transfer. It helps us to reduce the time of estrogen therapy before the transfer. Then the endometrium receptivity will be more balanced, so it is a good part of doing frozen embryo transfer, and in our clinic, it’s more or less the same. There is no big difference between a fresh and frozen embryo transfer. In our clinic, it is around five to ten per cent less in frozen embryo transfer. As I said, in a fresh cycle it takes a longer time for patients to be on the estrogen therapy, so when we’re performing a frozen transfer, the receptivity will be better because the estrogen therapy will take around two weeks. That’s a reason why we have such high success rates with frozen embryo transfer.

Do fertility treatments weaken my immune system and make me more likely to get COVID-19?

Not really. This is not an evidence-based that during fertility treatment we have a reduction in our immune system. During pregnancy, we can reduce our immune system, and we’re a bit more at a higher risk to have an infection, not only COVID-19, but also other types of infections, especially, in the third trimester, which is the most important time during pregnancy, so we need to try to take care of ourselves and try to avoid contact with anyone infected because this has not been proven, but there is little information on this. The data is not reporting a lot of cases, even though there were some cases where women, who were in the third trimester of pregnancy, had some negative success such as prematurity or problems with high blood pressure.

Should I start the planned hormonal stimulation or wait for the situation to normalize?

That’s absolutely one recommendation I can give, which is to wait until the situation is normalized. We do not know when the embryo transfer could happen. If for a month you’ll be on estrogen, this is going to decrease the success rate, so it’s necessary to talk first with all the experts to confirm when everything is under control and that you can start.

How can we prepare for IVF now during the quarantine? The idea is to use the time that patients spend at home?

It’s good to do some exercise and continue with a rich diet, take vitamins that were recommended, not only folic acid but also antioxidants or melatonin. We need to focus on the pre-treatment part, so have a healthy diet, take supplements, and exercise. Try to prepare for the moment where we are going to start with your treatment.

What effect can COVID-19 have during pregnancy? Are pregnant women more likely to get coronavirus?

The data on that is still limited. Several pregnant women had COVID-19 that we know of. We have received some data from China and other countries, that it can cause a higher miscarriage rate, and as I ‘ve mentioned there is a risk of prematurity. That’s the reason why we need to be aware of that, especially in the third trimester, it is better to avoid maximum contact and follow all the protocols.

Can COVID-19 affect embryo implantation?

What we know so far is that an asymptomatic process of COVID-19 has not been investigated in the uterus or the ovaries. It should not affect it, but of course, if we’re having a high fever and other symptoms, it could affect it. That’s a reason why probably when we are going to start with the treatments, we’re going to test all the patients for COVID-19, to provide the maximum security, and that the treatment can start and there are no risks.

What about the safety of donors and recipients? Can COVID-19 be transmitted to the recipient if the donor was a carrier of the virus?

The data of the articles that we have is that there is no possibility that COVID-19 will be transmitted because of the follicular liquid. This is something that we think is not possible. Probably we will recommend all patients and donors to do a COVID-19 test to maximize security and avoid any problems. There haven’t been any reports where the donors having egg retrieval could transmit COVID-19 with the eggs to the recipient.

Are you still doing treatments at Clinica Tambre?

We do continue to offer consultations, via phone, email, Skype to all of our patients, but we do follow the recommendations from the Spanish Society, European Society, and American Society, so we have not started treatments. Everything has been stopped. The treatments that started before the COVID-19 situation as well. Now, we just continue with pre-treatments for all our patients. We confirm the tests, solve any questions, etc.

When will I be able to continue my treatment?

I don’t know, who knows. Every 24 hours we have morning news, and we have more information about all this. It might be possible in May or June, and we’ll start the treatments, so that’s a reason why we are scheduling consultations with patients to talk about the situation in our country and their countries to see if we can just start the treatment as soon as possible.

Is it possible now to book an appointment with Tambre in autumn?

Yes, our attendants are always open so you can stay in touch with all our coordinators. You can book your first appointment in autumn, but of course, you can do it earlier as we are offering them via Skype or telephone, and we can start talking about your case, and then if you want to come in autumn that would be fine.

When do you anticipate that the flying abroad ban is lifted in Europe? In the summer? We know that some flights have been organized for May, but we need to wait and see how our government will react and what recommendations will be given.

We know that some flights have been organized for May, but we need to wait and see how our government will react and what recommendations will be given.

Is there anything that can be done for patients where treatment is bound to age (49)? Are there chances of not being able to continue?

When we’re talking about egg donation treatments, there is no difference if we’re doing treatments and you are 46 or 49, so we know especially for women in this age group, it is more frustrating not being able to proceed. But the idea is that they are not going to lower their chances because of these months that they need to wait. We need to cooperate with every patient, and we need to talk about their case during their medical evaluation. If a patient was accepted 2 or 3 months ago for the treatment, I would say they will be accepted 2-3 months later, as well. If everything was okay, we’ll just go ahead, if there have not been any changes in their medical aspects.

How will you ensure the safety of personnel and staff?

When we’ll go back to normality and start our activities, we’ll test all personnel to make sure we are COVID-19 free clinic.

What can I do now during COVID-19? My gynaecologist referred me to an IVF clinic. I haven’t had IVF before.

What you can do is to organize a Skype consultation and talk with the expert to try to have all the information about the necessary tests that you can do in your country. Discuss your options and prepare, plan everything so that you are ready to start after this COVID-19 situation.

Will the clinic be providing a letter to do the test? In my country, you need to be showing symptoms to be tested.

