On March 17, 2020, the American Society of Reproductive Medicine (ASRM), a professional organization for fertility specialists, issued a statement about fertility treatments amidst the novel coronavirus. They recommended all practitioners suspend initiation of new fertility treatment cycles—including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF), egg retrievals, and frozen embryo transfers—as well as consider cancelling all embryo transfers, at least for the time being. According to Jennifer Kawwass, MD, the medical director of the Emory Reproductive Center and one of the physicians who worked on the ASRM guidelines, the recommendations were meant to protect the healthcare system in the short-term as the United States dealt with the first wave of the virus. “The aim is not to suspend fertility treatment indefinitely, or even until there is no coronavirus in the US, but rather until the slope of the curve has shifted and the healthcare system can adequately care for those who are gravely ill,” Dr. Kawwass tells SELF.
In the weeks since the ASRM issued their statement, many fertility clinics around the country followed the recommendations, and for good reason. But for individuals receiving fertility treatment, the statement—and subsequent cancellations and delays of much-anticipated procedures—were added blows in an already emotionally challenging process.
The ASRM isn’t the only professional medical organization to recommend suspending “elective” or “non-essential” services during this time, and people with other medical needs across the country have found themselves in similar situations, waiting for non-emergency medical care that, while not immediately urgent, is still much needed. But the terminology of “elective” or “non-essential” when applied to assisted reproductive technology can have a particular sting for people who have been struggling, often for years, to have a baby. “The term ‘elective’ was purposely left out of the ASRM guidance, as infertility treatment is not elective,” says Dr. Kawwass. “However it is not, in most cases, urgent as currently defined in the setting of a global pandemic.” Currently, the only fertility care deemed “urgent” is fertility preservation prior to chemotherapy, radiation, or other life-saving medical treatments that may render a patient infertile, she says.
The Society for Assisted Reproductive Technology (SART) recently announced that there were over 74,000 babies born in the United States from assisted reproductive technology in 2018, up from roughly 72,000 the year before, according to reporting from 367 SART member clinics. The coronavirus will certainly have an impact on those numbers for 2020 and 2021. “There’s no question that some women will not have had a baby that would have had a baby under normal circumstances,” says David Adamson, MD, a clinical professor of obstetrics and gynecology at Stanford University and the CEO of ARC Fertility, a fertility clinic in Cupertino, CA. “For many, their need for IVF may not be ‘critical’ but it is an emergency in the sense that reproduction is a critical life event for those who want it, and if they lose their chance to have a baby, that’s a very serious outcome,” Dr. Adamson says.
With all this in mind, I spoke to three women about just how tough it is to be forced to take a break from fertility treatments right now. Each of their stories is unique, but they echo the same themes and feelings throughout: frustration, sadness, anger, and grief, to name a few. Here’s what they had to say.
“My surgery was like a light at the end of the tunnel. I had something to grasp on to.”
-MAELIE FORTMAN, PORT ST. LUICE, FLORIDA, as told to Sara Gaynes Levy
I’ve had two miscarriages. My husband and I decided to start trying to have a baby in June of 2018. I found out I was pregnant for the first time in December. We thought wow, this is fantastic. We were both really excited. In mid-January I found out I’d had a missed miscarriage—there was no heartbeat. In November of 2019, I found out I was pregnant again, but literally days later I had a natural miscarriage. After two in one year, I found a new OB who had me undergo some testing. In February of this year, they found that I had a uterine septum, which is extra tissue that makes my uterus shaped a little bit like a heart. It needs surgery, and I ended up having to go to an IVF specialist.
The surgery was scheduled for late March. Everything was moving along, but I started to see that this pandemic was happening. In mid-March, I reached out to the doctor’s office saying, have you heard anything? Is there any chance the surgery will be cancelled? And they just told me, ‘listen if anything happens we will notify you as soon as possible.’ I had been required to get blood work done by the surgical center prior to the surgery, and when I was able to go and get that done, I was thinking, everything’s moving forward. But then it got canceled.
I was so shocked and disappointed. I did not take the news very well when the surgery was canceled. Unfortunately, my father passed away last month. So to me, that surgery was like a light at the end of the tunnel. I had something to grasp on to. And when that disappeared, I absolutely just did not cope very well. I took maybe a couple of days to be very much in my feelings about it. I have a very supportive husband who tried to remind me all of this is not under our control. As much as we want to move on and move forward, we have to accept that.
