FAQ Related to COVID-19 and its vaccines
This communication from SART and ASRM are frequently asked questions (FAQ) on the ASRM COVID-19 Taskforce Recommendations for current and future patients who need fertility medical treatments.
FAQ Related to COVID-19
We understand it can be confusing when respected physicians or their organizations come to different conclusions. However, the virus and what we know about treatments and vaccines are all rapidly changing. As we learn more about COVID-19 care and management, recommendations will evolve. In reality, currently, there is little data on which to evaluate the impact of the vaccine or the disease on pregnant individuals. Also, given the challenges of enrolling pregnant individuals in clinical trials, it is unlikely we will have full data for many years. Meanwhile, patients must make decisions about their health now. Our conclusion is that the vaccines are safe for pregnant individuals or those contemplating pregnancy. However, it is important that each patient discuss vaccination with their physician and decide what the best course of action is for them and their family.
Please review the ASRM COVID-19 Task Force Update 11 and Update 12 for information on which the Task Force bases its recommendations.
What we know:
- While the majority of those infected will survive, the overall death rate from COVID-19 remains over 1%. It is increasingly recognized that some people suffer from long term consequences after COVID-19 infection. These lingering symptoms can include muscle weakness, sleep difficulties, anxiety, depression, hair loss, anosmia, joint pain, palpitations and decreased pulmonary function. In a recent study, 76% of patients hospitalized with COVID-19 reported at least one lingering symptom six months after infection, and this proportion was higher in women. Given the continued morbidity and mortality of COVID-19, prevention remains a top priority.
- Widespread vaccination is critical to slowing the spread of SARS-CoV-2 virus, reducing COVID-19, and bringing an end to the pandemic.
- Currently available mRNA-based COVID-19 vaccines from Pfizer-BioNTech and Moderna have documented safety and efficacy in large randomized clinical trials, preventing up to 95% of severe disease.
- The known and potential benefits of these vaccines outweigh the known and potential harms of COVID-19 infection.
- Available data indicate that COVID-19 vaccines do not cause infertility in women or men.
- In the randomized blinded Pfizer-BioNTech trial, a similar number of women conceived after receiving the vaccine as those who received the placebo.
- mRNA vaccines are taken up rapidly by muscle cells at the injection site and the mRNA is degraded in the cell once the protein is made so it does not cross the placenta.
- COVID-19 vaccination is recommended for women who are contemplating pregnancy or who are pregnant in order to minimize risks to themselves and their pregnancy.
- The Task Force does not recommend withholding the vaccine from patients who are planning to conceive, who are currently pregnant, or who are lactating. These recommendations are in line with those of the Advisory Committee for Immunization Practices (ACIP) of the U.S. Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM).
- Patients undergoing fertility treatment and pregnant patients should be encouraged to receive vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.
- A shared decision-making model between patients and providers should be used when considering vaccination and should take into consideration the ethical principles of autonomy, beneficence, and non-maleficence. Consideration of local COVID-19 transmission and risk of acquisition, personal risk of contracting COVID-19, risks of COVID-19 to the patient and potential risks to a fetus, efficacy of the vaccine and known side effects, and the lack of data about the vaccine during pregnancy should all be taken into consideration as patients make decisions regarding vaccination. Some individuals may elect to defer conception attempts until both doses of vaccine have been administered.
- Recent studies have suggested that pregnancy is a risk factor for severe COVID-19 disease. Furthermore, many women who are pregnant or contemplating pregnancy have additional risk factors such as obesity, hypertension or diabetes which may further increase the chance of severe disease from COVID-19 infection. These considerations should be included in decisions regarding vaccination.
- Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies. It should be noted that pregnant and lactating women were excluded from the initial phase III trials of these two vaccines, so specific safety data in these populations are not yet available and further studies are planned. However, the mechanism of action of mRNA vaccines and existing safety data provide reassurance regarding the safety of COVID-19 mRNA vaccines during pregnancy. The FDA EUA letter permits the vaccination of pregnant and breastfeeding individuals with a requirement that the company engage in post-authorization observational studies in pregnancy.
