Coronavirus (COVID-19) Health Alert

Based on ASRM’s recommendations issued on April 24, we are resuming all treatments at all CCRM Fertility locations, including egg retrievals, frozen and fresh embryo transfers (FETs) and intrauterine inseminations (IUIs).

Your health and safety remain our top priority. In order to continue to provide industry-leading care while limiting social exposure and virus transmission, we are controlling the number of patients onsite each day and we have implemented the safety measures listed below.

CCRM New York Patient Advisory: New York State, along with Connecticut and New Jersey, have issued a travel advisory effective midnight June 25, 2020, which requires that all individuals traveling from states with significant community spread of COVID-19 quarantine for a 14-day period from the time of last contact within the identified state. This quarantine applies to any person arriving from a state with a positive test rate higher than 10 per 100,000 residents over a 7-day rolling average or a state with a 10% or higher positivity rate over a 7-day rolling average. Click here to learn the positivity rate in your state.

COVID-19 Vaccine FAQ

In agreement with the American College of Obstetrics and Gynecology (ACOG), American Society for Reproductive Medicine (ASRM), and Society for Maternal Fetal Medicine (SMFM), CCRM Fertility recommends that the Pfizer-BioNTech and Moderna mRNA COVID-19 vaccines should not be withheld from patients attempting pregnancy, pregnant or nursing. The vaccine should be provided to these women based on eligibility criteria.

Since pregnant women were not included in vaccine trials, we do not have any definitive information on their safety for mom or baby. However, since COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies.

If there is no data in pregnancy or experience with this vaccine platform, what are reasons to think its risks outweigh its benefits in pregnancy?

While rapid in its development no “corners were cut” in achieving FDA-approved emergency use authorization (EUA)
mRNA vaccines are not live virus vaccines and do not cause infection, nor do they enter the cell’s nucleus
mRNA is rapidly degraded in the body. Even with the lipid nanoparticle carrier, the mRNA is likely gone within 5 hours.
Increased risks of COVID-19 in pregnancy include severe illness (ICU admission, need for mechanical ventilation and death), as well as adverse pregnancy outcomes (e.g. preterm birth)
It is important to understand that there may be risks of the vaccine pregnancy, or in women who are trying to conceive that have not yet been demonstrated. You must weigh these theoretic risks against the benefit of decreasing the risk of infection

What are other considerations when making decisions about vaccination?

Local COVID-19 transmission and risk of acquisition
Personal risk of contracting COVID-19
Risks of COVID-19 to her and potential risks to fetus
Efficacy of the vaccine and known side effects
Lack of data about the vaccine during pregnancy

CCRM believes the vaccine should be provided to women trying to achieve pregnancy.

What should I do if I am in the middle of fertility treatment or trying to conceive?

It should be noted, that while there is no reproductive or developmental toxicology data yet available, there does not currently exist reasonable, scientific doubt to compel a recommendation to delay, stop or alter fertility treatment or attempts at conception for those individuals eligible for vaccination in early phase vaccination allocations. Those patients, after discussion with their provider, who elect to defer attempts at conception during the initial vaccine series, can reasonably return to attempts at conception after the second dose. Out of an abundance of caution, it would be reasonable to discuss with your physician the potential to delay treatments that would directly lead to pregnancy (e.g. embryo transfer) until after the window in which side effects such as fever or flu-like symptoms could occur.

Will CCRM Fertility administer the COVID-19 vaccine to patients?

We will not administer the vaccines in our offices. Your primary care doctor may be administering the and the national program rollout will include administration of the vaccine at Walgreens, CVS, and other locations that have the capacity to store and determine eligibility.

What should I do if I have a fever after vaccination?
Pregnant women who experience fever following vaccination (more common after second dose in non-pregnant trial participants) should take fever reducing medication like acetaminophen due to associated risks of fever with adverse pregnancy outcomes.

What happens if I can’t get the second dose in the time prescribed?

The second dose of the Pfizer vaccine should be administered within 17-21 days of the first dose and the second dose of the Moderna vaccine should be administered within 28 days of the first dose. If more than this interval has passed the second dose should be administered at earliest opportunity. No doses will need to be repeated. It is important to understand that newer vaccines may have different dosing intervals.

Will I mount an immune response if I only get the first shot?
Getting both doses is necessary for the highest level of protection. Vaccine efficacy is lower and less durable after only one shot with 52% efficacy after the first injection.

I had COVID-19 before I got pregnant. Now that I am pregnant, do I get the vaccine?

Vaccination should be offered to eligible persons regardless of history of prior symptomatic or asymptomatic COVID infection. Viral or serologic testing for acute or prior infection is not recommended for vaccine decision making purposes.

