Selected Podcast
COVID-19 and the Impact on Fertility Treatment & Pregnancy
COVID-19 is everywhere in the news these days, and it can be a little overwhelming. We all know the basics - wash your hands, stay inside, practice social distancing. But how does this advice change when you are pregnant, or trying to get pregnant? Today we're talking COVID-19 and fertility.
Featuring:
Learn more about Molina Dayal, MD, MPH, FACOG
Dr. Maureen Schulte is a board certified obstetrician and gynecologist, and Fellowship trained in reproductive endocrinology and infertility. Originally from Chicago, her first introduction to Missouri was attending Truman State University where she graduated Magna Cum Laude with a focus in Health Science and Biology.
Learn more about Maureen Schulte, MD, FACOG
Molina Dayal, MD, MPH, FACOG | Maureen Schulte, MD, FACOG
Dr. Dayal is Board Certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, with nearly twenty years specializing in treating infertility. She is known for her individualized, “think outside of the box” approach as well as her personalized care for patients.Learn more about Molina Dayal, MD, MPH, FACOG
Dr. Maureen Schulte is a board certified obstetrician and gynecologist, and Fellowship trained in reproductive endocrinology and infertility. Originally from Chicago, her first introduction to Missouri was attending Truman State University where she graduated Magna Cum Laude with a focus in Health Science and Biology.
Learn more about Maureen Schulte, MD, FACOG
Transcription:
Caitlin Whyte: COVID-19 is everywhere in the news these days and it can be a little overwhelming. We all know the basics, wash your hands, stay inside practice, social distancing. But how does this advice change when you are pregnant or trying to get pregnant? Today we're talking COVID-19 and fertility and joining me for that discussion as always are our doctors, Molina Dayal and Maureen Schulte from SIRM, St. Louis. This is All Things Fertility. I'm your host, Caitlin Whyte. So Dr. Schulte, why don't you start us off? Let's get to the basics. What is COVID-19?
Dr. Schulte: So COVID-19 refers to Coronavirus disease 2019, and it's a respiratory illness that is caused by the novel Coronavirus, which is actually SARS Covi 2. And it is basically a cousin of the SARS virus. So SARS stands for severe acute respiratory syndrome and this novel Coronavirus means that it's a new virus. So it is, we think developed from an animal that has then infected humans. So it's a single stranded RNA virus. And the term COVID 2 actually represents the respiratory illness that's caused by this novel Coronavirus.
Host: And Dr. Dayal, We hear a lot about comparisons to the flu. How is this COVID-19 different from the flu and other viral infections?
Dr. Dayal: Well, what's interesting about COVID-19 is that it is transmitted in a very, very similar way. It tends to be transmitted with respiratory droplets, if that makes sense. So you know, these are just aerosolized from someone breathing and that's very, very similar to the flu and kind of the entire flu family. The thing that makes it a little bit different though is that we really don't understand completely the transmission dynamics of it. We don't really understand how people actually get it and we actually don't know much about what we call the epidemiology of, of that virus. There are no specific medications for the treatment of COVID-19 you know, for instance, you know, there, you know is something we can use for the flu with the flu vaccine. But there's nothing like this quite yet for COVID-19, and it's because it's such a brand new infection, you know, we just kind of assume that immunity is going to be minimal, at least at the beginning. And the one thing that we're learning over time is in contrast to the flu, it is actually much more contagious. And the, so far the mortality rate is a little bit higher. And I do think honestly, that that might change because as we learn of more and more people getting infected with COVID-19, what I'm hoping is that the actual mortality rate will actually be lower. That's what I'm hoping. And then lastly, COVID-19 impacts the lungs very differently than, than the flu.
Host: So Dr. Schulte, with so much being unknown, how are we supposed to prevent getting this?
