What vax fertility fears say about us
As COVID-19 vaccine eligibility continues to rapidly expand across the U.S., I’ve received more and more phone calls, texts and emails from women of childbearing age — not to mention their concerned parents and grandparents, school administrators, clergy and others — who are worried about the potential that the vaccine could harm their future fertility. It made me wonder why there seemed to be such a widespread and specific fear that a side effect of the vaccines was infertility.
A simple explanation would be that there was data supporting this fear. Thankfully, that is not the case. There is no data from animal studies, clinical trials or follow-up surveillance showing — or even suggesting — that the vaccine impairs female (or male) fertility. The absence of data showing harm is not due to a lack of inquiry; reproductive safety was a focus in the preclinical animal studies and clinical trials, and continues to be monitored in ongoing vaccine safety surveillance.
In the clinical trials themselves, 23 women conceived after the first injection, with no difference in the number of women who conceived in the group that received the vaccine and those who received the placebo (12 and 11, respectively). Of those women in the trial who conceived, there was only one miscarriage, and that woman had received the placebo.
If there isn’t data showing that the vaccine impairs fertility, is there at least a biological plausibility? Again, the answer seems to be a resounding “no.” A widely circulated, but since debunked, blog post claimed that the spike protein targeted by the vaccine was similar to a protein found on the surface of the placenta and that the vaccine could trigger an immune response to placental protein that would result in infertility. We and others have shown that there are no significant areas of similarity between the spike and the placental proteins. Moreover, infection with the actual SARS-CoV-2 virus also exposes the individual to the same spike protein, along with the 28 other proteins of SARs-CoV-2, plus the consequences of the active virus. Thus, even a theoretical concern about similarity to the spike protein is dwarfed by the impact of the actual virus.
In fact, fear of vaccines causing infertility is nothing new; this is a common trope and recurrent theme in dystopian literature. Fear of vaccines causing infertility led to the 2003 boycotts of polio vaccination efforts in Nigeria and the rollout of the HPV vaccine. Amazon even had a miniseries with a premise about a pharmaceutical company that created a pandemic to cause people to takes its vaccine which was designed not to prevent the infection but to block reproduction (it’s worth noting that the series was written seven years ago).
So why is there a particular focus and vaccines and fertility? I think the answer has more to do with us than with the actual vaccine. Fertility is both precious and precarious; of couples trying to conceive, 15% will experience infertility. Infertility seems to often strike randomly and without warning. No cause for the infertility will be found in 30% of infertile couples. When I ask couples with infertility about their prior medical and surgical histories, the answer I often get is “none.”
At the same time, the vital importance of fertility and the emotional toll of infertility for many was highlighted, ironically, by the current COVID-19 pandemic. In the early days of the pandemic, when fertility treatments were paused in the U.S. and some fertility treatments were canceled, 85% of patients who had a cycle canceled found the cycle cancellation to be moderately to extremely upsetting, with 22% rating it to be equivalent to losing a child. Couple this with the fact that fertility concerns are high among the social-media and tech-savvy people in their 20s, 30s and 40s, and you have the perfect recipe for widespread misconceptions.
Thus, the seemingly random and silent nature by which infertility impacts women and couples and the tremendous importance of fertility for so many, set in the backdrop of this new and frightening pandemic that is still filled with many unknowns, and with social media platforms adroit and fanning longstanding fears of vaccines and fertility, seems to be the perfect storm to create the current alarm.
While we will need to continue to monitor long-term data, those who are eligible for the vaccine need to make decisions in the present. Fortunately, existing evidence, biological plausibility and all available risk/benefit balance all suggest that COVID-19 vaccines are safe and effective at preventing serious illness and do no impact future fertility and are recommended for those planning to conceive.