I know that my egg reserve levels are lower than I’d like. I’m 35. There is a ticking clock here, there’s a timeline here. And I have conceived naturally twice. My IVF doctor did mention ‘you could try again, though there’s obviously that risk’ of losing the pregnancy. And I was like, there is no way. My father just passed away. If I go through a third miscarriage, I will lose it. That’s not even an option.
You have these treatment plans laid out and for them to be just torn apart during this time was a complete blow. A part of you realizes that of course, all these hospitals need all the medical equipment they can get. I understand. But it sucks for every single person who is dealing with this.
“Knowing that we’re not going in for another treatment for who knows how long? It feels like another loss.”
-KYLIE RUCH, SEATTLE, WASHINGTON, as told to Sara Gaynes Levy
My wife and I started talking about this whole journey probably about two years ago. In the last year, we found a fertility doctor that we loved. I think being a same sex couple, we were really fearful that we were going to meet a doctor who viewed us differently just because… we are a same sex couple. But we loved her from the beginning.
We decided we were going to do donor sperm from a sperm bank, and that I would carry the pregnancy. I am older by a year than my wife, and while she also wants to carry a pregnancy, she and I talked about things and I just have more of an awareness of pregnancy and birth. Through lots of conversations we kind of settled that I would go first and then she would go after me. When we started this journey, we had a big discussion around our finances. Going into it we knew that we wanted to buy enough vials of sperm to have three tries for each of us, so a total of six. And that in itself was such a financial burden. We didn’t have any friends we wanted to use. Once we had actually purchased the sperm, we were like, okay, now we can relax, set up all the appointments, and go from there. As we started talking to our insurance, it was frustrating, because there was no conclusion or real answer for what would be covered. We ended up meeting with the financial counselor at the fertility clinic who was able to go in the backside of things and give us a better sense of what the numbers looked like. We realized that we wanted a family so badly that everything else could wait. If it was date nights or going out to dinner, we were just going to cook at home. If we had house projects, we would do them once we were pregnant and pretty far progressed. We were gonna make it work no matter what that looked like financially.
In October of last year, we had our first IUI attempt, and it was a success, which was amazing. When I hit 13 weeks, we announced it to everyone on social media. And then at the end of that week, we had another appointment. There was no heartbeat.
We had to re-announce our loss. It was rough. Trying to find clarity and lessons and just trying to pick yourself back up was excruciating. We knew that we were going to have to start from the beginning, and we were more ready for that than I think we realized we would be. But I think we had felt so lucky knowing that we had gotten pregnant on try one, that we weren’t exhausted yet. So we were able to turn ourselves around and be like, well, hopefully this is gonna work.
With most miscarriages, especially if you’re doing fertility treatments, they tell you to wait at least one [period] cycle before trying again. We had gone in in mid-March of this year to chat with our doctor, because there had been some tissue from the implantation left in my uterus and so they needed to have an ultrasound to make sure that was gone before they would approve another IUI. At the appointment, our doctor was incredible, and she point blank said, I am not sure what all of this coronavirus stuff is going to look like as far as next steps. We may close tomorrow. I’m not sure. It could be fine. And it was nice of her to kind of lay that out because we had also been questioning what this was going to look like, but we were also really hopeful that it would be fine for at least a couple of weeks. A few days later was when the email went out that all appointments were being canceled. They weren’t doing any more fertility treatments.
I was at work when I got it, and I had a full blown panic attack. I’d had no control over my body since December and now we weren’t sure when this was going to end. And it’s not really like we can do stuff at home [to help with conception]. I was really heartbroken. My wife, who’s been incredible through the whole thing and my rock and support system, is not one to really show her emotions. And so I think when she started saying things like, oh, I just want to cry and this is terribleI was like, okay, yup, I’m not going crazy as some hormonal person. This is the real deal. Everything has officially stopped.
I will very much volunteer that I’m heartbroken, and I’m discouraged, and I’m angry. I’m still trying to sort through the emotions that come with loss and miscarriage. They found no reason for the miscarriage, so it’s just unanswered questions, and all the coronavirus stuff is more unanswered questions and more insecurities. Knowing that we’re not going in for another treatment for who knows how long? It feels like another loss.
I’m definitely still emotional. I still have moments and periods where I kind of just cry with myself and ask the universe why and when is it going to be over? It feels so open-ended. I tried for the three months prior to our first IUI to just get my body and my headspace on track. Right now it’s hard to do that, because you’re home alone and of course you don’t always have good food in your fridge, so that’s rough in itself. Even motivation to stay active and stay clear in your head—it’s a lot. But I don’t want to wallow in it. There is nothing I can do about it. If I sit there and I let myself get emotional and upset, I am just gonna have to pick myself back up again. Right now, it’s survival mode. It’s making it through the day, every day, one day at a time. Because that’s all I can do.