Dr. Schulte: So what we're thinking is that this novel Coronavirus is actually spread through respiratory droplets, as Dr. Dayal said, from people coughing and sneezing who are actually infected. And so to, you know, get the virus, you actually have to be in close proximity is what we believe. So that's less than a six foot distance between a symptomatic individual. However, as we learn more about this virus, we know that there's actual asymptomatic or presymptomatic viral shedding and we don't fully understand that process yet. So to protect everyone, we have, you know, the CDC has instituted social distancing guidelines and I can't stress that enough. I think that people really need to be distancing themselves from others at least six feet, you know, now obviously multiple States have ordered shut-ins. And so people are staying home as much as possible. So to protect yourself, it's really focusing on social distancing, hand-washing. And then in our office, in the healthcare setting, we are focusing on hand-washing, social distancing, being six feet away from our peers and using disinfectants and wearing masks due to the asymptomatic shedding, to protect ourselves and our patients.
Host: So now that we've covered some basics, let's get into your expertise, fertility and pregnancy. Dr. Dayal does COVID-19 affect fertility at all?
Dr. Dayal: As far as we know, this Coronavirus does not have an impact on fertility. But you know, if you sort of even extrapolate from some of the other viruses that are out there, whether it's the flu or any of the hepatitis viruses or frankly even HIV, none of those have any impact on fertility. But we also, you know, that's, that's what the caveat with the fact that we also know that this is an extremely new virus, but at this point we actually don't believe that there's any impact on fertility
Host: And Dr. Schulte, what about pregnancy? Is there any impact of COVID-19 on pregnancy that we know of?
Dr. Schulte: So currently we have very limited information on the impact of the novel Coronavirus in pregnancy. However, we can extrapolate data from other viral syndromes that are related to the novel Coronavirus, including SARS. And we know that infection in pregnancy with those viral illnesses may be associated with adverse outcomes, including increased risk of miscarriage, fetal growth restriction, and preterm birth. However, there is no specific data with this novel Coronavirus in every trimester of pregnancy. The only published data that we have on Coronavirus infection in pregnancy include two case series that total 18 women. And so as this progresses, unfortunately we are going to learn more. But at this point we are just trying to warn pregnant women that there could be, they could be at increased risk due to the fact that pregnancy is an immunocompromised state. But we do not, we have very limited data to make that recommendation to either, you know, halt pregnancy or, or stop trying to get pregnant at this time.
Dr. Dayal: And what's interesting about those case reports is that there, as Dr. Schulte was mentioning is you know, they're all recent reports. So we only know potentially bad exposure in the third trimester. We don't know what happens if they're exposed in the first or second trauma.
Host: All right, interesting. So I guess that kind of leads me into my next question again. I know there the answers are few and far between at this point, but Dr. Dayal could COVID-19 be passed from a pregnant woman to her fetus or her, you know, the newborn?
Dr. Dayal: We still do not know if a woman with COVID-19 can pass the virus that causes COVID-19 so the Coronavirus to her fetus or baby either during pregnancy or during delivery. You know, again, looking at those specific case series that Dr. Schulte was mentioning, there are no infants that were born to mothers with COVID-19 that have tested positive for the virus. But the problem is that these numbers are very, very small and so we actually really don't know
Dr. Schulte: Dr. Schulte looking at feeding after a newborn is born, can COVID-19 be pass through breast milk?
Dr. Schulte: Currently the CDC has no specific guidance for breastfeeding during an infection with similar viruses to the novel Coronavirus like SARS. However, we know that breastfeeding provides protection against many illnesses and there are really rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. So we again have limited data and we don't know. But at this time we are, you know, feeling that it should be safe. And in limited case series that we do have, the virus was not found in samples of amniotic fluid or breast milk at this time. So we are assuming it's safe.
Host: And Dr. Dayal, we talked about how COVID-19 we're not sure, but we're kind of assuming that it can't be passed from a pregnant woman to her fetus, but say a woman does get COVID-19 during a pregnancy. Could there be any effect on the baby?
Dr. Dayal: Preliminary report suggests that it can, if a woman has COVID-19 and perhaps has a high fever, what we do know about high fevers is that it can increase the chance of miscarriage and specifically with COVID-19 in these small case reports, there are indications that women can go into preterm labor, which of course can ultimately impact the baby by being born early.