- While COVID-19 vaccination can cause fever in some patients (up to 16% of those vaccinated and mostly after the second dose), this risk should not be a concern when deciding whether to vaccinate a pregnant individual or a patient desiring pregnancy. While fever in pregnancy (particularly the 1st trimester) has been associated with an increased risk of neural tube defects, a recent study demonstrated the association no longer remained significant if the patient is taking >400 mcg of folic acid daily. Another large Danish cohort study did not demonstrate any increased risk of congenital anomalies of those who reported fever in the first trimester. Additionally, the most common symptom of COVID-19 infection itself is fever (83-99% of affected patients). Patients who experience fever following vaccination should take an antipyretic medication, like acetaminophen.
While the COVID vaccine is new and there is a lot we do not know about it, the risks of developing severe illness from COVID are higher for pregnant woman. In severe cases, pregnant women with COVID are more likely to need ICU care and/or a ventilator than women with COVID who are not pregnant. The COVID-19 vaccine is made without live virus. In previous vaccines that used a similar design (i.e., those that also did not contain live virus), getting vaccinated was not associated with developing severe illness in either the pregnant mother or her unborn baby. Both the American College of Obstetrics and Gynecology (ACOG) and Society for Maternal and Fetal Medicine (SMFM) have released statements supporting use of the COVID-19 vaccine in pregnant and breastfeeding women (see links below), and although we do not know all the risks associated with taking the vaccine, when considering whether to take any medication prior to or during pregnancy, we always must consider the benefits relative to the theoretical or known risks. In this case, given how dangerous COVID can be during pregnancy, and the lack of evidence of harm to pregnant women associated with receiving the vaccine, we recommend that eligible women get the vaccine.
No, it is impossible to get COVID from the vaccine. The vaccine does not contain live SARS COV2 virus. It is an mRNA vaccine. Please reference the CDC website for more information: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/facts.html.
There are several different types of vaccines in development. All of them teach our immune systems how to recognize and fight the virus that causes COVID-19. Sometimes this process can cause symptoms such as fever. These symptoms are normal and are a sign that the body is building protection against the virus that causes COVID-19.
It typically takes a few weeks for the body to build immunity (protection against the virus that causes COVID-19) after vaccination. That means it is possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and still get sick. This is because the vaccine has not had enough time to provide protection.
No, the vaccine will not impact your current medical conditions. In fact, if you have underlying medical conditions, you may be at higher risk of having severe complications from COVID-19. As a result, getting the vaccine which, after both doses offer approximately 95% protection from COVID 19, will lower your overall risk of illness.
Side effects are more common after the 2nd dose than the 1st. The most common side effect after the 1st dose is arm soreness. Additional side effects include tiredness, headache, muscle pain, chills, joint pain, and fever. These typically last about 24 hours and can be improved with Tylenol or Advil.
In theory, yes. Scientists are still unsure whether vaccination is protective against asymptomatic viral shedding. Preliminary data is promising in that vaccinated individuals may be less likely to be asymptomatic carriers than non-vaccinated individuals. However, it is still recommended that those who receive the vaccine continue to practice social distancing, masking, hand washing, etc.
Because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies. It should be noted that pregnant and breastfeeding women were excluded from the initial phase III trials of these two vaccines, so specific safety data in these populations are not yet available and further studies are planned.
Because of this lack of data, we understand there are some organizations have chosen to recommend not to get vaccinated when trying to get pregnant and currently pregnant, we believe the risk-benefit ratio favors vaccination given the severity of COVID19 and its ability to be transmitted easily.
No. Physicians should promote vaccination to patients, their communities, and to the public but because access to the vaccination is based on staggered eligibility criteria, your fertility specialist should not REQUIRE it prior to providing therapy.
There are other more reliable sources of information found with these organizations:
No. Research shows that COVID-19 vaccines do not cause infertility in women or men. Importantly, data has shown that COVID-19 infection may temporarily reduce sperm quality. The impact of the changes to sperm quality on fertility are not yet known. If you are trying to conceive, it is important to get vaccinated. (
No. Research shows that a similar number of women got pregnant after receiving the vaccine versus a placebo. Many people have gotten pregnant since being vaccinated.
Like life, viruses are constantly adapting to their environment to survive. As a result, the COVID-19 virus is constantly changing in order to spread.
Yes. As of November 2021, unvaccinated people over 18 had a 4x higher risk of testing positive for COVID-19 and a 15% higher risk of dying from COVID-19. Compared to people who are vaccinated and also receive a booster shot, unvaccinated people were 13x more likely to test positive for COVID-19 and 68x more likely to die.