Do I need to get a pregnancy test before getting the COVID-19 vaccine?

Routine testing for pregnancy prior to either vaccination dose is not recommended.

What is known about the first trimester of pregnancy and COVID-19?

At this time, there is limited data available. Of 458 pregnant women with that were hospitalized with COVID-19, 10 had a pregnancy loss, with 4 losses (0.9%) occurring in pregnancies less than 20 weeks.

What is the risk of fever in pregnancy?
Fever in pregnancy (particularly the first trimester) is associated with an increased risk of neural tube defects, however a recent study demonstrated the association no longer remained significant if the patient is taking more than 400 mcg of folic acid. Another large Danish cohort study did not demonstrate any increased risk of congenital anomalies of those who reported fever in the first trimester. The most common symptom (83-99%) of COVID-19 infection is fever. As mentioned above, it would not be unreasonable to defer an embryo transfer until after the window for these side-effects from the vaccine has passed.

Can I get the vaccine if I am breastfeeding?

Yes, people who are breastfeeding can choose to get vaccinated. Though there is no specific information at this time on safety of breastfeeding, important facts are that the vaccine does not contain live virus and should not be a risk to infants. People who are breastfeeding should weigh their person exposure risk and consider vaccination.

Could all of this guidance change?

Yes. As vaccine capacity expands, and safety data accumulates, recommendations and guidance will be updated. We will update this site as recommendations evolve. We encourage you to discuss any questions or concerns regarding vaccination with your healthcare provider.

SOURCES:
CDC ACIP COVID-19 Vaccines Work Group
Safety and Efficacy of the BNT162b2 mRNA COVID Vaccine (NEJM)
FDA Fact Sheet for Vaccination Providers
FDA Fact Sheet for Recipients and Caregivers
Covid Vaccines in Pregnancy (AJOG)

COVID-19 SAFETY MEASURES IN CCRM FERTILITY CENTERS

In order to continue to provide industry-leading care while limiting social exposure and virus transmission, we have implemented the following measures:

Utilizing telehealth appointments as much as possible. This includes new patient appointments, regroups and financial consults.
All patients will be screened for exposure and risk factors for COVID-19, which includes taking your temperature upon entry to a CCRM clinic. Patients who do not pass the screening will need to reschedule their appointment.
Patients may be required to complete self-administered COVID-19 testing prior to treatment.
CCRM staff will undergo COVID-19 testing on a rolling basis.
CCRM staff will wear masks and gloves.
Patients are encouraged to wear a mask during their visit. If you do not bring a mask to your appointment, we will have one for you to use.
Adjusted the floor plan in the lobby and other waiting areas to accommodate social distancing guidelines.
Limiting the number of patients in the office. If your partner is not undergoing any testing or treatment that day, we ask that you come to your appointment unaccompanied. Patients can bring their partners to egg retrieval and embryo transfer appointments. Some locations may be able to maintain six feet social distancing during the intrauterine insemination (IUI) procedure, which would allow for your partner to be present for the procedure. In locations where social distancing is not possible, your partner will be asked to wait in the lobby or outside of the facility during the procedure.
Disinfecting all areas of the clinic.
Added additional safety measures in the laboratories to ensure staff, patient and sample safety.
Minimizing face-to-face interactions with administrative and financial staff. Patients may be asked to:
- Check into appointments using electronic self-check-in on computer or mobile device.
- Check out of appointments handled remotely. Note: We will require a credit card on file, so that we can forgo an in-person check-out.
- Use portals to communicate about administrative and financial matters.
- Sign paperwork electronically or electronic secure file transfer of completed documents.

TELEHEALTH APPOINTMENTS

In an effort to best serve our patients in these unique times, CCRM is offering telehealth appointments for new patient consultations, treatment planning for established and new patients, financial consults, preconception counseling.

Cycle Disruption Policy

If an individual demonstrates symptoms of illness during a treatment cycle, or if the individual is mid-cycle and tests positive for COVID-19, the cycle will be cancelled or suspended. CCRM may require COVID-19 testing before initiation of or during any portion of your treatment cycle.

CCRM’s need to comply with certain orders, mandates, travel restrictions or other guidance issued by federal, state, or local authorities and professional medical organizations may also result in a cancelled cycle.

If the patient’s cycle is cancelled for any reason stated above, all cycle and medication fees for therapy completed up to the point of cancellation will not be waived or refunded by CCRM.

CCRM TV

Featuring CCRM Fertility’s world-class physicians from across its 11 fertility centers throughout North America, CCRM TV aims to offer pregnancy preparedness education. We know this is a really difficult time, as many of you have had long, difficult and stressful fertility journeys. CCRM’s goal is to be a resource for you and we will do everything we can to ensure your safety while expediting your path to pregnancy.