If our protocol introduces the COVID-19 test, we will write letters to our patients to go to the laboratory to get tested. We haven’t decided yet, as the societies have not reported what to do, but, if the recommendation is to test the recipients for COVID-19 before the treatment, then, of course, we will inform you and, we will share a letter to your clinic/laboratory to perform this test.

Do you prefer to vitrify at a blastocyst stage?

Yes, we are always performing transfers with embryo culture up to the blastocyst stage. This is our recommendation for the hundred-per cent of treatments, no matter if its IVF with own eggs or egg donation, it is best to transfer blastocyst because the success rates are better in fresh but also in frozen embryo transfer.

What are the don’ts in the diet to avoid compromising the chances of getting pregnant? No alcohol, caffeine, smoke that is known. My question is which food is harmful for uterus preparation?

We indeed need to avoid alcohol, caffeine, smoking, but also we need to concentrate on a rich diet, including eating lots of fresh fruits and vegetables. Avoid eating a lot of meat or highly processed foodTalk with your doctor if you need to do a gluten-free diet or some specific diet.

What is the safe weight for pregnancy?

It’s not only the weight, but you also need to provide your height. The recommendation for a normal BMI is to be less than 25, it’s compulsory to have a BMI of less than 30, but of course, the recommendation is less than 25. There are some calculators you can check on the Internet where you can combine your height and your weight, and you will have the results. We do not accept patients who have a higher BMI than 32 or 33 because it can be risky. Keep in mind, we do take care of all cases, we do accept all, for a first consultation, and then depending on other pathologies and other high-risk characteristics we can discuss it further and check options.

You just mentioned that it is a good idea to get all of your pre-treatment tests now in our own country but if we have no idea when we can come to Europe for egg donation? Is that a good idea because the tests are only valid for a certain period. Should I wait for the pre-tests because I may not be able to come at all since I turn 51 this year and treatment in Europe may not be possible if COVID-19 postpones things for too long?

The majority of tests are valid for 12 months, so it is better to start doing tests whenever you can. If there is something we need to treat first such as the thyroid or test the sperm etc. then we will have enough time to check it before you come.

Do you recommend putting off testing my husband’s sperm?

As I said before if you can just try to do it right now or in one month, I would recommend doing it. Sometimes we need to do pre-treatment, or we need to concentrate on any other treatments, so it is better not to postpone it. If you needed to take curcumin or antioxidants — the recommendation is to take it at least for three months as it’s the time that new sperm is created. And that will take a lot longer for you to start the treatment.

I heard about a large cavity, what causes it? Is it something to worry about, or is it just like people have different heights?

A large cavity supposedly is because of the uterus, and we have different types of the uterus. The size is important, although it’s more important to confirm if there are fibroids or adenomyosis and if there is something that could reduce the chances of implementation. And if there is something we can offer to try to improve the ongoing pregnancy.

What type of fibroids should be removed, before treatment?

In the aspect of fibroids, we will need to take into consideration not only size but also location. Fibroids located in the endometrium are called submucosal, and those are necessary to be removed. Subserosal are the ones that are in the external part of the uterus, and those shouldn’t be removed — only if they are affecting your lifestyle in some terms or if their size is big. And there are the ones located in the uterus wall. These are important to check if it is necessary to remove them or not— it all depends on the location and size.

What is advisable to do during the two weeks waiting after the transfer?

It is a very frequently asked question. The recommendation is just to avoid sex and exercise for three days after the embryo transfer. Then you can continue your standard lifestyle. You can travel by plane if you need to go back home. We know, that women that are laying in their beds have less chance of implantation, so the recommendation is just to avoid sex and exercise three or four days maximum and then go ahead with your daily routine.

Do you prefer SET (single embryo transfer) at a blastocyst stage?

We do indeed recommend in all our treatments to do single embryo transfers. We do have very high rates with single embryo transfer in the blastocyst stage. It is not recommended to transfer two blastocysts at the same time for many reasons. First, we want to avoid multiple pregnancies because that can be dangerous during pregnancy, and what we always try to achieve is a healthy baby. Some other problems are also the reason why the embryos are not implanting. It can be endometrial receptivity, immunological factors, coagulation disorders, endometritis. We do not want to lose two embryos at the same time. When we are doing an embryo transfer, we want to maximize your chances in every case, but we always perform a single embryo transfer.

Authors
Laura Garcia de Miguel, MD

Laura Garcia de Miguel, MD

Dr Laura García de Miguel has worked in the field of gynaecology and obstetrics since 2008. At present, she is a medical director of Clínica Tambre in Madrid, Spain. Dr García de Miguel has extensive experience in IVF and provides a highly personalized approach to each and every patient and custom-tailored treatments to meet the needs of various patients. Dr García de Miguel specializes in treating patients who have had previous IVF failures or who respond poorly to hormonal or IVF treatment. Dr Laura speaks fluent Spanish, English, and French and treats patients from all over the world.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is an International Patient Coordinator who has been supporting IVF patients for over 2 years. Always eager to help and provide comprehensive information based on her thorough knowledge and experience whether you are just starting or are in the middle of your IVF journey. She’s a customer care specialist with +10 years of experience, worked also in the tourism industry, and dealt with international customers on a daily basis, including working abroad. When she’s not taking care of her customers and patients, you’ll find her traveling, biking, learning new things, or spending time outdoors.

Disclaimer:

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Contact details: The European Fertility Society C.I.C., 2 Lambseth Street, Eye, England, IP23 7AG

 

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