Babies on hold
For many, hopes put on hold, and future is unclear
Many couples’ fertility treatments stalled by outbreak.
When shelterinplace orders came down across the Bay Area, Lizzy Soltis was trying to get pregnant.
Soltis lives in San Francisco with her husband and 2yearold son, who was conceived through in vitro fertilization, or IVF. When Soltis went through the process the first time, she ended up with a number of extra embryos.
“We’ve had a joke for years that the siblings were in the freezer,” she said. Last year, she and her husband decided it was time to pull one out.
Because of a health condition, Soltis takes five months to prime her body for pregnancy. She was in the final weeks of preparation when the city shut down and her IVF procedure was canceled.
“I spent the first days of lockdown going through an embryoless miscarriage,” Soltis said. “I just looked at my husband and said, ‘I get twice the TP allotment.’ ”
For patients dealing with infertility, the process of starting a family can feel largely out of their control, but the coronavirus has added an extra layer of uncertainty. On March 17, the American Society for Reproductive Medicine published guidelines for the pandemic that — with a few exceptions — suggested suspending infertility treatment in the United States. Now, more than a month later, people across the Bay Area are watching the coronavirus play out in their communities and wondering when they will be able to start building their families again.
“It’s not quite a loss,” Soltis said of her IVF cancellation. “It’s a loss of an opportunity.”
According to data from the Centers for Disease Control and Prevention, more than 81,000 infants were born through assisted reproductive technology like IVF in 2018, up 33% from a decade ago. But the coronavirus has put egg retrievals and embryo transfers on hold. In the March guidelines and two subsequent updates, the American Society for Reproductive Medicine emphasized the need to protect patients, providers and society through social distancing and to conserve medical supplies. It also warned of the unknown effects of COVID19 on early pregnancy, when fever is associated with miscarriage, birth defects and preterm labor.
Delaying treatment “was not a decision we came to lightly,” said Dr. Marcelle Cedars, director of the Center for Reproductive Health at UCSF and a member of the group’s COVID19 task force. But, she added, the coronavirus pandemic is an unprecedented outbreak. “When you’re in that unprecedented situation, it really calls for unprecedented response.”
Tarah and Jamie Burns were in the middle of their fertility checklist when the coronavirus hit San Francisco. The samesex couple had saved the funds to begin treatment, sketched out a plan for IVF with a doctor at UCSF and learned to inject themselves with the drugs needed to prepare Jamie, 36, for egg retrieval and Tarah, 33, to carry the pregnancy. They had purchased $10,000 worth of sperm and were scheduled to start medication in late March.
Before they could get there, the appointment was called off.
“We went from, ‘wow, we could be pregnant in six weeks,’ to ‘we have no idea when we can start this process now,’ ” Tarah said.
Many infertility patients spend years waiting to have a child. Cedars said the ASRM tried to balance their needs with the public health responsibility to flatten the curve of infection. Infertility medicine is essential, she said, but in most cases, it’s not urgent.
The guidelines made exceptions for people in treatment for whom stopping might be dangerous and those whose fertility was at immediate risk from cancer therapy or other issues. For everyone else, familyplanning timelines have changed, with some who have incurred thousands of dollars in outofpocket expenses looking at having to do so again.
The suspension of fertility treatments inspired a fierce backlash. In a Change.org petition that has gathered more than 20,000 signatures, a Texas physician wrote that the reproductive medicine society’s guidelines “violate the principles of justice, autonomy, and nonmaleficence,” meaning inflicting the least harm possible.
San Francisco therapist Madeleine Katz, who specializes in fertility issues, said reproductive medicine is more emotional than other disciplines because having a family is tied to identity.
“From the time many people are young they have internalized the idea that they will be a parent one day,” said Katz. When that’s not possible — or when the process is put on hold — it damages their idea of self. “People don’t grow up knowing they’re going to have a hip replacement one day.”
Katz started a support group for clients to share their stories and struggles. Some feel like every month the pandemic puts off treatment lessens the chance of getting pregnant. One couple hoped to have a second child, but the mother is already 42. When this resolves they’re not sure it will be possible.
Cedars understands the fear that the coronavirus will steal waning windows of fertility, but says the data don’t support that position.
“We felt very comfortable that one or two months wouldn’t make a difference,” Cedars said. “If you start talking three, six, certainly 12 (months) that’s a whole other ball of wax.”
In the Bay Area, Cedars believes it won’t come to that. On Wednesday, Gov. Gavin Newsom announced that hospitals in California could resume scheduling essential surgeries, and the group’s task force is preparing new guidelines that take into account regional differences in infection rates and allow for more flexibility based on local health department ordinances.
If current trends continue, Cedars said treatments could resume locally in May and June. However, she cautions that anyone considering pregnancy will have to think about the risks of the coronavirus for a while.
“There’s going to be this background risk of infection for many months to come,” said Cedars, who is planning to study the impacts of firsttrimester infections. “We know some patients are going to choose to be pregnant with those unknowns, so at least we can help to answer those questions.”
Tarah and Jamie Burns may be those patients. When clinics reopen, Jamie said they will weigh the situation in San Francisco, listen to the advice of their doctor and consider the precautions to keep their pregnancy safe. But taking all that into account, she thinks they’ll still want to have a baby soon. “I believe that we’re ready to jump back in,” she said. “At the center of my heart I want to move forward.”