The COVID-19 pandemic has had an enormous impact on couples who are already having difficulties with family building. These couples have legitimate concerns about receiving in vitro fertilization treatments during a public health crisis. These concerns include making regular hospital visits and risking COVID exposure. These concerns include each and every procedure involved with their infertility treatments, assisted reproduction, and gestational surrogacy. Plans and embryos are frozen in time In April, May, and June of 2020, IVF clinics essentially shut down on recommendations from the American Society for Reproductive Medicine (ASRM). It urged “suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.” Further, ASRM advised reproductive medical clinics to “strongly consider cancellation of all embryo transfers, whether fresh or frozen.” These recommendations left some couples literally frozen in time. Scheduled embryo transfers were suddenly canceled. Also cancelled were donor egg retrievals, IVF procedures to create embryos, and other pre-pregnancy medical treatments that would culminate in a much-wanted pregnancy and birth of a child. Many of them had suffered years of infertility. Further, they may have spent years saving money for infertility treatment as well as surrogacy arrangements. And even though they may have prayed for the day they would conceive and have a child, they were once again thwarted, saddened, and frustrated. This pandemic wreaked havoc on all their plans. Assisted reproduction is a complex process Having a child through assisted reproduction is a complex process as it is. It requires a great deal of planning and preparation. Once a couple embarks on their journey to have a child, there are sequential steps that must be followed. Each of these can be disrupted by any number of circumstances that arise. These include: the creation of abnormal embryos, failed embryo transfers, miscarriages, and any number of the other discouraging events. Adding a global pandemic to the mix was akin to them having to make this journey during a major storm, low on gas, and with little to no visibility. An uncertain journey to building a family Fortunately, as summer approached, medical clinics eventually reopened with new safety procedures and guidelines in place. While people were able to resume their journey to parenthood, it wasn’t long before new concerns, difficulties, and hardships resulting from COVID-19 reared their ugly heads. One example is a couple that first met at a Jewish gathering for young professionals and had been together for ten years. During this time, they tried numerous tests, procedures, and treatments to conceive a child, all to no avail. Finally, they turned to gestational surrogacy. Just at the time they were going to be matched with a surrogate, the young woman fell ill with COVID and had to be hospitalized. She was eventually placed on a ventilator for twenty-eight days. Luckily she recovered and she and her husband were able to be matched with a gestational surrogate. Only now have they finally been matched with a gestational surrogate again. Hopefully, they will be able to make further progress toward fulfilling their dream of starting a family. Other family building problems related to the COVID-19 pandemic This is only one of many stories about hopeful parents who encountered an unexpected obstacle on the way to starting their families. Further complicating issues include: restrictions on travel perceived risks of infection related to air travel the need to quarantine when traveling from one state to another. These issues affect not only the parents, but also surrogates, and egg donors who may be unable to attend medical procedures in a logical and convenient manner. People have to use personal protective equipment when traveling by air and when attending medical appointments. But following these guidelines will not always solve all of the problems presented by the pandemic. Disrupting the parental bonding process One couple was trying to figure out how they could attend the birth of their child who was going to be delivered by their gestational surrogate. Generally, in almost all cases, intended parents attend and witness the births of their children at the hospital. In this case, the couple was told by the hospital that they wouldn’t be allowed into the hospital for the birth. They were advised that they would have to quarantine for two weeks in the town where the hospital was located in order to be allowed into the hospital. This presented myriad problems. For instance, who would care for the baby at the time of the birth? In gestational surrogacy arrangements, the intended parents are named as the legal parents of the baby before birth. It made no sense to disallow the legal parents from attending the birth. The hospital was trying to do the right thing to avoid potential coronavirus contagion. However, it was setting itself up for other liability by not facilitating the immediate bringing together of a newborn infant with his or her legal parents. Fortunately, the parents resolved the matter by moving to the town where the hospital was located. They remained there for the two week quarantine period prior to the birth. That couple was lucky. But some parents were not able to resolve the issue of getting into the hospital to attend the births of their children. They were literally left out in the cold until a staff member was able to bend the policies and allow one or both parents into the hospital for the birth. At times, these resolutions did not occur until the surrogate was in labor and just about to give birth. The risk of catching COVID Another major concern for intended parents planning to have children through gestational surrogacy is the risk that their surrogate will contract COVID-19. Whether the surrogate is pregnant, or not yet pregnant, this is always a very stressful concern. Pre-pregnancy COVID In the event the surrogate is in the pre-pregnancy phase there is no risk to a pregnancy or newborn. But, there is the chance that she may contract the virus. And this could render her unable to proceed with medical examinations, medications, treatment, and the embryo transfer, due to illness. There is a further complication that she may be unable to continue as a gestational surrogate due to illness and the aftermath of the illness. This is an emotional time for all of the parties. Women who become surrogates truly desire to become pregnant and bring a baby into the arms of the intended parents. It is also a financial matter. The surrogate will be unable to receive her anticipated compensation for her efforts to help build a family. Moreover, such an event significantly adds to the struggles of the intended parents to make progress toward finally having their child. COVID during pregnancy Another stressful occurrence is when a gestational surrogate, or any pregnant woman, contracts the virus while she is pregnant. On November 3, 2020, the CDC updated its coronavirus disease information on pregnancy and issued the following statement, “ased on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth.” The hope is that such an illness will be mild and will not greatly affect the pregnancy. Unfortunately, however, there is no assurance of such an outcome. In one such situation, the gestational surrogate came down with the coronavirus disease, as did her entire family. Fortunately, she recovered quickly and experienced only mild symptoms. Thankfully, when it comes to the infants born to women who test positive for COVID-19, “[T]he risk of passing the infection to a fetus appears to be very low. Currently, there is no evidence of any fetal malformations due to maternal infection with COVID-19.” This is starkly different and a source of relief from the worrisome concerns about the Zika virus which was known to cause deformities in fetuses. Will a COVID-19 vaccine be safe during pregnancy? There is virtually no information right now about whether the COVID-19 vaccine will be safe for pregnant women. They have not been included in the clinical trials in order to avoid undue risk to the pregnancy and fetus. However, not including pregnant women in the vaccine trials means that there are no data to inform physicians and pregnant women about the risk a vaccination will pose to the pregnancy. This makes it nearly impossible, even with counseling, for pregnant women to make a decision about whether to be vaccinated. There are different types of vaccines that are being developed. It might eventually be learned that one (or more) vaccine(s) may be better than the others for pregnant women. Further, more data about the effects of COVID on pregnancy will help clarify the potential effects of a vaccine on pregnancy. As Ruth Faden points out, “[T]he important thing is that pregnant women should not be left behind as these new technologies and new vaccines are developed. Their needs should be considered.” The bottom line for family building in the age of COVID Anyone seeking to continue their journey toward parenthood through assisted reproduction must remain close to their support team. That includes the doctors, lawyers, and counselors who assist them throughout the process. This ensures that they get the guidance and support they need as they pursue their dream to have a family. Source
