COVID-19 and Assisted Reproduction, let’s prepare for a new era
Talking about the importance of Assisted Reproduction (AR) and fertility treatments, when everyone’s life is at stake, seems frivolous. But the reality is that it is time to think about the future. When COVID-19 ends, the next thing will be to think about how to help society regain its hopes and treatments.
Closing fertility clinics is not the worst of our problems, but what will happen after this. Fears and precautions that have already been expressed by large scientific societies such as ESHRE and ASRM.
In the absence of classic medical forums, due to its cancellation, it is now more important than ever to be able to share scientific studies with society that help us make the best decisions going forward.
From the Igenomix Foundation, we have launched a series of webinars that allow us to keep up-to-date and share steps to follow after COVID. We invite you to participate and we encourage you, with your teams, to propose lines of research that help us.
Getting ready for the post pandemic era
The WHO declared the status of COVID-19 disease as a global pandemic. And since then, we are experiencing a paradigm shift. This pandemic, caused by a virus that belongs to a group that causes respiratory disease, is primarily fed to people with previous or immunosuppressed problems.
Although this is the third pandemic of the 21st century (MERS | SARS | COVID19) and has only a 3% mortality, it is spreading so rapidly that it is very difficult to keep people at risk safe.
We cannot deny that this fact is going to be a before and after in our lives. We must prepare to start again.
COVID-19 test, the way to know where we are and to take measures to control it
Molecular, genetic and immunological diagnostic methods are key. Rapid tests can be a means of diagnosis at any given time, but not for those who need to have all the information about their health. Knowing if we have passed the COVID-19, if we are suffering it or if there is no longer any trace of the disease, is not a matter of a single diagnostic test. We need to diagnose the disease by PCR or by sequencing and to know the immunological response and the precise moment in which we find ourselves through the mediation of IgG and IgM.
Just as we know today if a pregnant woman has passed Rubella, we should be interested to know if a gamete donor has passed the Coronavirus.
Research and caution in the reproductive period
To date, none of the previous pandemics appears to have wreaked havoc on pregnant women. But neither do we have such a vast literature that allows us to draw decisive conclusions, since the casuistry is very low. Perhaps now during this pandemic, with the largest number of people affected worldwide, we can know a little more.
Beyond treatment with Ribavirin, which affected babies in previous pandemics (SARS and MERS), as it is embryotoxic and has not been used on this occasion, we know little about the vertical transmission of the mother-child infection. Initially it was thought that there was no transmission, since it was a scientific publication with few cases of new-borns, in which it was observed that there was no morbidity or mortality, however, after several days of follow-up, it has been seen that several children have developed pneumonia and have died within a couple of weeks of birth. In those cases that are already known, as expected, the mother contracted the disease at the end of gestation, we do not yet know anything when the disease is suffered by the pregnant woman in the first and second trimester of pregnancy, since there has not yet been time to see what happens to those new-borns, until they are born.
It would be interesting to have knowledge about how the virus works in animals (although it probably does not reflect what can happen in humans) and the effects on its reproduction, but the reality is that there are no such studies either. So, it is advisable to be cautious and be cautious in a time like this and as it is about to come. Equally recommended is to start with serious research work on humans.
The best recommendation is always prevention
The WHO recommends testing all citizens and, although we already know that it is a utopia in almost any country, perhaps it is the responsibility of each organization to be able to do it. In Assisted Reproduction clinics, the optimum would be, to return to normality, to test employees, patients and donors, always establishing a circle of safety for all, where we could guarantee treatment with the maximum guarantees.
We don’t have enough information to make decisions right now, so caution is best. The option now is to stop the treatment or to defer and, in the future, to consider the existing diagnostic tests, as we have explained before, to continue with confidence.
As Professor Carlos Simón pointed out in our first webinar on pregnancy and COVID-19, “life comes first. In the post-pandemic era, safe reproduction is what we are going to be required to do, so we need all the data. And that requires research. We cannot think that governments are going to subsidize this. Scientists, we have to put our resources to find the way. We live surrounded by viruses and we have to handle this issue. “