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FERTILITY, PREGNANCY & CORONAVIRUS

What Do We The Experts Know So Far?

Over the past few weeks, every other news headline has mentioned COVID-19, or the new strain of the coronavirus infection that’s spreading around the world. We’re being told how to wash our hands, stay at home, maintain social distancing, etc., But what effect, if any, does the coronavirus outbreak have on our fertility and reproductive health? Here's what the reports by health experts say.

The Biggest Takeaways

• There is no evidence or studies that have been published so far to see if contracting the COVID-19 infection now will make it harder to get pregnant later.
• Research will take time to give exact data.
• Currently, pregnant women don’t appear to be at a higher risk for contracting the virus.
• Trying to get pregnant? As per reports and predictions, access to medical care over the next few months may be harder to come by (and pregnant women need medical care!), so if you're not already on plan, you may want to consider waiting.
• If you don’t have COVID-19 and are interested in pursuing assisted reproductive technology (ART), the American Society for Reproductive Medicine (ASRM) recommends that clinics postpone all elective procedures, including intrauterine insemination (IUI), in-vitro fertilization (IVF), egg or embryo freezing.
• If you’re a patient going through stimulation for IVF or IUI, you should consider cancelling the cycle because we don’t know the spread among health professional and your family next day or next week. Even hyper stimulation and any complication might aggravate or worsen the situation.
• During this period travelling will not be a good idea and high stress may even reduce the success rate.
• If you meet the diagnostic criteria for COVID-19, it’s recommended that you avoid getting pregnant and wait until the illness subsides before pursuing ART.
• Everyone, including pregnant women, should be exercising precautions to avoid infection.

Can I have my laparoscopy or hysteroscopy?

• In general, diagnostic hysterolaparoscopy and asymptomatic fertility enhancing surgeries for fibroids, cyst and adhesiolysis should not be planned during this pandemic.
• There is a suspected risk and need to investigate possible increased risks of transmission of COVID-19 during gynaecological laparoscopic surgery, particularly related to the potential generation of COVID-19 contaminated aerosols from CO2 leakage and the creation of smoke from the use of energy devices.
• During hysteroscopy the fluid can splash over and contaminate the team.
• The risk of generating contaminated aerosols may potentially be lower with (open surgery) laparotomy. However, to our knowledge, with the current few data, there is no evidence of an increased risk of COVID-19 transmission during gynaecological laparoscopic surgery when Personal Protective Equipment (PPE) is used.
• COVID-19 has been found in faeces presumably thorough transmission from the naso-pharynx with ingestion into the gastrointestinal tract (29% of cases) and in blood samples in approximately 1% of cases. Thus, operations involving the bowel may have different implications than in gynaecology.
• In infertility sometimes during a diagnostic laparoscopy unexpected or surprises like fully adherent bowel or bladder, undiagnosed TB adhesions, severe endometriosis etc., can alter our surgical plan, we may have to proceed to clear the disease. These procedures may have complication, prolong surgery time and additional expertise availability during complication may pose threat to life.

In the absence of evidence that COVID-19 transmission is increased by the generation of contaminated aerosols during gynaecological laparoscopic surgery, the BSGE (British Society of Gynaecology Endoscopy) recommends:

• Non-surgical methods of treatment should be actively recommended to reduce the risk of COVID19 transmission to health care workers, and reduce the need for hospital admission, provided they are a safe alternative (for example but not limited to methotrexate for unruptured ectopic pregnancy).
• Gynaecological operations that carry a risk of bowel involvement, however small (for example but not limited to tubo-ovarian abscess), should be performed by laparotomy.
• Elective gynaecological operations that have a risk of bowel involvement (for example but not limited to excision of recto-vaginal endometriosis, adhesiolysis) should be deferred.
• For other gynaecological laparoscopic emergency operations (for example but not limited to ruptured ectopic pregnancy, ovarian cyst accident) usual practice to minimise time in theatre and the risk of operative complications should be taken.