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| Getting Pregnant Was a Challenge. Then the Coronavirus Happened. | Getting Pregnant Was a Challenge. Then the Coronavirus Happened. |
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| As the coronavirus continues to spread across the globe, we’re working to answer the questions on many parents’ minds. This is a fast-moving situation, so some information may be outdated. For the latest updates, read The New York Times’s live coronavirus coverage here. | As the coronavirus continues to spread across the globe, we’re working to answer the questions on many parents’ minds. This is a fast-moving situation, so some information may be outdated. For the latest updates, read The New York Times’s live coronavirus coverage here. |
| After nearly two years of trying to have a baby, Karen Rzonca, 32, was hoping that this would be the month she finally got pregnant. | After nearly two years of trying to have a baby, Karen Rzonca, 32, was hoping that this would be the month she finally got pregnant. |
| When other reproductive medical treatments didn’t work, she and her husband, who live in New York City, decided to try in vitro fertilization, embarking on a path that thousands of women take each year, according to the Society for Assisted Reproductive Technology. First came the injections to stimulate egg production, then a surgical egg retrieval and embryo fertilization with her husband’s sperm. | When other reproductive medical treatments didn’t work, she and her husband, who live in New York City, decided to try in vitro fertilization, embarking on a path that thousands of women take each year, according to the Society for Assisted Reproductive Technology. First came the injections to stimulate egg production, then a surgical egg retrieval and embryo fertilization with her husband’s sperm. |
| On March 16, three days before one of the embryos would be inserted into her uterus, her doctor called with some bad news: The embryo transfer was canceled. If she were to contract the coronavirus it was unclear how it might affect her pregnancy or her baby, the doctor explained. And nobody knew when it would be safe to move forward. | On March 16, three days before one of the embryos would be inserted into her uterus, her doctor called with some bad news: The embryo transfer was canceled. If she were to contract the coronavirus it was unclear how it might affect her pregnancy or her baby, the doctor explained. And nobody knew when it would be safe to move forward. |
| “I definitely appreciated, I guess, the concern that the office had …” Rzonca said on March 19, her voice trailing off, leading to tears. “I pretty much took the phone call like a champ, hung up, and then cried my eyes out for two hours.” | “I definitely appreciated, I guess, the concern that the office had …” Rzonca said on March 19, her voice trailing off, leading to tears. “I pretty much took the phone call like a champ, hung up, and then cried my eyes out for two hours.” |
| As the coronavirus pandemic worsened, the American Society for Reproductive Medicine (A.S.R.M.) issued new guidelines on March 17, advising its more than 8,000 members to avoid starting new treatment cycles for I.V.F., IUI and egg freezing; consider canceling embryo transfers; and suspend all nonemergency surgeries. It made an exception for patients who have an urgent need to freeze their eggs or sperm, as might be the case with someone about to undergo chemotherapy, as well as patients who were midtreatment and had taken ovarian-stimulating drugs. | As the coronavirus pandemic worsened, the American Society for Reproductive Medicine (A.S.R.M.) issued new guidelines on March 17, advising its more than 8,000 members to avoid starting new treatment cycles for I.V.F., IUI and egg freezing; consider canceling embryo transfers; and suspend all nonemergency surgeries. It made an exception for patients who have an urgent need to freeze their eggs or sperm, as might be the case with someone about to undergo chemotherapy, as well as patients who were midtreatment and had taken ovarian-stimulating drugs. |
| Some fertility centers, including Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery in Boston and Weill Cornell Medicine’s Center for Reproductive Medicine in New York City, had already stopped treating new patients, even before the guidelines were issued, citing the urgent need to protect the well-being of its current patients, among other concerns. | Some fertility centers, including Brigham and Women’s Hospital Center for Infertility and Reproductive Surgery in Boston and Weill Cornell Medicine’s Center for Reproductive Medicine in New York City, had already stopped treating new patients, even before the guidelines were issued, citing the urgent need to protect the well-being of its current patients, among other concerns. |
| The A.S.R.M. will re-evaluate its guidelines at the end of March at the latest. But given how quickly the coronavirus is spreading, it’s unclear if the recommendations will be reversed then. | The A.S.R.M. will re-evaluate its guidelines at the end of March at the latest. But given how quickly the coronavirus is spreading, it’s unclear if the recommendations will be reversed then. |
