The COVID-19 pandemic and subsequent shelter-in-place and quarantine orders have affected all aspects of the surrogacy journey. Living and operating in a society where COVID-19 exists is becoming a reality for many.
While life begins to resume and the world re-opens its doors, it’s safe to assume we will be facing a “new normal” in all facets of life. The surrogacy process is no different, and it is important we stay on top of developments regarding COVID-19 as they relate to surrogacy and pregnancy. We believe that current and relevant information, paired with the advice and guidance of your doctors and fertility clinics, as well as your own instincts, will help all our intended parents and gestational carriers determine the right next steps for your unique situation.
Family Inceptions has assembled the most up-to-date information and resources for both intended parents and gestational carriers in an effort to provide clarity, eliminate stress, and begin to plan the next steps of your surrogacy journey.
Our New Normal – Understand the Risk
As more and more states allow for the opening of businesses it is important to understand this does not mean your risk has been mitigated. It simply means the number of new cases of COVID-19 has decreased to a number accepted as a flattening of the curve’, but it does not mean we are safe and risk-free.
Each state has their own unique regulations and recommendations on use of masks in public, acceptable group sizes for meetings, social distancing, etc. It is your responsibility to understand exactly what these requirements are for your geographic location or a location to which you may travel for a cycle. You are advised to take all the necessary precautions recommended by your local and state government and your doctors and clinic.
Clinics Begin to Open, But with New Policies
July 2020 Update: On July 10, 2020, The American Society of Reproductive Medicine (ASRM) issued updated guidelines for patient management and clinics. Click here to read the updated guidelines in full. In summary, the new guidelines include:
- Masks should be worn by patients and staff when within a medical facility without exception, even when alone or not in close proximity to others. This includes in areas such as bathrooms, changing areas and semen collection rooms.
- Baseline PCR testing for COVID-19 should be encouraged prior to starting any type of fertility treatment and prior to surgical interventions. Additionally, given the lack of current data, a prudent strategy may be to encourage patients who test negative for COVID-19 to self-quarantine throughout the course of their treatment and ideally into early pregnancy.
- Given the continued restrictions on international travel, we recommend careful consideration of country of origin for intended parents, regional conditions in the gestational carrier’s state of residence and in the clinic where treatment is being sought. Careful consideration of local disease prevalence and adherence to travel
restrictions should be factored into decision making for oocyte donation cycles where the intended parent and oocyte donor reside in different states.
- When possible, utilization of oocyte vitrification or shipment of frozen sperm for embryo creation should be considered as an alternative to travel when oocyte donor and intended parents reside in different states.
IVF clinics have been very cautious about starting new cycles; however, many started to offer more surrogacy and egg donation services and most expect to be offering services within the next 3-8 weeks. All patients are advised to request the clinic’s documentation regarding their protocols for keeping patients safe, the risks of pregnancy during COVID, and the possibility of cancellations of cycles. In addition, it is important to recognize that patients may interpret a physician’s willingness to treat as an indication that their risk is minimal, and this may well not be the case. The issue of risk/benefit should be highlighted as a starting point for all patients prior to beginning or resuming treatment.
Pregnant? Continue Taking Precautions
July 2020 Update: On July 10, 2020, The American Society of Reproductive Medicine (ASRM) issued updated information regarding the effects of COVID-19 on pregnancy. Click here to read the updated information in full. In summary, the new information includes:
- Full term newborns delivered from mothers with active COVID-19 infections have done well overall.
- Severe illness, including COVID-19, may precipitate premature labor or lead to early delivery with resultant neonatal complications of prematurity.
- A case series of nine women affected with COVID-19 that delivered via cesarean section showed no viral RNA in the amniotic fluid, cord blood, or breastmilk.
- Preeclampsia was reported in six of eight women with severe COVID-19 pneumonia admitted to the intensive care unit while there were no symptoms of preeclampsia in 34 women with mild forms of COVID-19.
- A study published in MMWR suggests that pregnancy is associated with increased risk for intensive care unit (ICU) admission and receipt of mechanical ventilation but is not associated with increased risk for mortality. The authors highlighted several limitations to their study, including missing data on underlying conditions for a large proportion of cases. It is also worth noting that as of June 30, 2020, there were 10,537 cases of COVID-19 and 30 total deaths in pregnant women with COVID-19. Thus, pregnant women represent a small fraction of the 3 million cases and 130,000 deaths that have occurred overall in the U.S. Nonetheless, the report highlights the importance of taking measures to prevent infection in pregnant women.
- In the U.S., one-third of pregnant women with laboratory-confirmed COVID-19 are hospitalized, compared to 5.8% of non-pregnant women. After adjusting for age, underlying co-morbidities, race and ethnicity, pregnant women are more likely to be admitted to an ICU, and receive mechanical ventilation. Despite this, the risk of death is similar to that of non-pregnant women.
- A meta-analysis of 24 studies involving 136 COVID-19 infected patients revealed a preterm delivery rate of 38% and cesarean delivery rate of 76%, much higher than international averages.
- A prospective cohort study of 241 pregnant women from five New York city hospitals, all with laboratory-confirmed SARS-CoV-2 infection, demonstrated that the majority were asymptomatic; however, almost one-third of these women became symptomatic during their delivery admission. The worse the respiratory symptoms, the higher the rate of cesarean section, which reached a high of 92%, and the higher the rate of preterm delivery. Admission to the ICU was required for 7% of women and mechanical ventilation
needed for 4%. Obesity was associated with COVID-19 severity.
- Another prospective study analyzing data from 462 SARS-CoV-2 infected pregnant women in 11 New York city hospitals demonstrated an ICU admission rate of 19%, of which 15% died. Hispanic women constituted the largest ethnic group in the study.
June 2020 Update: On June 25, 2020, the CDC announced that “pregnant people might be at an increased risk for severe illness from COVID-19 compared to non-pregnant people. Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.”
Unfortunately, much is still unknown about the risks of COVID-19 to the pregnancy and to the baby. Some studies show minimal risk, while others are making correlations between COVID-19 and pre-term labor, miscarriages, and stillbirths. Therefore, taking precautions to ensure your health, as well as the health of the baby you are carrying, is recommended. In general, pregnant women are more susceptible to illness and viral respiratory infections as they experience immunologic and physiologic changes, including changes to their respiratory and immune systems. These changes make pregnant women part of the high-risk population for coronavirus, just like they are for influenza and pneumonia. It is recommended pregnant women continue to practice social distancing, wear protective gear including masks and gloves when in public, and limit exposure as much as possible.
Read all our FAQs regarding Pregnancy and COVID-19: Five Things You Need to Know About Surrogacy and Coronavirus
We’re Still Matching
Aspects of everyday life may have come to a halt due to COVID-19, but our work at Family Inceptions wasn’t one of them. We continued actively matching Intended Parents with Gestational Surrogates and Egg Donors, completing initial steps online, over the phone, and via video conferencing. These efforts to screen, evaluate, and match, while still maintaining social- distancing, continue daily as we aim to deliver our clients with the highest level of service.