Hutchison’s Huddle: Fertility and the COVID-19 Pandemic

COVID-19 is changing the way we are living. Unfortunately, one of those ways is pausing of fertility treatments to help “flatten the curve” and reduce the spread of the virus, all while keeping fertility patients and our country safe. We know how hard it is to put your dreams on hold and we know you have concerns about how this will impact your future fertility. Thankfully, there are things you can continue to do to prepare for fertility treatment while remaining safe at home.

To help our patients navigate these hard times, Dr. Hutchison took to Facebook Live to answer questions and concerns surrounding COVID-19.

Learn more about what we are doing to help our patients during the COVID-19 Pandemic.

Hi, this is Dr. Scot Hutchison here at Reproductive Health Center in Tucson, Arizona. And today we’re going to talk a little bit about COVID-19. And first let me just say how sorry for those who were teed up to start fertility treatment, and it had your cycles cancel and I’m so sorry. It’s hard enough being a fertility patient and then to actually get all geared up to actually go through whatever treatment you were planning on doing and then having that taken away is  very disappointing and devastating for people. So, anyway, there’s [many] questions that people have asked and we want to try to get to those. 

So let’s talk a little bit about the COVID-19 virus. It is primarily spread, according to the CDC still, they think by droplet transmission–so coughing and sneezing. So I would strongly recommend that you stay away from other people right now. The social distancing is very effective and I think it’s fine if you want to go outside walking, as long as you are well away from other individuals and just keep your distance. The incubation period–There is probably some droplet transmission, so when people touch things, they can be infected and then if you touch that virus to your face, you will probably get the disease. Looking up, it does make its way into GI secretions like stool and natural secretions as well, but we don’t really know about infectivity from that source or from semen or anything like that. So it looks like it really is mostly a droplet transmission disease. That being said, I would disinfect everything that other people touch. For example, I have a patient who has an office, they’re only having one person man the office, and there’s a cleaning person who comes in there, but I would recommend cleaning and wiping down everything they touch afterwards as well, just to be on the safe side. 

Face masks–definitely if you’re around sick people, I think are a good idea. If you’re having to care for someone who is in your home and having a separate room for them to be isolated from the remainder of the family is as ideal as well. The symptoms usually are recorded as a little bit of a sore throat, dry cough, fever, headache. And by fever, we mean more than 100.5 degrees Fahrenheit. Eventually, the things that can put people in the hospital are shortness of breath, and septic shock can result. We don’t really know what happens with pregnancy with COVID. The few patients that have been studied appeared that the babies did not get the disease and don’t have any symptoms. And right now, there really is a little call to not even breastfeed those babies even in a woman who has had the disease or has the disease. But they do recommend that you know, very good hand washing, and certainly cleaning breast pumps and things like that before feeding the baby because there are so many other benefits to the baby from breast milk as far as disease prevention. 

So what else can we talk about with it? Well, I would, again, work from home if you can. If you’re going to go to the grocery store, it probably is a reasonable thing to keep your distance from other people. And when you buy things I would get in there and I get out. Currently, FEMA recommends that you only buy about a week for what you need at a time. And I think that’s reasonable. None of those supply chains appear to be affected. And keep in mind there are a lot of people who were not very fortunate who probably can’t stock up on a large amounts of supplies and items. So when you clear out the shelves and you leave nothing for them, they really may have a hard time just eating, being able to feed their family. 

So besides staying home and staying away from other people, there were a bunch of questions here. People said, How will COVID be affecting my fertility treatments? Well, we don’t really know. We’re hoping to get back to transferring here pretty quickly, or helping people get pregnant, until we have a little bit better idea of how pregnant women are affected with the virus as far as making their respiratory compromise worse, I think it’s better to probably hold off on treatment. There are other concerns that you know, like, I had a patient who was miscarrying and I had to do a section-DNC for last week, and of course, we’re having to do that in a hospital setting and so we’re exposing her to potentially getting sick. So even if you could stay home and have a completely uneventful pregnancy, I still am a little bit leery of knowing exactly what’s going to happen in about nine months from now. And one of my anesthesiology friends was saying when we were finishing up egg retrievals last week, it might be really a bummer to have to go to the hospital and labor and know that there was not going to be an anesthesiologist there to give you an epidural. I think, most likely, things will be under control by them. But I think that it’s reasonable to be a little bit cautious with things. The American Society for Reproductive Medicine had sent out a thing–and they’re going to revise it by no later they said, then the 30th–and that was to delay starting new cycles. You could continue–they actually recommended consideration of cycle cancellation for even ones that were going forward. We had about half of our patients who are going through embryo transfers and insemination decide to cancel, the other half went ahead and proceeded on and I’m fine with that. 

But anyway, there’s another–oh, so patients are saying Sprouts has been better stocked than Frye’s… 

Do we know if it [COVID-19] will affect a fetus? And the answer to that is no in the long term, but it appears not to affect babies.