| Within days of the A.S.R.M. announcement, Beverly Reed, M.D., a fertility doctor at IVFMD, near Dallas, had created an online petition to protest the new guidelines. | Within days of the A.S.R.M. announcement, Beverly Reed, M.D., a fertility doctor at IVFMD, near Dallas, had created an online petition to protest the new guidelines. |
| “Many fertility physicians and patients are against this decision and feel that this is a women’s rights violation,” Dr. Reed said in an email on March 22. “American women in general are not being told to avoid pregnancy. So, why are infertility patients being told not to? In addition, it unfairly prevents same sex couples and single mothers by choice from getting pregnant.” | “Many fertility physicians and patients are against this decision and feel that this is a women’s rights violation,” Dr. Reed said in an email on March 22. “American women in general are not being told to avoid pregnancy. So, why are infertility patients being told not to? In addition, it unfairly prevents same sex couples and single mothers by choice from getting pregnant.” |
| Much is still unknown about how the new coronavirus affects pregnancy. The good news: There is no evidence yet that pregnant women are at a higher risk of developing the disease, and limited studies of women in late stages of pregnancy indicate the virus is not transmitted by a mother before the baby is born, during birth or via breast milk. But experts do not know what effects the coronavirus might have on a fetus, particularly in the early stages of development, or how severely it could sicken pregnant women. | Much is still unknown about how the new coronavirus affects pregnancy. The good news: There is no evidence yet that pregnant women are at a higher risk of developing the disease, and limited studies of women in late stages of pregnancy indicate the virus is not transmitted by a mother before the baby is born, during birth or via breast milk. But experts do not know what effects the coronavirus might have on a fetus, particularly in the early stages of development, or how severely it could sicken pregnant women. |
| “We really are in unprecedented times,” said Catherine Racowsky, Ph.D., the president of A.S.R.M. and the director of the Assisted Reproductive Technology Laboratory at Brigham and Women’s Hospital. “We feel this is the safe way to move forward for now.” | “We really are in unprecedented times,” said Catherine Racowsky, Ph.D., the president of A.S.R.M. and the director of the Assisted Reproductive Technology Laboratory at Brigham and Women’s Hospital. “We feel this is the safe way to move forward for now.” |
| While many fertility doctors are canceling appointments and temporarily halting new cycles, the New Hope Fertility Center in New York is having conversations with each patient and deciding on a course of treatment on a case-by-case basis, said Dr. John Zhang, M.D., Ph.D., the founder, director and chief executive of the center. | While many fertility doctors are canceling appointments and temporarily halting new cycles, the New Hope Fertility Center in New York is having conversations with each patient and deciding on a course of treatment on a case-by-case basis, said Dr. John Zhang, M.D., Ph.D., the founder, director and chief executive of the center. |
| The U.S. government has called for hospitals to suspend elective surgeries to slow the spread of the coronavirus, and because most fertility procedures are considered elective, some doctors have argued that non-urgent fertility surgeries should be suspended to conserve the already dwindling supply of medical equipment and personnel who might be called on to fight the coronavirus. | The U.S. government has called for hospitals to suspend elective surgeries to slow the spread of the coronavirus, and because most fertility procedures are considered elective, some doctors have argued that non-urgent fertility surgeries should be suspended to conserve the already dwindling supply of medical equipment and personnel who might be called on to fight the coronavirus. |
| Fertility clinic officials who have suspended or canceled treatments say they recognize how difficult this is for patients who have been struggling to conceive. | Fertility clinic officials who have suspended or canceled treatments say they recognize how difficult this is for patients who have been struggling to conceive. |
| “These procedures, as elective as they may be, they are very much time-sensitive to our patients, there is no question,” said Dr. Antonio R. Gargiulo, M.D., a reproductive endocrinology and infertility specialist at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital. “To them, every month counts — every week counts.” | “These procedures, as elective as they may be, they are very much time-sensitive to our patients, there is no question,” said Dr. Antonio R. Gargiulo, M.D., a reproductive endocrinology and infertility specialist at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital. “To them, every month counts — every week counts.” |
| The new coronavirus is “very aggressive,” he added, and spreading quickly. “We know nothing as to how this may affect the early development of the fetus, the risk of miscarriage, the risk of malformation, the risk of long-term viability of the baby.” | The new coronavirus is “very aggressive,” he added, and spreading quickly. “We know nothing as to how this may affect the early development of the fetus, the risk of miscarriage, the risk of malformation, the risk of long-term viability of the baby.” |
