Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic

ASRM COVID-19 Task Force Update #16

Reproductive Facts Regarding COVID-19 Vaccination

• As of July 16, 2021, the 7-day moving average of daily new cases of COVID-19 in the United States (U.S.) increased by nearly 70% compared with the previous 7-day moving average.(1)
   
• The current status of the COVID-19 pandemic in the U.S. has been called “a pandemic of the unvaccinated”(2). The incidence of COVID-19 hospitalizations and deaths fell precipitously as COVID-19 vaccinations became widely available. Unfortunately, hospitalization rates are rising again, due to the highly contagious delta variant, especially in states with low vaccination rates. Nearly all (97%) recently hospitalized patients are unvaccinated.(2-5)
   
• Current CDC data suggest only 16.3% of pregnant women included in CDC’s Vaccine Safety Data link have received >1 dose of a COVID-19 vaccine during pregnancy.(6) This low rate of vaccination is particularly concerning given the known increased risk of adverse outcomes for women infected with COVID-19 during pregnancy. (7,8)
  
  
• Reproductive endocrinologists should discuss COVID-19 vaccination with all patients and encourage vaccination for all patients during evaluation and treatment for infertility. Vaccination either pre-conception or early during pregnancy is the best way to reduce maternal/fetal complications. Physician counseling has been shown to have significant positive impact on patient willingness to consider vaccination.(9)
  
  
• None of the currently available COVID-19 vaccines reach or cross the placenta. The intramuscularly administered vaccine mRNA remains in the deltoid muscle cell cytoplasm for just a few days before it is destroyed.(10,11) However, protective antibodies to COVID19 have been shown to cross the placenta and confer protection to the baby after delivery.(12,13)
• COVID19 vaccination does not induce antibodies against the placenta.(14)
  
  
• Existing data suggest COVID19 vaccination during pregnancy does not increase risk of miscarriage.(15)
  
  
• COVID19 vaccination does not impact male or female fertility or fertility treatment outcomes.(16-18)

REFERENCES

1. Centers for Disease Control and Prevention. COVID Data Tracker Weekly Review. Available at https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html, last accessed July 2021.
   
   
2. Rochelle Walensky. July 16,2021 Press Briefing by White House COVID-19 Response Team and Public Health Officials. Accessible at https://www.whitehouse.gov/briefing-room/press-briefings/2021/07/16/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-45/, last accessed July 2021.
   
   
3. Allison Aubrey. 97% Of People Entering Hospitals For COVID-19 Are Unvaccinated. National Public Radio July 16, 2021. Available at https://www.npr.org/2021/07/16/1017012853/97-of-people-entering-hospitals-for-covid-19-are-unvaccinated, last accessed July 2021.
   
   
4. Johnson CK, Stobbe M. Nearly all COVID deaths in US are now among unvaccinated. Associated Press June 29, 2021. Available at https://apnews.com/article/coronavirus-pandemic-health-941fcf43d9731c76c16e7354f5d5e187, last accessed July 2021.
   
   
5. Keating D, Shapiro L. For unvaccinated, coronavirus is soaring again. Washington Post July 21, 2021. Available at https://www.washingtonpost.com/health/interactive/2021/unvaccinated-case-rate-delta-surge/, last accessed July 2021.
   
   
6. Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, et al. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy — Eight Integrated Health Care Organizations, United States, December 14, 2020–May 8, 2021. MMWR Morb Mortal Wkly Rep 2021;70:895–9.
   
   
7. Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641–7.
   
   
8. Villar J, Ariff S, Gunier R, Thiruvengadam R, Rauch S, Kholin A, et al. Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection. The INTERCOVID Multinational Cohort Study. JAMA Pediatr. Published online April 22, 2021. Available at https://jamanetwork.com/journals/jamapediatrics/fullarticle/2779182, last accessed July 2021.
   
   
9. UCSF Aspire. Assessing the Safety of Pregnancy In the CoRonavirus PandEmic, Unpublished data. Available at https://aspire.ucsf.edu, last accessed July 2021.
   
   
10. Centers for Disease Control and Prevention, Infectious Diseases Society of America. COVID-19 Realtime Learning Website. Vaccines FAQ, mRNA vaccines. Available at https://www.idsociety.org/covid-19-real-time-learning-network/vaccines/vaccines-information--faq/, last accessed July 2021.
    
    
11. Pardi N, Tuyishimea S, Muramatsua H, Karikoa K, Muib BL, Tamb YK, et al. Expression kinetics of nucleoside-modified mRNA delivered in lipid nanoparticles to mice by various routes. J Controlled Release 2015;217:345-51. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624045/, last accessed July 2021.
    
    
12. Gray KJ, Bordt EA, Atyeo C, Deriso E, Akinwunmi B, Young N et al. Coronavirus disease 2019 vaccine response in pregnant and lactating women: a cohort study. Am J Obstet Gynecol Gynecology. Published online March 2021, available at https://www.ajog.org/article/S0002-9378(21)00187-3/fulltext, last accessed July 2021.
    
    
13. Beharier O, Mayo RP, Raz T, Sacks KN, Schreiber L, Suissa-Cohen Y, et al. Efficient maternal to neonatal transfer of antibodies against SARS-CoV-2 and BNT162b2 mRNA COVID-19 vaccine. J Clin Invest 2021;131:e150319. Available at https://doi.org/10.1172/JCI150319, last accessed July 2021.
    
    
14. Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Vaccination in Pregnancy. Obstet Gynecol. Published online July 08, 2021. Available at https://journals.lww.com/greenjournal/Fulltext/9900/
    Severe_Acute_Respiratory_Syndrome_Coronavirus_2.206.aspx, last accessed July 2021.
    
    
15. Shimabukuro TT, Kim SY, Myers TR, Moro PL, Oduyebi T, Panagiotakopoulos L, et al. Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons. N Engl J Med 2021;384:2273-82.
    
    
16. Gonzalez DC, Nassau DE, Khodamoradi K, Ibrahim E, Blachman-Braun R, Ory J, et al. Sperm parameters before and after COVID-19 mRNA vaccination. JAMA 2021;326:273-4.
    
    
17. Morris RS. 2021 SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility. Fertil Steril Reports. Available online June 2, 2021. Available at https://www.sciencedirect.com/science/article/pii/S2666334121000684, last accessed July 2021.
    
    
18. Orvieto R, Segev-Zahav A, Aizer A. Does COVID-19 infection influence patients’ performance during IVF-ET cycle?: an observational study. Gynecol Endocrinol. Published online May 11, 2021. Available at https://pubmed.ncbi.nlm.nih.gov/33974475/, last accessed July 2021.

Read the Full Text Recommendations:

• Update #16 - published July 23, 2021
• Update #15 - published May, 20, 2021
• Update #14 - published March, 23, 2021
• Update #13 - published February 22, 2021
• Update #12 - published January 19, 2021
• Update #11 - published December 16, 2020
• Update #10 - published November 17, 2020
• Update #9 - published October 12, 2020
• Update #8 - published September 8, 2020
• Update #7 - published August 10, 2020
• Update #6 - published July 10, 2020
• Update #5 - published June 8, 2020
• Update #4 - published May 11, 2020
• Update #3 - published April 24, 2020
• Update #2 - published April 13, 2020
• Update #1 - published March 30, 2020
• Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic - published March 17, 2020