“I’m trying to focus on the fact that hopefully, one day, we will get to transfer our embryo and that will be successful.”
-EMILY GAULD, ANN ARBOR, MICHIGAN, as told to Sara Gaynes Levy
My husband and I started trying to get pregnant in January of 2019. We got pretty lucky, I guess, and we got pregnant in March or April. But I miscarried that pregnancy very early. Over the course of the next eight months, we experienced three more miscarriages.
After that, we started seeing a fertility specialist and did all the testing and found out that my husband has a genetic condition called a balanced translocation. Some of the genetic material in his chromosomes are swapped. All the genetic material is there, but the side effect is that you have a increased chance of miscarriage. On the one hand, we were really happy to have found an answer, because there are so many women who have miscarriages or experience infertility and never have an answer for it. I didn’t realize how much I was blaming myself throughout this whole thing until we found out, and I immediately relaxed. It wasn’t that glass of wine that I had before I took a pregnancy test.
It’s not a thing that can be fixed or go away. So it was recommended to us that we start IVF. Luckily we have incredible health insurance that covers our first round of IVF, so it was an option for us. Because the embryos in IVF are created outside of the body, they’re able to biopsy them and do genetic testing on them so that they know which embryos are affected by the translocation. We started simulation in February and I had my egg retrieval in early March. Because we had to do the genetic testing, we were already kind of mentally and emotionally prepared for a frozen embryo transfer. I think, actually, if we had done a fresh embryo transfer, we would have been able to do it before everything shut down. But it would have been the same odds of miscarriage as if we’d conceived naturally. So for us, they retrieved the eggs, fertilized them, saw how many grew, and on day five they could do a biopsy.
We found out that we had six embryos grow enough to be biopsied and they were sent off to genetic testing. I reached out to the clinic because I could tell everything around us was starting to close up. That’s when I found out I couldn’t go through with the fertility treatments as planned. Here’s the thing: You have to go on birth control to prep for an embryo transfer. So I had two options from there. First was to start birth control immediately, so that once the treatment becomes an option again, I can jump into transfer prep as soon as possible. The other option is to wait and start birth control until everything is up and running again, and possibly try to conceive the old fashioned way in the meantime.
It was a really tough decision, but we decided to not go back on birth control. One of the main reasons that they’ve recommended stopping fertility treatments is for hospital capacity if something goes wrong. We thought through that, given our miscarriage history, it’s likely that if we do become pregnant we will miscarry again. But—and this is an unfortunate thing to know about yourself—we know that we tend to miscarry early. We don’t really need any medical assistance with it and we know how to assess when it’s over. So we thought, let’s just keep going. We don’t know how long this is going to last. In my mind it’s better to have tried than to just wait.
When we found out things were shutting down, we didn’t even know if we had any genetically normal embryos yet—we got the biopsy results the next day and we found out that of the six that we sent, we had one viable embryo. That was stressful and scary because you get one shot, but also really great, because there is such a high chance of not having any come back normal and to have to repeat the entire process over again. I think it ended up being better to get the news in the order that we did. I think it probably would have hit a lot harder to find out that we had the one embryo and then find out that we couldn’t actually go forward with the process.
I’m trying to focus on the fact that we did get one normal embryo and that hopefully one day we will get to transfer it and that will be successful. I think this would feel a lot harder if we had not gotten any normal embryos.
It’s been weird going back to trying to conceive naturally. I’m doing all the charting and tracking and stuff again. We’re both home, and for that it’s been very convenient! But in a weird way, IVF was really nice because I could disconnect our early stages of fertility from my body. I remember right after the retrieval, I was meeting a friend, and I said, I’m so glad that I know that there are embryos being fertilized and they’re growing and it doesn’t matter what I go and do right now. There was a real relief in that.
They’re keeping our embryos frozen for six months. If it goes beyond that, we have to move to long-term storage, which we’d pay for out of pocket. That kind of adds some extra pressure on this as well. Because if this transfer doesn’t work, then if we want to do IVF again, we don’t have the sort of financial cushion that we had for the first time.
I’m in an online group for people dealing with balanced translocation, and somebody posted “it’s no longer possible for me to have the baby that I wanted in 2020, because now if I conceive, the baby will be born next year.” That was powerful to see. We’ve talked it up so much. We said we’re starting IVF, this is our year. We might still get the pregnancy out of it, hopefully. But it was really tough to realize: we’re not going to get the baby.