Natural Conception During the COVID-19 Crisis
The COVID-19 (novel Coronavirus) pandemic has created significant challenges for couples trying to conceive. Illness, social distancing, and financial concerns have led some couples to delay childbearing. For many other women and couples, however, valid concerns about the decline in fertility with age have created significant anxiety. It is estimated that approximately one in seven couples suffers from infertility, diagnosed as failure to conceive pregnancy despite twelve months of regular intercourse, or exposure to sperm, if the woman is 35 years of age or younger, or six months if the woman is older than 35. The assistance of fertility specialists and assisted reproductive technology is required for conception to occur in many cases of infertility including those involving fallopian tube disease, advanced age of one or both partners, ovulation disorders, uterine abnormalities, and significant sperm abnormalities.
In response to the COVID-19 crisis, many fertility centers have temporarily halted some or all fertility treatments in order to optimize social distancing and maintain critical medical resources. However, many couples continue to try to conceive at home. Current data does not indicate an increased risk of birth defects or miscarriages in women infected with COVID-19, and small studies have not shown that the virus is spread from mother to fetus. However, it is possible that pregnant woman infected with COVID-19 will have a more severe course than non-pregnant infected women. More data is needed to better elucidate these risks.
For couples who wish to try to conceive naturally, the following recommendations are useful:
Stay virus-free:
It is imperative that both partners follow CDC guidelines to minimize the risk of infection. These guidelines include maintaining appropriate social distancing, adequate hand washing, and disinfection of surfaces and clothing.
Maintain adequate nutrition and a healthy weight:
A healthy diet includes lean proteins (including meat, low mercury fish, and beans and legumes), fruits and vegetables, whole grains, and foods rich in calcium and healthy fats.
Maintaining a body mass index (BMI; weight (in Kg)/ height (in meters)2) of 18.5 to 24.9 is considered ideal for optimal health and conception). Women who are underweight often have deficient circulating levels of estrogen and ovulation defects. Overweight and obese women also suffer frequently from hormonal imbalances, ovulation defects, and an increased miscarriage rate.
Take a prenatal vitamin:
A prenatal vitamin taken orally each day when trying to conceive and once pregnant is recommended as a source of essential nutrients and iron.
Continue an appropriate level of exercise:
Women who are trying to conceive and those who have already conceived should continue to get a regular exercise which might include yoga (excluding “hot” yoga), aerobic exercise, and weight training. Unless instructed to curb exercise by the Obstetrician, women should feel free to continue their exercise routine until they give birth. In women trying to conceive and in women with an early pregnancy, extreme heat and breathlessness should be avoided. Once pregnant, contact sports should be avoided as well.
Avoid toxic exposure:
Pregnant woman who smoke or drink alcohol during pregnancy have a significantly higher risk of preterm labor, small for gestational age babies, and miscarriages. Women who smoke also have an accelerated loss of eggs and diminished ovarian reserve. Consuming more than 2 cups of coffee per day ( > 250 mg of caffeine) has been shown in some studies to prolong infertility and increase the miscarriage rate.
Monitor menstrual cycles and ovulation, and time intercourse:
The normal duration of a menstrual cycle ranges between 21 and 35 days. Recording the first day of the period and the number of days until the next period begins can help predict when a woman will ovulate. Women with regular cycles typically ovulate 12 to 14 days prior to the arrival of their next period (e.g. a woman with a 28 day cycle might ovulate on day s 12-14 whereas a woman with a 33 day cycle might ovulate on days 17-19).
In order to monitor ovulation at home, options include using a thermometer to record the basal body temperature starting about 16 days prior to the next expected menses. A rise in temperature of 0.3-0.6 0 celsius over two days suggests ovulation has occurred. This method is helpful to predict future ovulation but is not useful in determining the best time to have intercourse, which is ideally 2-3 days prior to ovulation. Therefore, a home OPK (ovulation prediction kit) can be used to test the urine for a surge of luteinizing hormone (LH) which signals that ovulation will occur within the next 24 to 48 hours.
When ovulation is about to occur, copious amounts of thin, stringy cervical mucus are secreted into the vagina. The appearance of this mucus is another marker of the ideal window for intercourse.
Intercourse is best performed in the 2 to 4 days preceding ovulation. Intercourse once a day for 2-3 days at that time is recommended.
Recommendations for men:
Similar to women, men should avoid obesity as it can lead to significant hormonal abnormalities and compromised sperm function. Men should also avoid smoking due to its adverse effects on sperm quality. New data suggest an adverse effect of alcohol on the DNA of sperm which might also have a negative impact on a couple’s fertility. In addition, exposure of the sperm-producing cells within the testicles to excessive heat also reduces sperm number and quality; as such, men should avoid taking prolonged hot baths and the use of hot tubs.
When to see a Reproductive Endocrinologist:
Despite the COVID-19 pandemic, the reproductive endocrinologists of Reproductive Medicine Associates of New York are available to consult with and treat patients suffering from infertility.
It is recommended to see a reproductive endocrinologist if any of the following is true
- The couple has failed to conceive for > 6 months and the woman is 35 or older
- The couple or woman has a history of two or more miscarriages
- The woman has a mother or sister with menopause at age 45 or younger
- The woman has a history of pelvic surgery or pelvic diseases
- The woman has irregular cycles and/or ovulation dysfunction and has failed to conceive with three cycles of Clomiphene Citrate or Letrozole with her gynecologist
- The man has difficulty ejaculating or achieving an erection
- The man had a semen analysis revealing a low sperm count (< 10 Million per ml) or poor sperm motility (<40% moving) or morphology (<4 % normal forms)
- The woman has significant autoimmune disease (e.g. hypothyroidism, lupus, rheumatoid arthritis)
- The woman or a man who is planning to start chemotherapy for cancer or autoimmune diseaseThe woman is over 30 and is planning to delay childbearing