Host: And again, what can people do to prevent the spread of COVID-19 Dr. Schulte, we hear hand-washing, we hear social distancing, but just kind of drill it through our heads. What should we be doing?
Dr. Schulte: Yes, so stay inside and I think that's the biggest message I have. So stay inside and limit exposure, limit exposure, limit exposure. And I think, you know, all of my friends are healthcare workers. Obviously Dr. Dayal and I are physicians and we are seeing our patients efficiently and effectively throughout this time. But we have even made a ton of changes in our private practice setting. But you know, our friends are running the emergency rooms and running labor and delivery and they are on the front line to protect everyone at home. So the biggest thing that we can do as a country, right, to protect ourselves and our global friends really are to stay inside. Okay? Social distancing is huge. They're not just telling us to scare us, right? This is actually what needs to be happening right now and washing your hands for 20 seconds and limiting exposure is the best way to fight this. And as the experts learn and understand about this novel Coronavirus, you know, they're going to share data with us. And I'm hoping that more testing will become available sooner than later so people can contest and we can know, you know, the number of actual cases that are out there right now.
Host: And wrapping up here, Dr. Dayal, one more question. If I say there's a pregnant woman listening, you mentioned before that just being pregnant in general is kind of an immunocompromised state. What would your advice be to someone listening who might be a little afraid of being pregnant during this time of COVID-19?
Dr. Dayal: Well overall, you know, the data related to pregnancy and COVID-19 is relatively reassuring. You know, it's, it's not supposed to have a huge detrimental impact on pregnancy, but that data is very, very early. And again, it's based on third trimester exposures. But I would really go with what Moe was saying. I mean it's important to keep yourself protected, you know, so keep your hands washed frequently. I mean just wash them as frequently as you possibly can for that 20 seconds. Use a hand sanitizer in between those washes if needed. You know, avoid touching your eyes, nose and mouth. Avoid close contact with other individuals who are sick and you know, definitely keep that social distancing. I think that is huge. That is really going to be the thing that flattens this curve. And certainly if you're sick, just stay at home or if somebody around you is sick, really try to limit your exposure to that individual. And you know, hopefully with all those measures that'll decrease the chance of actually getting infected and then having any consequences of that.
Host: Well, Doctors, I'll let you get back to it, but thank you so much again for your time during this strange and busy era. That was Dr. Molina Dayal and Dr. Maureen Schulte from SIRM St. Louis. To learn more about the team at SIRM St. Louis, or to schedule an appointment, visit StLouisfertilitycenter.com. If you enjoyed this podcast, find more it in our podcast library and be sure to give us a like and to follow if you do. This has been All Things Fertility. I'm your host Caitlin Whyte. Stay safe and stay sanitized. We'll catch you next time.
Caitlin Whyte: COVID-19 is everywhere in the news these days and it can be a little overwhelming. We all know the basics, wash your hands, stay inside practice, social distancing. But how does this advice change when you are pregnant or trying to get pregnant? Today we're talking COVID-19 and fertility and joining me for that discussion as always are our doctors, Molina Dayal and Maureen Schulte from SIRM, St. Louis. This is All Things Fertility. I'm your host, Caitlin Whyte. So Dr. Schulte, why don't you start us off? Let's get to the basics. What is COVID-19?
Dr. Schulte: So COVID-19 refers to Coronavirus disease 2019, and it's a respiratory illness that is caused by the novel Coronavirus, which is actually SARS Covi 2. And it is basically a cousin of the SARS virus. So SARS stands for severe acute respiratory syndrome and this novel Coronavirus means that it's a new virus. So it is, we think developed from an animal that has then infected humans. So it's a single stranded RNA virus. And the term COVID 2 actually represents the respiratory illness that's caused by this novel Coronavirus.
Host: And Dr. Dayal, We hear a lot about comparisons to the flu. How is this COVID-19 different from the flu and other viral infections?
