COVID-19 VACCINE, indications for couples seeking pregnancy

Many couples who are trying to get pregnant naturally, or through an assisted reproduction path, wonder how to behave with vaccination against COVID19. Here are the clarifications of Dr. Filippo Maria Ubaldi, president of the Italian Society of Fertility and Sterility-Reproductive Medicine (Sifes-Mr)

 do or not to do, or wait, for Covid-19 vaccination?

This question has been circulating for weeks among couples who want a child. The indications of the health authorities point to the need to evaluate case by case, studying in depth the individual situation of each woman or man who is trying to have a baby, in the absence of specific data in the vaccine trials available.

“The main attention must be paid to the future mother – underlines Filippo Maria Ubaldi, president of the Italian Society of Fertility and Sterility-Reproductive Medicine (Sifes-Mr) – in her state of health, in the presence of other chronic diseases that may expose her to risks of severe forms of Covid-19 or pregnancy complications; or even to his profession, in the hypothesis in which it may represent an additional factor of exposure to the Sars-Cov-2 virus.

What we as specialists in reproductive medicine suggest, is that the decision be discussed with the gynecologist and that the urgency criteria are taken into account, in addition to the general condition of the patient, her age and / or ovarian reserve.

All this considering that, in 2017, more than 70% of women who underwent assisted reproduction treatment were ‘over 35’. For these patients, even a few months can make a difference in the success of the treatment.”

There are 3 situations in which aspiring or future mothers find themselves at this time and we see them in detail.

1. Aspiring mom working in healthcare

As part of the medical, paramedical or administrative staff, and must undergo vaccination shortly as part of the vaccination campaign underway in Italy. “We are contacting – explains Ubaldi – many women who already have the established date to do the vaccination, but who must also undergo PMA (medically assisted procreation) treatment in the imminence.

They ask us: can I get the vaccine and proceed with PMA, or do I start the path of assisted fertilization and postpone immunization?

In the case of the Pfizer vaccine, the time that elapses between the first and second dose, plus the handful of days that the European Society of Human Reproduction and Embryology (ESHRE) recommends waiting after completing the vaccination cycle, does not change much in the success of PMA, and allow you to be safe from the risks related to the virus.

Then, you can proceed with the first dose, then with the second after 3 weeks, and then wait a few more days, without this negatively affecting the success of the PMA process. In the case of the AstraZeneca vaccine, which requires a second dose after 3 months, the evaluation must take into account the important elements recalled: age of the woman and ovarian reserve”.

2. Aspiring mom who is likely to get vaccinated in 5-6 months

This category includes “the vast majority of patients in infertility centers – highlights President Sifes-Mr – who will make the vaccine in June, July, perhaps even beyond.

They ask us: should I wait for the vaccine or can I start the PMA journey in the meantime?

For these patients, factors such as age and ovarian reserve prevail: the passage of 5-6 months or more, can make a real difference and reduce the chances of success for PMA. In this case, it may be advisable to start the assisted reproduction process and subsequently evaluate the Covid-19 vaccination with the gynecologist”.

3. Pregnant women

Exactly as specified in the document recently shared and signed by the most important Italian scientific societies of gynecology, pediatrics, neonatology and resuscitation (Italian Society of Gynecology and Obstetrics, SIGO, the Association of Italian Hospital Obstetricians and Gynecologists, AOGOI, the Association of Italian University Gynecologists, AGUI, the Association of Territorial Gynecologists, AGITE, the National Federation of Obstetric Colleges, FNOPO, the Society Italian of Neonatology, SIN, the Italian Society of Perinatal Medicine, SIMP, the Italian Society of Pediatrics, SIP, the Cultural Association of Pediatricians, ACP, the Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care, SIAARTI), vaccination is a personal choice and the woman must in all cases be informed exhaustively by your doctor on the potential risks of the vaccine, but also on the risks associated with COVID19 infection in pregnancy, both for maternal and fetal health. “Pregnant women who do not have a recent history of COVID 19 infection and who have specific additional risk factors may favorably consider receiving the COVID 19 vaccine, which is executable at any time of pregnancy.”

Infertility specialists know well the reality of women looking for a pregnancy, perhaps for years:

“They have a deep desire to become mothers – explains Ubaldi – and often time plays against them. The pandemic has already put them in great difficulty due to the stop to treatments, the difficulty of moving and traveling.

That is why we must help them make the decision whether to undergo vaccination or not. We know that the increase in maternal age translates into a reduction in the pregnancy rate and above all in an increased risk of abortion: for these couples, in the presence of a scarce ovarian reserve, time is golden.

So the advice is to rely on the opinion of the gynecologist who follows the woman in her therapeutic process, considering all the important factors that must influence this very important choice “.