The spread of novel corona virus SARS Cov-2(Covid-19) across the globe has terribly influenced not only the health system but also the economic and social systems of the country. Initially, nationwide emergencies, lockdowns and closure of all planned health procedures including fertility treatments were imposed. As this is a novel virus, its effects upon pregnancy, unborn baby and in children are largely unknown. But with increasing experience with this disease and its effects, all kinds of IVF services have been gradually resumed. Although this virus has been found in both sperms and female eggs as well as on the outer covering of developing baby, risk of transmission from mother to baby as well as serious effects on babies haven’t been found till now. Hence, ICMR has recommended to resume of all IVF services gradually with proper precautions and safety protocols.

Few common questions which come into the minds of an infertile couple seeking treatment are:

Q.1 What is covid-19 virus?
Ans: SARS-COV2 is a novel virus with 76% similarity with an already known SARS-CoV virus found in animals. It is currently known to affect lungs, Digestive, Urinary and heart primarily. Reproductive system is not a primary site of infection of this virus. The virus has been constantly mutating since the time it has been first detected. The novel delta variant of this virus has found to be more infectious but not more deleterious than the original virus. This variant can also be detected through the same RT-PCR test and vaccine is also effective against this new variant.

Q.2 What is the effect of Covid-19 virus on baby?
Ans: Although mother to baby in womb transmission has been reported in fetus but its risk is low and its effects on baby are still unclear. No birth defects have been reported till now.

Q.3 What is the effect of Covid-19 on male infertility?
Ans. Covid-19 virus has been found in testicular tissue as well as semen of males but its effects on reproductive potential are still not very clear. It may affect sperm quality negatively, but magnitude of its effects may depend upon severity of infection. Sexual transmission of this virus from one partner to another hasn’t been found.

Q.4 Does Covid-19 infection during pregnancy increases maternal morbidity?
Ans. Covid-19 infection during pregnancy can have serious effects on the mother with more chances of increased BP records and ICU admissions. Chances of Pre-mature delivery and Caesarean sections also increase. Vaccination of all pregnant women is hence recommended to decrease this morbidity and mortality. All recommended precautions such as handwashing with soap, not touching your face and practicing social distancing should be followed during pregnancy.

Q.5 What is the risk of covid-19 infection during pregnancy to the unborn child?
Ans: Although the effects of covid-19 during pregnancy haven’t been fully elucidated, but current evidence does not show any increased chances of neonatal morbidity or birth defects to a child who is born at full term.

Q.6 Is there an effect of antiviral drugs used for treatment on fertility potential of individual or on pregnancy?
Ans: Common drugs used for covid-19 treatment are:
Remdesivir: There is some evidence that high dose of remdesivir given for treatment of Covid infection may decrease sperm quality, but effect is temporary and depends upon both severity of infection and dosage of remdesivir given.
Glucocorticoids: Steroids given as a short-term therapy for covid treatment may have minimal effect on pregnancy. No evidence of impaired fertility has been found.
Antibiotics: Only those antibiotics which are safe to be used during pregnancy are given during treatment.

Q.7 Is it safe to start egg donation /surrogacy during this pandemic?
Ans: Although the selection management and availability of egg down or surrogate can be complex during this pandemic when we have to take all due precautions regarding safety of infertile couple as well as egg donor or surrogate. But with proper testing and recommended covid precautions, donor cycles & surrogacy can be attempted.

Q.8 What special tests are required before starting a cycle?
Ans: Covid RT-PCR of commissioning couple is to be done prior to starting an IVF cycle and it has to be repeated before egg pickup again. It is recommended that couple should minimize socialization and maintain social distancing while undergoing IVF so as to minimize chances of acquiring infection. Husband’s semen sample should be kept cyrofrozen at the start of the cycle as a backup in case he acquires infection during IVF.

Q.9 What will happen if any of the partner becomes covid positive during IVF cycle?
Ans: In case, female partner turns positive before egg pickup, IVF cycle needs to be cancelled. If she acquires infection after Oocyte retrieval, then all embryos are cryofrozen and to be transferred after at-least one month of recovery from infection. If husband acquires infection during a cycle and his cryofrozen semen sample is available, then that can be used for IVF.

Q.10 After how much time of recovery from covid-19, one can start fertility treatment?
Ans: As per the international guidelines (HFEA, UK), it is safe to start fertility treatment after 28days of recovery from infection.

Q.11 Can a couple get vaccinated before, during or after an IVF cycle?
Ans: Yes, a couple can get vaccinated during an IVF cycle but it is recommended to keep a gap of at-least one week from any procedure, so as to avoid any mild side-effects which may happen after vaccination to be coinciding with procedure.

Q.12 Can vaccine be taken during pregnancy and lactation?
Ans: Yes, Vaccine can be taken during pregnancy and lactation.

Q.13 How much is the risk of hospital acquired covid-19 infection?
Ans: Jindal IVF center is one of the premiere hospitals of the region which is NABH accredited and follows all safety protocols recommended by ICMR for COVID prevention. Whole medical staff is vaccinated and takes appropriate recommended safety measures. Social distancing is maintained. IVF Laboratory also follows all safety norms recommended by ICMR for infection prevention. The risk of cross contamination of covid-19 between samples in IVF lab is negligible. Hence, one can pursue IVF during this pandemic also without any fear of getting infected through the hospital.