Dr. Dayal: Well, what's interesting about COVID-19 is that it is transmitted in a very, very similar way. It tends to be transmitted with respiratory droplets, if that makes sense. So you know, these are just aerosolized from someone breathing and that's very, very similar to the flu and kind of the entire flu family. The thing that makes it a little bit different though is that we really don't understand completely the transmission dynamics of it. We don't really understand how people actually get it and we actually don't know much about what we call the epidemiology of, of that virus. There are no specific medications for the treatment of COVID-19 you know, for instance, you know, there, you know is something we can use for the flu with the flu vaccine. But there's nothing like this quite yet for COVID-19, and it's because it's such a brand new infection, you know, we just kind of assume that immunity is going to be minimal, at least at the beginning. And the one thing that we're learning over time is in contrast to the flu, it is actually much more contagious. And the, so far the mortality rate is a little bit higher. And I do think honestly, that that might change because as we learn of more and more people getting infected with COVID-19, what I'm hoping is that the actual mortality rate will actually be lower. That's what I'm hoping. And then lastly, COVID-19 impacts the lungs very differently than, than the flu.
Host: So Dr. Schulte, with so much being unknown, how are we supposed to prevent getting this?
Dr. Schulte: So what we're thinking is that this novel Coronavirus is actually spread through respiratory droplets, as Dr. Dayal said, from people coughing and sneezing who are actually infected. And so to, you know, get the virus, you actually have to be in close proximity is what we believe. So that's less than a six foot distance between a symptomatic individual. However, as we learn more about this virus, we know that there's actual asymptomatic or presymptomatic viral shedding and we don't fully understand that process yet. So to protect everyone, we have, you know, the CDC has instituted social distancing guidelines and I can't stress that enough. I think that people really need to be distancing themselves from others at least six feet, you know, now obviously multiple States have ordered shut-ins. And so people are staying home as much as possible. So to protect yourself, it's really focusing on social distancing, hand-washing. And then in our office, in the healthcare setting, we are focusing on hand-washing, social distancing, being six feet away from our peers and using disinfectants and wearing masks due to the asymptomatic shedding, to protect ourselves and our patients.
Host: So now that we've covered some basics, let's get into your expertise, fertility and pregnancy. Dr. Dayal does COVID-19 affect fertility at all?
Dr. Dayal: As far as we know, this Coronavirus does not have an impact on fertility. But you know, if you sort of even extrapolate from some of the other viruses that are out there, whether it's the flu or any of the hepatitis viruses or frankly even HIV, none of those have any impact on fertility. But we also, you know, that's, that's what the caveat with the fact that we also know that this is an extremely new virus, but at this point we actually don't believe that there's any impact on fertility
Host: And Dr. Schulte, what about pregnancy? Is there any impact of COVID-19 on pregnancy that we know of?
Dr. Schulte: So currently we have very limited information on the impact of the novel Coronavirus in pregnancy. However, we can extrapolate data from other viral syndromes that are related to the novel Coronavirus, including SARS. And we know that infection in pregnancy with those viral illnesses may be associated with adverse outcomes, including increased risk of miscarriage, fetal growth restriction, and preterm birth. However, there is no specific data with this novel Coronavirus in every trimester of pregnancy. The only published data that we have on Coronavirus infection in pregnancy include two case series that total 18 women. And so as this progresses, unfortunately we are going to learn more. But at this point we are just trying to warn pregnant women that there could be, they could be at increased risk due to the fact that pregnancy is an immunocompromised state. But we do not, we have very limited data to make that recommendation to either, you know, halt pregnancy or, or stop trying to get pregnant at this time.
Dr. Dayal: And what's interesting about those case reports is that there, as Dr. Schulte was mentioning is you know, they're all recent reports. So we only know potentially bad exposure in the third trimester. We don't know what happens if they're exposed in the first or second trauma.
Host: All right, interesting. So I guess that kind of leads me into my next question again. I know there the answers are few and far between at this point, but Dr. Dayal could COVID-19 be passed from a pregnant woman to her fetus or her, you know, the newborn?
