As we emerge from winter into spring there isn’t a single one of us who isn’t affected by the current pandemic that is sweeping the globe and causing so much illness, stress and anxiety. I am the clinical lead for one of the largest reproductive medicine units in the UK and it has been heart breaking for me and my team to have to discontinue much longed for fertility treatments, which have been put on hold until we resume normal activities – although when that will be is anyone’s guess at the moment. Our patients have been incredibly understanding and if you happen to be one of them please keep an eye on our clinic website for updates (leedsfertilityclinic.co.uk). Of course everyone is concerned to know what effect, if any, the CoronaVirus will have on your fertility and reproductive health.
First a few definitions: The virus itself is a member of the CoronaVirus family, of which other variations gives us different types of flu. It has been named “Severe Acute Respiratory Syndrome CoronaVirus 2” or SARS-CoV-2 whilst the name of the disease that it causes has been termed Coronavirus disease or COVID-19. If you have the acute infection this should be picked up by a swab, usually from your throat to detect the virus (SARS-CoV-2) a blood test should then detect the presence of antibodies, which are the body’s way of trying to fight off the disease. IgM antibodies are present during the acute infection after which IgG antibodies are made and their presence is thought to indicate that an individual is immune – although there is currently uncertainty as to whether immunity occurs in everyone and, if so for how long.
The main routes of transmission are from droplets released into the air by coughing and sneezing or direct contact with contaminated surfaces. Some people may shed the virus before the onset of symptoms and some people with Covid-19 may remain asymptomatic but will still shed the virus (so called “carriers”). The illness itself can vary quite widely, producing a dry cough only in some whilst others may become unwell with a high fever, difficulty breathing and pneumonia. The median time from symptom onset to clinical recovery is 2 weeks for mild disease and 3-6 weeks if severe. Sadly many people are dying, sometimes because they have an underlying illness, particularly if there is underlying lung disease or reduced immunity. However the illness is unpredictable and can cause serious problems at any age, even if you were previously fit and healthy.
So what can you do to protect yourself and to protect others? First we know that the main route of infection is from droplets of saliva – so hold a tissue in front of your mouth and nose if you cough or sneeze and discard it immediately. The virus can then survive for up to 5 days on some surfaces (3 days on plastic and 2 days on stainless steel). So wash your hands repeatedly when you’re out and about and be careful not to touch your face (especially mouth, nose and eyes) with hands that haven’t recently been washed. There’s lots of information on the NHS website giving more guidance of what you should be doing, how to protect yourself and what to do if you think you’re developing symptoms.
Now, what about your fertility? We don’t have any good evidence that Covid-19 has a major effect on fertility or pregnancy, although we have to remember that it is a new disease that was first identified in China in December 2019. Many babies have been born from women with Covid-19, some of whom have been found to have the infection at birth. Initially it was thought that babies picked up the infection from the mother after birth but a recent report has identified IgM antibody in a baby born from an infected mother and, as IgM cannot pass through the placenta, this means that the virus itself crossed the placenta and infected the baby whilst still in the womb. There is no evidence to date that babies born from infected mothers have an increased risk of congenital anomalies or disability, but again it is too early to say for sure. We do know, however, that any cause of a very high fever can cause problems in early pregnancy and may even result in miscarriage.
A major illness can stop ovulation from occurring, as the body is not in a good state to cope with the demands of pregnancy and similarly if you become underweight because of illness then your nutrition will be diminished and this can also result in a cessation of ovulation and your periods. There is also some emerging evidence that Covid-19 infection in men may have a detrimental effect on sperm quality and function – again it is still early days in the study of this condition and this has certainly not been proven conclusively. The virus may be found in all bodily fluids, but it appears to be infectious particularly from fluid from the respiratory tract. It is unclear whether virus particles in the breast milk or semen are infectious and so current guidance is to breast feed your baby as the benefits for the baby’s health and immunity far outweigh any known risks. You don’t need to be having protected sexual intercourse as we don’t think SARS-CoV-2 is sexually transmitted, although you may not wish to get pregnant until after the crisis is over.
Try to keep yourself as healthy as possible by eating well and ensuring that you are taking vitamin D supplements. Vitamin D is mostly derived from sunlight, and here in the UK we are just emerging from winter and so most people are likely to be low in vitamin D if not already taking supplements. Good nutritional health and vitamin levels are not only important for your general wellbeing and reproductive health – something we cover in detail in our courses – but also there is good evidence that they will strengthen your immunity, reduce your risk of developing infection and improve your prospects of a good recovery.
During these difficult times we wish you and your families the best of health.