Mika Mansukhani has spent three years undergoing intensive treatments in the hope of getting pregnant. Last summer, she and her husband finally got one viable, genetically sound embryo to transfer into her uterus. Doctors carefully froze the embryo at a New York City clinic, and March was going to be their month to transfer it.
Then the novel coronavirus arrived, sweeping through the city and putting her hope of becoming a mom — along with the hopes of thousands of others across the country — back on ice. “A lot of this is about waiting,” she says. “This is another blow.”
In the US, assisted reproductive technology was involved in the birth of more than 74,500 babies in 2018 alone (the year for which the most recent data is available). Now, though, infertility clinics all over the country are canceling many of these much-anticipated procedures, including embryo transfers, due to the Covid-19 pandemic.
This is adding further stress for individuals and couples — who are often already strained by the process emotionally, physically, and financially — as they try to figure out when they might have another chance at becoming parents. And it’s adding a new layer of complexity for doctors as they work to determine who can delay treatment and who should continue.
Why some providers and individuals are suspending infertility treatments
On March 17, the American Society for Reproductive Medicine (ASRM) issued strongly worded recommendations that included not starting any new cycles of assisted ovulation, intrauterine inseminations (IUIs), in vitro fertilization (IVF), or “non-urgent” egg freezing. They also told clinicians to “strongly consider cancellation of all embryo transfers, whether fresh or frozen.”
The reasons for such rapid and firm measures are two-part. First, many non-urgent medical visits are being suspended for social distancing to try to slow the spread of the coronavirus. Second, it’s an effort to conserve the capacity of the medical system to treat people with more life-threatening illnesses.
“Many fertility centers are in hospitals or academic medical centers,” says Eric Widra, chief medical officer at Shady Grove Fertility, which has offices in seven states and normally performs thousands of procedures each year. “Providing fertility treatment in those settings can divert personnel and resources away from acutely ill people.” For their clinics, which are free-standing, they are continuing to offer treatment as they can if they can do it “in a fashion that limits the risk of spreading the disease and does not tax the health care system,” he says.
Additionally, the impacts of the new coronavirus on pregnant people and fetuses have not yet been thoroughly studied. Doctors are optimistic that the virus doesn’t pose an outsized risk during pregnancy, but there is still a lack of good data. Some potential parents also worry about just needing routine obstetric medical care from a pandemic-strained medical system.
Why some people are delaying their one good shot
In 2015, when Mansukhani and her husband were still dating, he was diagnosed with leukemia. His treatments, which included a bone marrow transplant, would render him infertile. So the couple decided to bank his sperm.
After they got married in 2017, they started working with an infertility clinic right away. After numerous egg retrievals (a process that involves weeks of medication, including intramuscular shots, and an invasive surgical procedure), in the summer of 2019, they had reached their final chance. One good embryo emerged from genetic screening.
“Since then, we’ve been trying to make sure that everything is in tip-top shape,” says Mansukhani, who is now 40. So she added acupuncture, fertility massages, and other measures to her already-intensive regimen of medications and lifestyle restrictions to make sure they had the best odds of the embryo implanting in her uterus and growing normally.
But the pandemic was gaining speed.
On March 13, just days before the planned transfer, she had a difficult conversation with her doctor. “Until then,” Mansukhani says, “I just wanted to plow ahead.” But after that, it seemed like “the world around us was sort of collapsing. I realized this is not a risk that I was willing to take.” So they postponed.
Doctors who treat infertility are keenly aware of their patients’ sense of urgency. “Infertility is a disease, and for some, it is time-sensitive,” Widra says. “We do not know how long this crisis will last.”
“We are working on a case-by-case basis,” says John Zhang, medical director and founder of New Hope Fertility in New York City. “Some patients have spent six months to have one opportunity to find one egg,” he says.
“It’s based on the patient,” he says. “If they haven’t started and are 35 years or younger, then we will delay. But for a patient 39 years or older who has been on treatment for six to nine months,” Zhang and his team would plan to continue for now.
Zhang, Widra, and other experts are working to stay on top of the latest developments in the rapidly evolving pandemic so they can recommend the best courses of action. “What is correct today may be wrong tomorrow and vice-versa,” Widra says. “We need to stay thoughtful, logical, and nimble as we navigate this.”
What it’s like to be continuing fertility treatment right now
Across the river in New Jersey, Marya Conetta, 30, was also facing the decision of whether to proceed with a frozen embryo transfer. She and her husband, after years of miscarriages, decided to go ahead with it on March 16. “Things kept escalating and getting worse every day,” she says. But she decided that, “for all of the people conceiving naturally, they’re kind of doing it anyway. This is our way of procreating.”
And it worked. The couple got good news about their pregnancy from early blood tests and an ultrasound. But they haven’t been able to go through all of it together. Since the transfer, her husband hasn’t been allowed to accompany her to the clinic for any of her appointments, due to restrictions on the number of visitors.
“Last week I had my first ultrasound appointment, and my husband was not allowed to be in the room,” she says. “We were not allowed to FaceTime either due to HIPPA laws. It was one of the hardest things to comprehend.”
Her next ultrasound will look for a heartbeat, and, she says, “the amount of anxiety I am feeling is indescribable. Being someone who has suffered multiple miscarriages, I know the feeling of not finding a heartbeat on the ultrasound. My greatest fear is that the baby does not have a heartbeat and I will be alone in the room without my husband.”
Conetta is also trying to shelve her worries about what things would look like if she winds up getting Covid-19 during her pregnancy. And she noted concern about continuing availability of her prescription medications, which are used for more than a month after the transfer to sustain pregnancy. “I’m feeling so many emotions — joy and excitement accompanied by fear and anxiety.”
Infertility already comes with emotional burdens
Jokes about a Covid-19 “baby boom,” anticipating additional pregnancies as couples spend more time at home together, are not helpful to people like Mansukhani. It’s just a painful reminder that they will not be one of those statistics, she says.
“If only it were that easy for some of us,” she says, adding that there is “a lot of this social pressure — and a lack of awareness about the actual trauma and toll of infertility.” And it’s a trauma that is not uncommon. An estimated one in eight couples in the US struggles to get pregnant on their own, not to mention individuals who want to start a family by themselves.
Even after the pandemic ends, this event might have longer-reaching impacts on assisted pregnancies. Widra anticipates a coronavirus dip for at least months after the pandemic is under control. He says he expects the economic recession will impact how many people decide to get treatment, which can cost upward of tens of thousands of dollars and is usually not covered by insurance.
But even for those who’ll continue on as soon as they can, many have already spent years waiting and hoping. And it is hard to call on yet more reserves of patience.
Mansukhani turns 41 this month. “It’s a number I’m still grappling with. I just had this idea in my head that I don’t want to turn 41 and have nothing to show for it. I don’t want to turn 41 and be in exactly the same position that I’ve been in for so long.”
Three days after she and her husband made the decision to not go through with the embryo transfer, she got a high fever, which can be particularly bad in early pregnancy. And that confirmed for her that they had made the right decision for them. “The best thing for us right now is just to focus on getting through day to day,” says Mansukhani.