Dr. Dayal: We still do not know if a woman with COVID-19 can pass the virus that causes COVID-19 so the Coronavirus to her fetus or baby either during pregnancy or during delivery. You know, again, looking at those specific case series that Dr. Schulte was mentioning, there are no infants that were born to mothers with COVID-19 that have tested positive for the virus. But the problem is that these numbers are very, very small and so we actually really don't know
Dr. Schulte: Dr. Schulte looking at feeding after a newborn is born, can COVID-19 be pass through breast milk?
Dr. Schulte: Currently the CDC has no specific guidance for breastfeeding during an infection with similar viruses to the novel Coronavirus like SARS. However, we know that breastfeeding provides protection against many illnesses and there are really rare exceptions when breastfeeding or feeding expressed breast milk is not recommended. So we again have limited data and we don't know. But at this time we are, you know, feeling that it should be safe. And in limited case series that we do have, the virus was not found in samples of amniotic fluid or breast milk at this time. So we are assuming it's safe.
Host: And Dr. Dayal, we talked about how COVID-19 we're not sure, but we're kind of assuming that it can't be passed from a pregnant woman to her fetus, but say a woman does get COVID-19 during a pregnancy. Could there be any effect on the baby?
Dr. Dayal: Preliminary report suggests that it can, if a woman has COVID-19 and perhaps has a high fever, what we do know about high fevers is that it can increase the chance of miscarriage and specifically with COVID-19 in these small case reports, there are indications that women can go into preterm labor, which of course can ultimately impact the baby by being born early.
Host: And again, what can people do to prevent the spread of COVID-19 Dr. Schulte, we hear hand-washing, we hear social distancing, but just kind of drill it through our heads. What should we be doing?
Dr. Schulte: Yes, so stay inside and I think that's the biggest message I have. So stay inside and limit exposure, limit exposure, limit exposure. And I think, you know, all of my friends are healthcare workers. Obviously Dr. Dayal and I are physicians and we are seeing our patients efficiently and effectively throughout this time. But we have even made a ton of changes in our private practice setting. But you know, our friends are running the emergency rooms and running labor and delivery and they are on the front line to protect everyone at home. So the biggest thing that we can do as a country, right, to protect ourselves and our global friends really are to stay inside. Okay? Social distancing is huge. They're not just telling us to scare us, right? This is actually what needs to be happening right now and washing your hands for 20 seconds and limiting exposure is the best way to fight this. And as the experts learn and understand about this novel Coronavirus, you know, they're going to share data with us. And I'm hoping that more testing will become available sooner than later so people can contest and we can know, you know, the number of actual cases that are out there right now.
Host: And wrapping up here, Dr. Dayal, one more question. If I say there's a pregnant woman listening, you mentioned before that just being pregnant in general is kind of an immunocompromised state. What would your advice be to someone listening who might be a little afraid of being pregnant during this time of COVID-19?
Dr. Dayal: Well overall, you know, the data related to pregnancy and COVID-19 is relatively reassuring. You know, it's, it's not supposed to have a huge detrimental impact on pregnancy, but that data is very, very early. And again, it's based on third trimester exposures. But I would really go with what Moe was saying. I mean it's important to keep yourself protected, you know, so keep your hands washed frequently. I mean just wash them as frequently as you possibly can for that 20 seconds. Use a hand sanitizer in between those washes if needed. You know, avoid touching your eyes, nose and mouth. Avoid close contact with other individuals who are sick and you know, definitely keep that social distancing. I think that is huge. That is really going to be the thing that flattens this curve. And certainly if you're sick, just stay at home or if somebody around you is sick, really try to limit your exposure to that individual. And you know, hopefully with all those measures that'll decrease the chance of actually getting infected and then having any consequences of that.
Host: Well, Doctors, I'll let you get back to it, but thank you so much again for your time during this strange and busy era. That was Dr. Molina Dayal and Dr. Maureen Schulte from SIRM St. Louis. To learn more about the team at SIRM St. Louis, or to schedule an appointment, visit StLouisfertilitycenter.com. If you enjoyed this podcast, find more it in our podcast library and be sure to give us a like and to follow if you do. This has been All Things Fertility. I'm your host Caitlin Whyte. Stay safe and stay sanitized. We'll catch you next time.