Pregnancy and the COVID-19 vaccination is a hot topic in the fertility world today. The US Food and Drug Administration has granted full approval to the Pfizer-BioNTech Covid-19 vaccine for people age16 and older. The CDC encourages all pregnant people or people who are thinking about becoming pregnant and those breastfeeding to get vaccinated to protect themselves from COVID-19. And the American Society for Reproductive Medicine says while all women should be strongly encouraged to receive COVID-19 vaccination when pregnant or attempting pregnancy, clinics should strongly consider requiring vaccination for gestational carriers and advise intended parents to include the requirement of vaccination of gestational carriers in their contracts.
How do you take all of that information and apply it to pregnancy and surrogacy? There are many questions and concerns from all parties regarding how that impacts surrogates and intended parents. Dr. Jennifer Hirshfeld-Cytron, board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility with Fertility Centers of Illinois, answered our questions about the COVID-19 vaccine and surrogacy on the podcast All Things Conceivable: A Surrogacy Podcast with Nazca Fontes.
NF: How is COVID going to impact a pregnant woman?
The concern with COVID and pregnancy is that it impacts the health of the mother. In obstetrics, you learn on day one of your OB-GYN residency that, in order to have a healthy baby, you have to have a healthy mom. Sometimes we miss that because we are so focused on the pregnancy, but the mother’s health is always going to be key. We have seen other components of someone’s medical history who are immunocompromised, diabetic, or obese who have a greater likelihood to have real complications of COVID-19. Not just the positive test, not the cold and flu symptoms that are an inconvenience in your home for 10 days, but that individual who’s hospitalized, who’s having difficulty breathing, or, God forbid, must be intubated. Pregnancy now is one of those risk factors to make it more likely that you could end up hospitalized or intubated. Some data has demonstrated increased risk of ICU stays, increased risk of miscarriage, and increased risk of stillbirth. So the virus itself can particularly impact the health of a pregnant woman, which makes it even more pertinent to discuss ways to prevent pregnant women from getting COVID.
NF: Should women who want to become pregnant get the vaccine?
They should. The vaccine can provide protection. Even with the Delta variant, when you’ve been vaccinated, the risk of hospitalization is still quite low. It’s a pandemic of the unvaccinated. The unvaccinated individuals are the ones getting sick enough that they’re being hospitalized. And the vaccine is the tool we have to prevent it. I think the challenge that many of us in medicine have with the COVID-19 vaccine and the hesitancy is that it is different than something like wearing a seatbelt or wearing a bike helmet because you’re not just making a choice for yourself. You’re actually making that choice for the entire community. And the moment someone steps into a clinic or a public space who has not been vaccinated, they hold risks of exposure, particularly to pregnant women. I think that is a huge disservice to our community. The absence of vaccination is not just a personal decision. It has long-term impacts on the whole society.
NF: I think oftentimes that that point gets lost in the emotional response to whether I believe the vaccine is right for me. I like that you point out the benefits of a COVID-19 vaccination far outweigh the potential risks. What is the efficacy of the vaccine?
95 plus percent, if not higher for prevention of hospitalization. Some people who got vaccinated but still had a positive COVID test, may be frustrated. But if someone’s at home with a cold, that’s not what we’re really worried about. What we’re really worried about is someone being hospitalized or being in the ICU. The effectiveness of the COVID-19 vaccine to that woman, regardless if she’s pregnant or not, is the same.
NF: I would love to know your reaction to this. A pregnant woman goes into her obstetrician’s office and she says, “Hey doctor, I want to get pregnant, but I’m a smoker.” What would that doctor tell that woman?
It is very hard to make change, whether it’s smoking, the amount of caffeine we drink, or how we should eat. But when someone is motivated to become pregnant, it is incredible to me the amount of changes that someone is willing to make to optimize their health, not only for themselves, but for pregnancy or to optimize their capacity to conceive. So the ability to make change is not easy, but this is a time that we really can make an influence on people to make better, healthier decisions and optimize preconception health. Our job is to educate people that just like quitting smoking, obtaining a healthy weight, or limiting alcohol, the vaccine is a way that we are making your body as healthy as possible to receive a pregnancy, whether it’s for a “keeper” baby or not.
NF: There is some misinformation out there. Does COVID-19 vaccination cause infertility?
There has been no data, whether it’s animal or data in human trials, that the Covid-19 vaccine causes infertility. In the social media world, it is unfortunate that once bad information gets out there, it’s like wildfire and you can’t contain it. But this is not data-driven; this is fear-driven. And if somebody is going to use fear to make a decision, they’re going to end up in a very compromised position. In my mind, it is equal to quitting tobacco. Tobacco is harmful to pregnancy. If you smoke, you should not be a surrogate. If you’re uncomfortable getting vaccinated, you should not be a surrogate.