No. The vaccines are broken down soon after they are injected and do not get to the placenta.
ASRM/SART has developed guidelines to minimize risk of viral transmission while pursuing fertility care. The most recent guidance can be found here and is updated periodically.
As anyone who has been through fertility treatment or has prepared to begin fertility treatment knows, multiple clinic visits and procedures are required. Unfortunately, even if a clinic screens patients and staff to lower the risk of COVID-19 exposure in the fertility clinic, there is no way to guarantee prevention of exposure. COVID-19 is spreading rapidly throughout the United States. People who have the COVID-19 are contagious days before they develop any symptoms. The virus can be in the air that they breathe out and the air you breathe in. This risk is reduced by wearing masks and by increasing physical distance between people.
However, these precautions are not foolproof and do not guarantee your safety. We wish we could screen in a way that could eliminate risk, but we honestly cannot.
Yes. In fact, some research shows that antibody levels were higher in babies who were exposed to vaccination rather than infection in utero (or during pregnancy).
COVID-19 infection can last for weeks. Since pregnant women are known to be at increased risk of severe complications, you can start trying 10 days after symptoms started or after a positive COVID-19 test.
Based on currently available information, pregnant women who become infected with COVID-19 do not appear to be at increased risk of miscarriage or other complications of pregnancy. However, pregnant women are known to be at greater risk of severe complications from other respiratory viral infections such as influenza and SARS. For that reason, pregnant women are considered an at-risk population for COVID-19.
Notably, in many reports cesarean delivery has been used for women who presented in labor and delivery. Though evidence is limited, there are anecdotal cases where pregnant women infected with COVID-19 have encountered an exacerbation of breathing difficulties after delivery.
A recent report from the CDC suggests that pregnant women with COVID-19 appeared to be at increased risk of mechanical ventilation and admission to the intensive care unit (ICU) compared to nonpregnant women, though the total number of women with severe complications overall is low. Pregnant women were not found to be at increased risk of death associated with COVID-19 compared with non-pregnant women.
Infection with COVID-19 can be particularly concerning for those who are pregnant, as they may be at higher risk for severe complications. Although the effects of COVID-19 infection during pregnancy have not yet been fully defined, including effects of infection in the first trimester of pregnancy, infection may precipitate premature labor and/or delivery. However, full term newborns delivered from mothers with active COVID-19 infections have done well.
We know that the infertility treatment is often stressful. The upheaval in many life domains created by the COVID-19 pandemic adds to that strain., There are several strategies you can use to cope. First, remember that your fertility nurse is likely experienced in providing emotional support for patients coping with infertility and pregnancy loss. Start by sharing what you are feeling with her/him. Your nurse also can connect you with your clinic’s specialized fertility counselor. This counselor can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. You also locate a fertility counselor through the Mental Health Professional Group of ASRM. Click here for a directory of mental health providers. Most of these fertility counselors offer telehealth services that may be covered by your insurance carrier. Here are some additional ideas for coping:
- Get accurate and current information to reduce anxiety. Utilize reliable sources such as the CDC, WHO and ASRM.
- Limit your use of social media and other sources of news. Set a certain time of day for gathering news. Choose a time when you are not likely to be triggered. Stop using tech devices an hour or more before bedtime…turn them off.
- Utilize relaxation or mindfulness apps to reduce anxiety and tension and improve sleep. Focus on the present moment. Some examples are Ferticalm (for women), FertiStrong (for men), Buddhify, Headspace, MindshiftCBT, and Personal Zen.
- Engage in pleasurable activities and hobbies. What do you do for fun? Taking even ½ hour per day to focus on things other than the pandemic and your fertility journey will help.
- Pay attention to the messages you give yourself. Positive self-talk can be powerful. Saying things like “This isn’t the situation I expected but it doesn’t mean it won’t work out eventually” can be helpful.
- Stay in touch with others in your support network, either socially distanced or virtually. Staying connected with others reduces the sense of isolation. If you are experiencing Zoom fatigue, consider connecting on the weekend or after you have given yourself a break.
- Join RESOLVE: The National Infertility Association (www.resolve.org). RESOLVE has an online support community, local support groups (now meeting virtually), webinars and other content to help you connect, get support, and stay informed.