And then there was a question, Am I able to proceed on my own? And again, like I had a patient I talked to today who is completely working from home and I think is pretty low risk for exposure at least in the near future, and for her, we’re going ahead. Another patient of mine, both she and her husband are directly involved with patient care in a hospital-based environment and for them, I recommended that they not proceed on just because I think that their risk of exposure is pretty high. Folks like that, you know, they’ll get the disease and weather it very nicely and then they’re sitting pretty because most likely you’re going to be immune to this disease [COVID-19] for the foreseeable future anyway. Certainly, it’d be great if we get a vaccine because then if this does seem to be like a flu-like illness that keeps popping up season to season we may be able to put a damper on it to a large degree.

And then they say, Well, how do I know my embryos will be stored safely until we start treatments again? Well, the embryo storage tanks are big, liquid nitrogen containers. They’re basically giant thermoses. And they don’t really have–they don’t have any moving parts. They have a big seal at the top and a big foam buffer as an insulator–so sort of think of like a turbo Yeti cooler. And then they have locks and alarms on them. And if the liquid nitrogen reaches a certain level, then they will alarm and they actually notify the staff, one-by-one, until someone responds in sequence. But they’re good for weeks. We’ve never had any of them dry out in the about 20 years now we’ve been doing this. So they are checked on a regular basis with liquid nitrogen, but they probably could be ignored for weeks and weeks and still not cause any trouble. So I don’t think there’s really going to be any worry about embryos or eggs or sperm that are stored causing trouble right now. 

So what else here? They said, am I still able to come in for testing? So what we’re trying to do is do–we’re doing semen analyses and semen freezes. And certainly now in this situation where, you know, the COVID tends to cause a fever. You know, we don’t know how long this virus has been around here because certainly in Arizona, we haven’t had really sufficient testing. And I’ve had some guys where we had to cancel the cycle last round because of fever. And who knows, maybe they have the disease. I think that having a sperm sample frozen ahead of time could potentially rescue an IVF cycle. Because if you get a bad fever during the IVF cycle, those sperm are going to be toasted and you’re going to be much more likely to yield abnormal embryos or just not work because of the DNA fragmentation that occurs with higher temperatures. We also are doing day three lab testing. Certainly, what I tell people to do is go to the lab early in the morning so that you can get your labs before other people in the crowd search start showing up there. But I think that that would be perfectly fine. We’re doing, for our IVF patients, it’s a little extreme, I think, but I’m trying to minimize people’s exposure to the labs again. And so what we are recommending is that people do urine pregnancy tests and then if  they get a positive, we will send them to the lab for a serial ECGs and repeat thyroid labs. But otherwise, waiting until day 12 and then if the urine pregnancy tests are still negative, then discontinuing medication. 

Let’s see here. Will there be a problem with the embryo that you transfer due to the coronavirus (COVID-19)? We really don’t know. My biggest worry is just being pregnant and then getting the coronavirus later, but it’s very possible that if you transferred and then you actually got a fever that actually would decrease the chance of you getting pregnant by damaging the embryo. The interesting thing about this coronavirus is that it appears that a large number of people have very, very minimal symptoms or no symptoms at all–even some of the older folks. And then some of the younger folks are outright dying, you know, we really don’t know! My recommendation is that you eat really healthy food, get a lot of sleep, take your vitamin D–2000 a day–eat your vegetables, eat your leafy greens, and stay away from junk food. I wouldn’t drink alcohol right now. I wouldn’t smoke pot. I wouldn’t smoke cigarettes because the data from China, it appears that the smokers are much more likely to have trouble. And that may have accounted for why the male death rate was so much higher than the female because males in China are proportionally smoked a lot more than the females. 

Here’s another question I wanted to mention if you get pregnant, be prepared for an ultrasound appointment to bar your partner–so true! And that was another question, can I bring my partner into the office for testing and procedures right now? And when we’re saying no, just to minimize everybody’s exposure. Frankly, I’m more worried about healthcare professionals infecting the patients than the other way around. Certainly. And then someone said, Can I bring in children? And the answer that is no as well. Again, I’m really worried about it going the other way. But yeah, it would really be a bummer to not be able to have your partner be there with your pregnancy ultrasound. However, the good part is almost everybody’s got one of these phones now and the cameras just keep getting better so you could FaceTime with somebody while you do the ultrasound, but clearly if it was a bad outcome, and you really wanted the support from your family member, that would not be there, which is a real bummer.

So then someone said, if I am sick or I’m around someone sick, how do I go about rescheduling my appointment? Just just give us a call. Not a big deal. 

Another person said, are you still doing surgeries? And you know the emerging things, yeah. But otherwise, you don’t want to be exposed right now with this [COVID-19]. 

Someone also said, how are you keeping the office clean and safe at this time? Well, we still have the same cleaning crew. But again, we’re disinfecting everything on top of that. The other interesting thing is that I think a lot of offices have done what we started doing, gosh, about three, four weeks ago, which is we just do one person at a time. So you call, and we’ll text you or talk to you, and let you know when you can come in, but we’re just staggering the people who are coming in so that no one is congregating. Nobody is meeting. They come in through the door, which has been disinfected or sanitized, and then they use the alcohol based 60-70% sanitizer before they’re ever roomed. And then we wipe down the restroom that they use in the exam room that they use. Oddly enough, I think even when we open back up, that really may be the way things continue. We’ve thought about–we may have alternate entrances so that we can minimize, if we have more traffic, we can minimize people passing each other in the hallway and things like that. But I think that this is going to be our new normal for probably a quite a bit.

