Covid-19 Vaccines & Fertility: Fact vs. Fiction
There are understandably a lot of questions about the Covid-19 vaccines in the US and their potential impact on fertility. Given what an important topic this is for our audience, we aggregated what we know now.
Below are seven frequently asked questions about the Covid-19 vaccine if you’re pregnant or considering pregnancy. Keep in mind that information is evolving rapidly. Your OB/GYN or PCP can advise you more fully about benefits and risks, based on your personal health risks and preferences.
1. Fact or fiction: Covid-19 can affect pregnant women more severely than non-pregnant women.
Fact.
At this point in the pandemic, we know that Covid-19 infection can be more severe for pregnant women. According to the CDC, pregnant Covid-19 patients are more likely to experience severe illness than non-pregnant patients of the same age.
Additionally, preterm birth is more common among pregnant people infected with Covid-19 than among healthy pregnant women.
Given these statistics, the CDC has stated that pregnant women are in an “increased risk” category with regard to Covid-19. Vaccination is one of the best tools available to prevent infection.
2. Fact or fiction: Getting the Covid-19 vaccine can cause infertility.
Fiction.
Some concerns circulating on social media claim that the spike protein in the vaccine will attach itself to similar receptors on the placenta, harming it, and therefore causing infertility.
This is a myth that gained steam last December after a German doctor and a former Pfizer employee asked the EMA (the European equivalent of the FDA) to halt Covid-19 vaccine trials.
One of their concerns was that a protein in the human placenta (syncytin-1) shares similar genetic instructions with a protein in the Coronavirus. This gave rise to the idea that the vaccine could cause infertility by encouraging the immune system to mistakenly attack the placenta and therefore make women infertile.
However, the claim that Covid-19 vaccines either contain syncytin-1 or trigger a message to generate antibodies to it is false. The American Society for Reproductive Medicine (ASRM) published a detailed paper in January 2021 contrasting the low plausibility of harm from the vaccine with the real risk of contracting Covid-19, excerpt below:
Without [the reader] having a medical background, a social media post regarding the COVID-19 vaccine leading to infertility can lead to unnecessary worry and vaccination reluctance. Nevertheless, the Covid-19 mRNA vaccines have now been administered to hundreds of thousands of people to date, and there has yet to be any reported issues for men or women with regard to infertility.
Additionally, ASRM was quoted in February 2021 saying, “No loss of fertility has been reported among trial participants or among the millions who have received the vaccines since their authorization, and no signs of infertility appeared in animal studies. Loss of fertility is scientifically unlikely.”
3. Fact or Fiction: Leading health organizations do not recommend pregnant women be offered Covid-19 vaccination.
Fiction.
Three of the top organizations focused on pregnancy and fertility – the American Society for Reproductive Medicine (ASRM), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM) issued a joint statement on February 5, 2021 saying, “As experts in reproductive health, we continue to recommend that the vaccine be available to pregnant individuals. We also assure patients that there is no evidence that the vaccine can lead to loss of fertility.”
The confusion likely arose from the fact that the World Health Organization did not initially recommend pregnant women get a Covid-19 vaccine unless they were at high risk of exposure to the virus (e.g. healthcare workers). As of January 29, 2021, the WHO’s recommendation for pregnant women is consistent with the CDC’s.
4. Fact or Fiction: The COVID vaccines were not initially tested on pregnant women.
Fact.
Pregnant women weren’t part of the original clinical trials.
Pregnant women are systematically (and understandably) excluded from most clinical trials in the U.S. because it makes running the trials simpler: “It’s easier to exclude pregnant women because when you include pregnant women, you have to be concerned about both the woman’s health as well as the development of the fetus and baby,” shares Denise Jamieson, OBG Chair at Emory University’s School of Medicine.
5. Fact or Fiction: We now have data from pregnant women who have received a vaccine.
Fact – but, the data is still emerging.
Technically, we do have data, but it is still emerging, and we continue to await results and reporting from the CDC. Given the natural length of pregnancy, it takes time to follow pregnancies and collect and analyze data. We do now have data that show over 100,000 pregnant women have received one of the Covid-19 vaccines as of May 10, 2021.
Of these 100,000, nearly 5,000 are being closely monitored via the CDC’s Vaccine Pregnancy Registry. This registry will allow the CDC to better understand how Covid-19 vaccination affects pregnant people. As the CDC learns more about the effects of vaccination during pregnancy, data will be presented at the Advisory Committee on Immunization Practices (ACIP) meetings, which are open to the public, and in published reports.
While more analysis is necessary, it’s important to note that preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines.
6. Fact or Fiction: Given the recent pause on the J&J vaccine, women trying to conceive should consider the mRNA vaccines if possible.
Fact.
Pregnant women are at risk for blood clots from conception through six weeks postpartum. So while we know that only a handful of people out of millions experienced the extremely rare and serious blood clot after receiving the J&J vaccine, there is understandable reason to pause. However, it’s worth noting that the blood clots usually associated with pregnancy (deep vein thrombosis and pulmonary embolisms) are different from the blood clots linked to the J&J vaccine (cerebral venous sinus thrombosis). The CDC and FDA have recommended that use of Johnson & Johnson’s Covid-19 vaccine resume in the United States, effective April 23, 2021.
Out of an abundance of caution and since we have alternative Covid-19 vaccines where this risk has not been seen, pregnant women are recommended to consider an mRNA vaccine.
7. Fact or Fiction: Women should not get vaccinated 3 days before or after fertility treatments.
Fact.
There was a recent NYT article advising women not get vaccinated 3 days before or after fertility treatments.
The practical recommendation from the ASRM that was referenced by the Times (issued in late February 2021) is that patients scheduled for elective surgery, including egg retrieval, embryo transfer, and IUI, avoid Covid-19 vaccination for three days before and after.
This recommendation is not because being vaccinated is unsafe, rather because known side effects of the vaccine may impact monitoring during and post surgery. Common side effects after Covid-19 vaccination, as we know (especially after the second dose), include fever, chills, fatigue, body aches, and headaches — and typically occur and resolve within the three day window the ASRM recommends.
These side effects could also make it difficult to determine if a post-procedure fever was related to the vaccine or to a developing infection related to the procedure.
Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has Covid-like symptoms, including those that are possible side-effects of the vaccine (even if their Covid-19 test is negative).
In sum, the last thing you would want is a fertility procedure cancelled because the anesthesiologist detected a fever that may be related to the vaccine, hence the practical recommendation.
Some of the information in this blog may change after publication. For the latest on Covid-19 and fertility, readers are encouraged to use online resources from the CDC as well as the ASRM and ACOG, and always consult their medical providers before making any medical decisions.
All content created for informational purposes only, and is not intended or implied to be a substitute for professional medical or mental health advice, diagnosis or treatment.
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