17 Apr FAQs for patients – ASEBIR

By Reproclinic Editorial Committee

In view of the current situation produced by the SARS-CoV-2 coronavirus pandemic, ASEBIR (Spanish Association for the Study of Reproductive Biology) has found appropriate publishing a guide with the most common patients’ questions.

FAQS for patients

•  I’ve been cancelled from starting my cycle, why?

The health alert issued by the Spanish Ministry of Health for the SARS-CoV-2 pandemic indicates that no patient nor professional should take the risk of leaving home if it’s not for an urgent medical matter. Although for many of our patients getting pregnant is a priority issue, at this time, health must be paramount, so we must be cautious and minimize the risks of infection; while beginning a treatment would involve leaving home more than merely essential. Your safety must come first!

• I had already started my cycle and I was told that I could finish it, but without transferring the pre-embryos, why?

A pregnant person is always a higher risk patient for almost any disease, among other reasons because it is often impossible to administer the necessary medication due to the risk for the foetus. In this situation and knowing that SARS-CoV-2 is proving to be so contagious, the probability of being infected by the virus is quite high, even by doing the quarantine. Performing the transfer of the embryos resulting from the initiated cycle, would result in pregnancy if everything goes well and this situation would thus generate a patient at risk, and that is precisely what we want to avoid.

In addition, although there is not enough scientific evidence to show that SARS-CoV-2 can by itself generate alterations in pregnancy, there seems to be a direct correlation between the virus itself and early abortions or premature births due to the fever it generates (the first known case in Spain was an extremely premature child born in Malaga from a mother infected with coronavirus). It is true that most cases could be asymptomatic, but no one would want to risk a premature baby if things were to go wrong or a child with the after-effects of infection during pregnancy. For this same reason, and when in doubt, it is recommended not to transfer, thus avoiding the risk situation.

As for the treatment, it can be terminated since the stimulation is used to obtain the oocytes or pre-embryos that, whenever possible, would be frozen by vitrification, to be then transferred at a time of greater health security.

• But, if cryopreserved pre-embryos are finally obtained, will they have the same guarantees as a fresh pre-embryo?

Hundreds of scientific articles have been published that support the capacity of vitrified pre-embryos to survive and equal their implantation potential with respect to fresh ones. In fact, nowadays, in most of in vitro fertilisation cycles, transfers are carried out on a deferred basis to ensure that the conditions of the endometrium (the layer where the pre-embryo will nest inside the uterus) are the most optimum, bearing in mind that during stimulation, the endometrium is trailing the ovary which is what treatment is really aiming at this moment.

• And, will I be able to decide when I want to transfer the pre-embryos or use my oocytes?

Once the alarm is lifted, patients and clinics should get in touch again to assess each case and decide together which is the best time, and above all the most appropriate, to start treatment.

• Is there a limit to the decision to transfer these pre-embryos or use the oocytes?

From the moment the state of alarm will be over, you can decide when to do so, bearing in mind that cryopreserved pre-embryos or oocytes can remain in that state for years.

• If I become infected with the coronavirus before deciding to perform the embryo transfer, use the oocytes, or restart treatment, will my chances of becoming pregnant decrease, or will I become more infertile?

With available data and referring to other SARS (previous coronaviruses that we have suffered), no decrease in fertility has been described either at the oocyte or sperm level. Neither does it seem that the ability to get pregnant after the infection is affected, although you must respect all your doctor’s recommendations once the illness will be over.

• What happens if I get pregnant spontaneously?

The final situation is the same as if you had had an embryo transfer after an in vitro fertilization cycle, although in this case it would have been occurred in an uncontrolled manner. ASEBIR’s recommendation not to carry out transfers at this time is given because of the uncertainty in the face of a virus that is still unknown and for which we have no scientific data, since we cannot corroborate that the result of an infection may be innocuous during pregnancy, neither for the patient nor her foetus.

In the event of a spontaneous pregnancy, it is advisable to keep in touch with your doctor or obstetrician so that they can give you the most appropriate recommendations for your case.