Someone also said–oh, this makes me want to cry. Thanks! From your first infertility patient. Oh, thank you. Nice to see you.

Another person said, I’m newly pregnant, worried about COVID. Should I be–you know, I think you just try to minimize your exposure to other people. It appears that young healthy women are going to be fine for the most part. And the bonus part of it on the other end of it, is that once you’ve got it, then you’re probably a firewall and will protect your family from further infection from at least from spread from you. 

Another person said, COVID-19, if I’m pregnant, what precautions [should I take]? Again, I think just being smart and if you can work from home do so. I was talking to a physician today who is on a message group with several other physicians who were young mothers and she was saying that she really felt for a couple of these gals who are mid to late trimester who were taking care of people in New York and things are pretty chaotic there with lots and lots of people who are ill and of course, then these women are pregnant on top of it and trying to trying to stay safe.

Somebody asked, do you prefer we pay bills online or phone? Sure. I think that’s better for everybody. 

Nice to hear your comments. Thank you. That is fantastic. 

If anybody has any other questions, we’re happy to answer–oh, wait, there’s more. But wait, there’s more! Yeah, Karina is reminding me, we’re still doing discussions and new patients over the telephone. But again, no, intrauterine inseminations, or frozen embryo transfers until American Society for Reproductive Medicine says otherwise, but it actually is working really well. So we’ve done quite a few of those now and it’s surprising how much you can do with revealing people’s records and we’ll get around to doing the taking a look at ovaries and things like that. But what I’ve been really happy about is that we’ve been able to get people kind of teed up to make him healthier. So instead of you know how having a long dig out period, we’re going to be able to have people getting everything taken care of with regard to the quality of their eggs and sperm now before treatment, because really remember your eggs and sperm are there on an assembly line that’s about three months long. So I mean three to six months even is probably best for the avoiding alcohol, avoiding toxins, smoking marijuana, taking the Coenzyme Q10 100-125 milligrams twice a day, taking the vitamin D3–2000 international units a day–and then eating really healthy food, that’s gonna pay dividends for you down the road here in the future. 

Oh, there’s a question, would you recommend against traveling in the state for work? I’ve been able to work from home exclusively, but I’m now being asked to go on an event. Yes. I would strongly–yeah, I wouldn’t travel in the state if you can help it. You know, we don’t have as many cases of COVID here as there are obviously in the Seattle area or in New York, but time will tell and I’m sure we will. And in particular, I think that for tech workers, I really think people really need to understand that working remotely is another new normal that I think is a great idea, because it will keep us safe until this is all out of control. 

So anyway, thank you all for tuning in. That was very fun! 

Oh, wait, wait, hang on here. Oh, next week–the topic fertility treatment after COVID-19. So we’ll talk about how we can all get ready to go for having more children. 

Hang on. Um, another question, is it okay to walk outside if you keep your distance from others? And I think that yes, I think that the data is for that. In particular, we’ve been going out and walking. We have a dog who’s sort of socially inappropriate, but she’s really cute and so people constantly want to walk up to her and pet her and it kind of freaks her out. And so, the cool thing now is when we go walking around, people see you and they peel off about 100 yards away and so it’s been really easy to walk the dog. And I think that if you’re 100 yards away from somebody, I don’t think you’re gonna get infected. 

Another patient says I’m 17 weeks pregnant, taking prenatal daily, any other vitamins to suggest? I would probably do the 2000 of vitamin D3, I think that’s a really good idea. As far as the COQ10, we don’t really know, and same thing with the Inositol or Metformin. I’m a big fan of Metformin, it may lower the risk of miscarriage early or in the first trimester. I like it. I tell people to take it through the first trimester and then talk about it with the OB. But I think just the extra vitamin D if you’re taking your prenatal. 

And remember when you’re pregnant,  if you wouldn’t feed it to your toddler in a highchair, don’t eat it. You know, we’ve been normalized to think that junk food is okay. It’s just been, you know, from my childhood on there, “big food” has been promoting stuff that is super unhealthy for us. Remember, you know, the guys out there, there’s a study from the Netherlands that the equivalent of the Flaming Hot Cheetos or Cool Ranch Doritos in the group that ate them had progressively declining sperm counts and motility. So please stay away from that stuff in this interim. I know it’s super tasty, but I would get that out of the picture certainly–I’ve probably shared with you all, I don’t have any self control after Jenny goes to bed, so I will go try to find everything where junk food was and try to eat it all. And otherwise, I’m fine! But you know, you just have to know what your limitations are. And so try to keep that stuff to a bare minimum.

Well, if no one has any other questions, I think we’re good! I’ll try to keep looking at the CDC stuff and keep abreast of what’s happening and give you any more updates on the particular COVID thing, but next week we’ll talk about treatment after COVID-19. And thank you all for tuning in, especially my patients from KU.