| “I don’t know that it’s a great idea to have an attempted pregnancy right now,” he said. | “I don’t know that it’s a great idea to have an attempted pregnancy right now,” he said. |
| Caroline Haugen, 36, who lives in Traverse City, Mich., tried “for quite some time” to conceive her first child. She visited The Fertility Center in Grand Rapids, Mich., where she received medicated IUIs and eventually became pregnant with a girl, who was born in December 2016. She and her husband decided to expand their family this year and planned to return in April for another IUI. | Caroline Haugen, 36, who lives in Traverse City, Mich., tried “for quite some time” to conceive her first child. She visited The Fertility Center in Grand Rapids, Mich., where she received medicated IUIs and eventually became pregnant with a girl, who was born in December 2016. She and her husband decided to expand their family this year and planned to return in April for another IUI. |
| Updated June 22, 2020 | Updated June 22, 2020 |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| On March 16 she had an ultrasound to examine her uterine lining and the next day a nurse called to tell her that she was cleared to start a new IUI cycle. Haugen called back on March 20, a couple of days before her medications were expected to arrive, to check back in with the nurse. It was then that she found out her clinic would not be starting any new cycles out of concern over the potential ramifications of coronavirus. | |
| “I cried,” she said. “Because it feels like a negative all over again. Except we didn’t even try.” | “I cried,” she said. “Because it feels like a negative all over again. Except we didn’t even try.” |
| Haugen acknowledged that her clinic is “just doing what’s recommended.” Even so, she added, “You want to say, ‘No! Do it to me anyways!’” | Haugen acknowledged that her clinic is “just doing what’s recommended.” Even so, she added, “You want to say, ‘No! Do it to me anyways!’” |
| The coronavirus adds another layer of worry for fertility patients, adding to the mental and physical stressors of struggling to get pregnant. Fertility treatments can also present a large financial burden. | The coronavirus adds another layer of worry for fertility patients, adding to the mental and physical stressors of struggling to get pregnant. Fertility treatments can also present a large financial burden. |
| If a patient were to fall ill during a treatment cycle, she might need to stop treatment after having already spent a great deal of money. That’s a very real concern for patients in most states, including Washington, where insurers are not mandated to cover fertility treatments. The UW Medicine Reproductive Care clinic is adapting the latest guidelines but will make exceptions for urgent cases like cancer patients or other unique circumstances. | If a patient were to fall ill during a treatment cycle, she might need to stop treatment after having already spent a great deal of money. That’s a very real concern for patients in most states, including Washington, where insurers are not mandated to cover fertility treatments. The UW Medicine Reproductive Care clinic is adapting the latest guidelines but will make exceptions for urgent cases like cancer patients or other unique circumstances. |
| Canceling a treatment cycle can mean wasted medication, which is often costly and typically cannot be reimbursed. | Canceling a treatment cycle can mean wasted medication, which is often costly and typically cannot be reimbursed. |
| Rzonca and her husband had already spent thousands out of pocket for the procedure, including genetic testing, but because she has three normal, frozen embryos they can reschedule the embryo transfer when it’s safe to do so. | Rzonca and her husband had already spent thousands out of pocket for the procedure, including genetic testing, but because she has three normal, frozen embryos they can reschedule the embryo transfer when it’s safe to do so. |
| In contrast, many women who hadn’t yet started medically assisted fertility treatments this year will need to wait to harvest their eggs, including older women who might be nearing the end of their reproductive years. | In contrast, many women who hadn’t yet started medically assisted fertility treatments this year will need to wait to harvest their eggs, including older women who might be nearing the end of their reproductive years. |
| The waiting, such an omnipresent part of the process, is one of the hardest parts, Rzonca said. | The waiting, such an omnipresent part of the process, is one of the hardest parts, Rzonca said. |
| She and her husband have decided to try on their own, at home, where they are both working for at least several more weeks. | She and her husband have decided to try on their own, at home, where they are both working for at least several more weeks. |
| “Yes, of course, this is a terrible, risky time to become a pregnant person for the first time and not know the effect of the virus,” she said. “But we’re definitely not going to hold back.” | “Yes, of course, this is a terrible, risky time to become a pregnant person for the first time and not know the effect of the virus,” she said. “But we’re definitely not going to hold back.” |