COVID-19 is changing the way people navigate their pregnancies, births, and first weeks at home with their baby. But what is happening for those not yet celebrating a pregnancy? And what about families planning to grow with the assistance of a surrogate or by adoption? For many in these situations, plans are shifting or being put on hold. More waiting may be required after what is often a physically and emotionally intense journey.

Cleo’s Considering Guides support people as they endeavor to welcome babies through a wide variety of ways. We are here for our families through these turbulent times. We want to share what we know is happening for some and provide tips for navigating current challenges.

COVID-19 and Preconception

The Landscape

People trying to conceive are wondering if now is really a good time. We’ve certainly heard that question a lot, and the frank answer is “it depends.” We currently don’t have data about first trimester exposures to this particular coronavirus since it just emerged this winter.

We can extrapolate from similar viruses and take what we know about second and third trimester exposures into consideration — namely that fevers early in pregnancy do pose risks, but those are minimized if fever-reducing medications are used.

We also see so far that COVID-19 does not appear to increase risk of miscarriages or birth defects. It is still not completely clear if vertical transmission from pregnant person to baby in utero occurs. While there is new evidence that it may be possible, it does not seem like the most likely scenario. In addition, COVID-19 does not appear to increase complications for most newborns.

So, What Now?

Navigating risk is a personal decision, and while some people will digest this information and be comfortable moving forward with steps to get pregnant, others may prefer to wait until more is known about COVID-19. It is important to check in with trusted care providers and discuss circumstances unique to your health and fertility as you move through preconception planning.

COVID-19 and Infertility Care

The Landscape

Shortly after the COVID-19 pandemic was declared, many professional organizations involved with reproductive medicine released policy statements that effectively halted most assisted fertility procedures. Countries experiencing varying degrees of a lockdown also instituted policies impacting medical procedures deemed “nonessential,” and in many places that meant that fertility clinics were effectively closed until further notice.

Ascribing the term “nonessential” to an egg retrieval, IUI, or embryo transfer is troubling and inaccurate. Reproductive medicine is quite essential for many individuals and families hoping to welcome a baby.

So, What Now?

While many procedures have been put on hold, the American Society for Reproductive Medicine (ASRM) updated their guidelines on April 24 to help providers resume care. These guidelines include suggestions for risk assessment, risk mitigation, consideration of resource availability, and thorough counseling that should make it possible to provide fertility services in an environment where COVID-19 exists.

ASRM states that the final decision on how to prioritize care is best handled at the local level, in consultation with patients. Now is a good time to check back in with your clinic. If your fertility care is still on hold, there are ways you can keep moving toward your goals. Every provider and clinic will be exploring this realm a little differently and the unique reality of each region and setting will undoubtedly influence what is available.

While in-person visits may not be possible, most providers are still happy to have phone or video consults. This will help make sure you are ready to take the next in-person step as soon as restrictions are eased. Some small clinics that are not attached to or affiliated with a larger hospital may still be moving forward with diagnostic ultrasounds, semen analysis and collection, IUI’s, embryo transfers, and more.

Questions to explore with your provider:

• Can you do an initial consult or follow-up via phone or video?
• Can you move forward with lab work? Blood draws?
• Are diagnostic ultrasounds or hysteroscopic procedures possible if necessary?
• Is it possible to consider or continue using fertility promoting medications without in-person monitoring (e.g. metformin or clomid)?
• Is semen analysis and/or sperm banking possible? (Note: if you are in the US and would like male fertility support that works extremely well with social distancing, please check out Dadi. They are fantastic.)
• Is trying to conceive at home recommended? Can your provider offer timed intercourse guidance specific to your fertility? (Cleo Families, see your Journey or ask your Considering Guide for a refresher on timed intercourse and ovulation predictor kits.)
• Is it possible to schedule necessary in-person treatments?

COVID-19 and Surrogacy

The Landscape

Families with hopes or plans to work with a gestational carrier/surrogate are coping with additional uncertainty and delays. While some have been able to move forward with embryo transfers, for most, processes have halted. In general, transfers appear to have been less impacted than complete cycle starts that require egg retrievals and fertilization processes.

Many families who have pregnancies in process with the help of a gestational carrier are facing uncertainty related to whether they will be there for their baby’s birth or even be able to bring their baby home. As the movement of people is significantly restricted right now, we are learning of families who are stuck far from home, unable to get passports issued for their new babies, or who may not be able to travel to witness their babies’ births. These are heart-wrenching scenarios, robbing many families of an experience they had been anticipating for years.

So, What Now?

If your process is on pause: It is important to have an in-depth discussion with your care provider as well as your surrogacy agency to determine what steps are possible now and whether legal considerations and contracts can be extended in a way that does not carry additional fees. The costs involved in surrogacy are often significant, and if agencies and legal associates need to press pause it is worth exploring ways to reduce or eliminate additional costs to you and your family due to these unique circumstances.

If you are in the middle of medical clearance or at risk of needing to repeat any tests: Some steps such as medical clearance processes may still be possible, but take care to double-check how close together certain steps need to be. For example, you want to know how long lab results are “good” for ahead of an embryo transfer so that you don’t need to duplicate steps and costs down the road. If any tests do need to be redone, see if they can be done now so that you can be ready to move to the next step as soon as that is possible.

If your surrogate or gestational carrier is currently pregnant: We encourage anyone whose baby will be born in another country to communicate with your agency and embassy early on and frequently so that “emergency” exceptions can be granted if possible.

For those whose baby will be born domestically, we recommend keeping a close eye on policies related to birth support in the hospital where your baby will be born, and contacting the leadership of the labor and postpartum floor now so that being in attendance during your baby’s birth and throughout the postpartum stay goes as smoothly as possible. It’s important to get on your hospital’s radar ahead of time, and if your hospital doesn’t yet have a policy, they could have time to make one that hopefully respects parental rights.

COVID-19 and Adoption

The Landscape

For our families working towards a near-term adoption, the impact on COVID-19 on both domestic and international travel has significantly changed timelines. This poses significant hardship for families and the children that they are already preparing their homes and hearts to welcome. If connections have already been made, agencies are working to support virtual communications until babies and children can be united with their adoptive parents. And for those who were preparing to initiate steps towards adoption, many agencies are still welcoming calls so that planning can begin.

Timelines for adoption generally take several months to a few years depending on the age of the baby or child and whether the adoption is taking place domestically or internationally. It is anticipated that these timelines will extend somewhat during this pandemic, but no one seems able to estimate by how long.

So, What Now?

Every situation seems to be different, depending on the country where the baby or child is living, their age, the agency, and the location of the parent(s). Thus, clear and regular communication with both agencies and embassies seems to be more important than ever. Lawyers continue to work from home, though some on reduced hours and a longer turn-around time, so be sure to ask for clarity how legal timelines are changing.

Familiar Uncertainty

For individuals and couples navigating infertility diagnoses or growing their families through surrogacy or adoption, the uncertainty they now face may be all too familiar. If you are longing for a child, seeing social media memes about “COVID babies” being inundated with posts about the challenges of pregnancy and parenting may only increase your sense of isolation. Know that you’re not alone. Just as always, those struggling to become parents and grow their families are out there, navigating this confusion alongside you.

For anyone reading this who could use additional support, we highly recommend the following resources. They are wonderful lifelines always, and especially now.

• RESOLVE (Infertility support)
• Modern Health
• All Mental Health

Sage Bearman, CNM, RN, is a Cleo Considering Guide

Cleo aims to give the most accurate information about COVID-19, but details and recommendations about this pandemic may have changed since this story was published. For the latest information, please check out resources from the WHO, CDC, and local public health departments.