ADDITIONAL PATIENT RESOURCES

How You Can Prepare For Fertility Treatment During COVID-19
Mental Health Management Tips During COVID-19

STEPS YOU CAN TAKE TO AVOID GETTING SICK

To limit the potential spread of COVID-19, we recommend that our patients take the following steps:

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty or if you’ve been around those that are sick.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Wear a cloth mask in public settings. (CDC)
If you are in a private setting and do not have on your cloth face covering, remember to always cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe (Lysol or Clorox products).
Stay home as much as possible.
Avoid traveling to areas with active outbreaks of COVID-19 and remain away from others that may have traveled for a minimum of 14 days.
If you are actively sick with a fever, please stay home until the fever has been clear of your system for 14 days post fever to prevent the spread of disease to our patients and staff.
Please contact your primary care physician if you are sick or have any health concerns.
For current travel advisories and up-to-date information on COVID-19, please visit the CDC’s COVID-19 website.

COVID-19 Q&A FOR PATIENTS

Q: Does COVID-19 impact fertility or pregnancy?

A: Currently, our understanding of the impact of COVID-19 on reproduction and pregnancy is limited. There are reports of women who have tested positive for COVID-19, who have delivered babies who do not have disease. Additionally, there is limited information from published scientific reports about the susceptibility of pregnant women to COVID-19 and the severity of infection. Available data are reassuring, but are limited to small case series.

In general, pregnant women experience immunologic and physiologic changes that make them more susceptible to viral respiratory infections, including potentially COVID-19. It is reasonable to predict that pregnant women might be at greater risk for severe illness, morbidity, or mortality compared with the general population, as is observed with other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV),- Middle East respiratory syndrome coronavirus (MERS-CoV)], and other viral respiratory infections, such as influenza, during pregnancy. Pregnant women who have severe chronic medical conditions may be at higher risk of preterm delivery and other pregnancy complication, which would require closer fetal monitoring (per the recommendations of the Society for Maternal- Fetal Medicine).

It’s important to note that coronaviruses are unrelated to the ZIKA virus, which has very clear implications for pregnancy and fetal development. Miscarriage and still birth are more common with influenza infection in pregnancy, and therefore could be a risk of COVID delaying pregnancy until risk of infection is low would be prudent to minimize the above risks.

It is unknown if a pregnant woman with COVID-19 can transmit the virus that causes COVID-19 to her fetus or neonate by other routes of vertical transmission (before, during, or after delivery). However, in recently published case series of infants born to mothers with COVID-19, none of the infants tested positive for the virus that causes COVID-19. Additionally, virus was not detected in samples of amniotic fluid or breastmilk.

At this time, there are limited data available regarding the risks associated with COVID-19 infection in the first and second trimesters of pregnancy. There are conflicting data regarding the risks of congenital malformations in the setting of maternal fever in general. Currently, there are inconclusive data on the risk of miscarriage or congenital anomalies following COVID-19 infection given the limited number of cases reported and the quality of the published data available. Data from the recent SARS epidemic are reassuring and suggest that there is no increased risk of fetal loss or congenital anomalies associated with infection early in pregnancy. (CDC)

Q: If I recently traveled abroad, will that impact when I start treatment at CCRM?

A: Patients are recommended to wait two weeks after traveling to areas with reported cases of COVID-19 before you visit a CCRM office or clinic.

Q: Is CCRM testing for COVID-19?

A: CCRM is not currently testing for COVID-19. If you are exhibiting symptoms and have been in close contact with someone who has COVID-19, or if you have recently traveled to an area with ongoing spread of COVID-19, please call your primary healthcare provider. Your healthcare provider will work with the state health department and the CDC to determine if you need to be tested and can provide information on where to go for testing.

Q: How will you ensure that my eggs/embryos/sperm will remain safe in the lab?

A: CCRM has some of the most state-of-the-art technologies available and implements some of the strictest lab standards and protocols in the industry, to provide our patients with the gold standard in patient care. Learn more here.

Q: What should I do if I become sick?

A: If you get sick with fever (100.4°F/38°C or higher), cough, or have trouble breathing:

Seek medical care. Call ahead before you go to a doctor’s office or emergency room.
Tell your doctor about your recent travel and your symptoms.
Avoid contact with others.
Update your CCRM Fertility care team with your condition as soon as possible.

Important Update on Fertility House Calls: In response to the recent recommendations issued by the American Society for Reproductive Medicine (ASRM) related to the COVID-19 virus pandemic, CCRM’s Fertility House Calls program are temporarily suspended. We appreciate your interest and it is our intention to reactivate the program as soon as possible. For any questions or further information, please contact CCRM Fertility at 303-225-3423.