The rollout of COVID vaccination programmes has brought with it a renewed hope of a return to normality but has also raised questions about the impact of vaccination on fertility treatment and pregnancy.
To help explain and clarify the advice to fertility patients and clinicians, and to fight misinformation spreading online, the Progress Educational Trust (PET) – the charity that publishes BioNew – held an online event.
'The COVID-19 Vaccine: A Shot in the Arm for Fertility Treatment?' was chaired by PET's director Sarah Norcross, and featured speakers outlining the approaches taken by UK, EU and US bodies.
Professor Jason Kasraie, chair of the Association of Reproductive and Clinical Scientists (ARCS), gave the first presentation – an overview of the UK guidance issued by ARCS and the British Fertility Society (BFS). He emphasised that there is no known risk in giving non-live vaccines to pregnant women or those looking to conceive.
ARCS and BFS say there is no need to avoid pregnancy after vaccination, and women who would benefit from the vaccine should receive it without compromising their planned fertility treatment. However, as with any medical treatment, patients should be involved in the decisionmaking process. Pointing out the prevalence of fearmongering misinformation online, Professor Kasraie stressed the importance of being careful about how risk is communicated, when there is currently no cause for fear.
The next speaker, Dr Anna Veiga, coordinator of the European Society of Human Reproduction and Embryology (ESHRE)'s COVID-19 Working Group, explained that ESHRE's relatively cautious position relates to an absence of concrete evidence.
ESHRE has decided not to offer a universal recommendation on whether or not men and women attempting assisted conception should get vaccinated before starting treatment, and instead emphasises the importance of weighing up the factors that are relevant to each individual patient. ESHRE recommends postponing the start of fertility treatment for at least a few days after the vaccine, to allow the immune response to settle.
Regarding vaccination and pregnancy, ESHRE suggests that pregnant women should not be vaccinated unless they are at particularly high risk. ESHRE also suggests that if a woman becomes pregnant after receiving the first vaccine dose then, then – unless the woman is at particularly high risk – the second dose should be delayed until the pregnancy is over. There is no advice to avoid pregnancy after vaccination.
Despite this cautious approach towards the vaccine, Dr Veiga noted that pregnant women have been shown to be at higher risk of developing severe COVID-19 compared to non-pregnant women. Women may therefore still decide to go ahead with vaccination, since the benefits of protection from COVID-19 might outweigh any theoretical risks from, vaccination.
Dr Sigal Klipstein, member of the American Society of Reproductive Medicine (ASRM)'s COVID-19 Task Force, explained that the ASRM's more permissive advice is based on assessing the known and very real risks of COVID-19 alongside the largely theoretical risks of the vaccine. As such, the ASRM recommends vaccination to everyone who can access the vaccine – whether before or during pregnancy – on the grounds that the benefits outweigh the risks.
To emphasise this point, Dr Klipstein gave the example of Israel's decision to make pregnant women a priority group for vaccination, due to their increased risk of developing severe COVID-19. Dr Klipstein further emphasised the important role of fertility specialists in promoting vaccination to their patients, their communities and the public, so as to counter worrying trends of vaccine hesitancy.
During the event, attendees were polled on whether they thought a consensus was needed between all relevant professional bodies on the COVID vaccine and fertility treatment. A clear majority (77 percent) voted yes, prompting Norcross to ask the panel if there was any hope of a consensus being worked out. All three speakers agreed that a uniform message would help avoid confusion and vaccine hesitancy, but that it would be difficult to achieve a consensus, due to each national body's need to follow the formal position of their country's health authorities. The speakers did, however, note that there was significant agreement on key points.
While most of the discussion focused on vaccination of women and the impact on pregnancy, there was an audience question about the impact vaccination might have on sperm quality. The panel agreed that there is no suggestion of risk to the quality of sperm, but that it might be beneficial for men to leave some time between vaccination and fertility treatment, simply to avoid any temporary side effects of the vaccine (such as a fever) having an effect on sperm production. However, it remains prudent for men to get vaccinated before a planned conception, not least so that they avoid the risk of transmitting COVID-19 to the pregnant woman.
Several audience questions addressed the lack of evidence available on the impact of the vaccine. The panel agreed that while there is currently little evidence on the impact of the vaccines on IVF treatment, gamete donation or the health of newborns, there is new information coming in constantly and at unprecedented speeds. Studies of long-term effects will by their nature take time, but there is reassurance to be drawn from studies undertaken on other non-live vaccines.
Dr Klipstein warned against the temptation of an overabundance of caution in the absence of data, as this could end up forcing women into an impossible scenario of weighing up the risk posed by COVID-19 to their own health with any theoretical risks to their baby from the vaccine. Professor Kasraie observed that IVF patients are known to be especially anxious during the pregnancy, so placing them in a position where they have to shield throughout the nine months of pregnancy – for fear of catching COVID-19 – could exacerbate their isolation and anxiety.
Overall, the event showed that despite some differences in the advice given by UK, EU and US bodies, there is significant agreement on the important role of vaccination in protecting the health of fertility patients and professionals alike. Evidence of the harm that can be caused by COVID-19 during pregnancy is clear, known and real. Evidence of harm that can be caused by COVID vaccines is at best theoretical and unsupported by evidence. Certain precautions may be taken in the absence of data, but it is important to ensure that such precautions are not taken to be an indication that there is a known risk.
PET is grateful to the Edwards and Steptoe Research Trust Fund, the British Fertility Society, the Bristol Fertility Clinic and CooperSurgical for supporting this event.