NF: Are fertility clinics making it mandatory to have the vaccine to go through a surrogacy journey or to become accepted in the program as a surrogate?
It is not universally mandated. I think potentially it may come to that. On a case by case, physicians will approve or discourage a surrogate based on their vaccination status. I can only speak for myself, but I would gather the vast majority of Reproductive Endocrinologists are going to discourage surrogates that are uncomfortable with the vaccine. But as of now, it’s not mandatory to be vaccinated.
NF: So Jenny, I’ve heard some surrogates say the vaccination is “not safe.” Is the COVID vaccine safe for pregnant women and the baby they’re carrying?
Yes, the COVID-19 vaccine is safe. Strongly, yes. About 22 healthcare organizations have supported the vaccine including the American College of Obstetricians and Gynecologists, the American Society of Reproductive Medicine and the CDC. What helped these organizations support the vaccine is a study out of the UK, looking at about 1,300 patients, retrospectively, and identifying about 30% of those that were vaccinated compared to those that were not. They looked at pregnancy markers like miscarriage and stillbirth and showed that those who were vaccinated and those who were not vaccinated had equal risk. The vaccine did not increase your risk of any of those concerns. The vaccine does not increase your risk of miscarriage. Some of the concerns are that the vaccine can temporarily give you a fever. We do not believe that a fever that is induced in the relationship of a vaccine is the same as a fever from certain viruses. Fevers from certain viruses have been linked to miscarriage, but the vaccine itself has not. As more studies are done and the data accumulates, we’ve become more and more reassured that they continue to support the safety of the vaccine. They do not increase your risk of infertility. They do not worsen the pregnancy. They protect the pregnancy, because the virus is a risk to your pregnancy.
NF: 18 months now into this pandemic, it does seem as if medical recommendations shift and change. Where should our listeners go to get the most up to date information and recommendation from experts?
The Center for Disease Control and the American Society of Reproductive Medicines have been our guidance for standard of care. If your concerns are unique to pregnancy, American College of Obstetrics and Gynecology is a great start. Opinions and recommendations change, but that demonstrates science. If we never changed our opinion from the moment the virus hit the door til now and we kept saying the same thing…that’s the opposite of science. Science is taking in data and changing your perspective. So the fact that things are shifting shows that we’re learning. You want things to shift. They shouldn’t stay the same.
NF: Is it safe to embark on a surrogacy journey right now?
I think absolutely. Someone who has made that big decision to utilize a surrogate, whether it was for a history of their own personal fertility struggles, or they have medical comorbidities that they can’t carry, or it’s a single male or a same-sex male couple or any combination or permutation, this is a big decision. We’re 18 months into this and we’re getting better. Even if it’s not universally recommended to require a surrogate to be vaccinated, I strongly would encourage it. The vast majority of clinics are screening individuals before the transfer. And if someone screens positive or test positive for COVID, they will cancel the transfer as another mechanism of security. We are changing our protocols. We are testing individuals prior to pregnancy to make sure, so people can feel confident moving ahead. It is a time of unrest, and I appreciate that, but it’s hard to delay someone when it’s been so long to get to this point in the journey. There’s no question in the context of COVID fertility centers and agencies, that people are doing their best to make this as safe as possible.
NF: Do you have advice for our listeners today?
It is an incredible gift to consider being a surrogate. I don’t want to minimize it for one second and to now take that next step to say, what can I proactively do to make my health optimal in this pandemic and the pregnancy optimal. The vaccine is in that category. No one in medicine is going to be effective if we just bulldoze people with information. You can probably tell I’m very pro-vaccine, but I think the way that we can change people’s minds is by empowering them with information. So I implore everyone out there who’s concerned about safety to ask their physician. Ask them to review the data. Ask them pointedly the questions and the concerns that you personally have and use good information to make a good decision.
"When surrogates come to the decision to embark on a surrogacy journey, they’re helping families that have been through struggle, after struggle, after struggle. And what they’re looking for more than anything is to partner with a like-minded surrogate who gives them the best, healthiest chance for creating the family of their dreams and for that healthy baby. Rarely do I take such an extreme stance on a topic in these podcasts, but listeners, please hear me. The physicians here are the experts. Consider the risks for you and the baby that you may be carrying or will be caring for an intended parent and put your best foot forward on behalf of that family, so that they can have their dreams fulfilled and you can be safe. Roll up your sleeves and get that vaccination."
- Nazca Fontes, Founder and CEO, ConceiveAbilities