In March, as the magnitude of COVID-19 and its impact on our daily lives was just becoming clearer, I held onto a ray of hope: I was about to start a new round of IVF.
I spent hours on the phone taking care of medical bureaucracy. My husband took what wound up being half a day off work to pick up the prescription in person, and then waited at the one pharmacy in the city that had the medicine, only to be turned away because the pharmacist decided that the doctor’s signature looked inauthentic.
As I was panicking about the lack of medicine, which had to be taken that evening, I got the call: All fertility treatments in Israel were put on hold, indefinitely, because of Coronavirus.
I was devastated. I spent hours on the couch, crying, unable to speak. I hadn’t felt this way since I was told I needed open heart surgery two years ago. The hope of maybe getting pregnant, or at least, knowing I had some embryos in the freezer, was what was keeping me going through these difficult times. It seemed an act of faith in humanity, and in myself, to choose to try to reproduce. I now had that foundation being pulled out from beneath my feet.
Today, the Israeli government approved opening most shops, as well as takeout from restaurants and beauty and hair salons. But Israel has still not approved re-starting fertility treatments. One of the ways Coronavirus is thought to spread is by touching the face or hands of someone with the virus, and then touching our own face or hands. Beauty and hair salons involve the stylist intensively touching one’s face and/or head for a prolonged period of time. It is a clear risk to all those involved. Yet the government has deemed one’s personal appearance a legitimate reason to take that risk.
A major reason I was given for not allowing fertility treatments was that treatments would be exposing myself to risk by repeated doctor appointments, some of which involve intense physical contact. But isn’t fertility a legitimate reason to take that chance? Shouldn’t it be my choice if I want to expose my body to risk? IVF includes a process under general anesthesia, as well as numerous drugs that have potentially dangerous side effects and might increase your chances of certain types of cancers. It’s hardly risk-free. I chose to embark on IVF precisely because I am willing to take a risk in order to become a parent.
Another major reason I was given was that we don’t know if or what type of effect Coronavirus might have on a fetus. There is no positive evidence that there is any risk. It’s simply that any time there’s a new disease in town, it’s hypothetically possible that it affects a fetus, so the medical establishment decided that it’s better to be safe than sorry. But the worries about Coronavirus and pregnancy are low enough that fertile women are not being told to try to prevent themselves from getting pregnant. So why are infertile women asked to make that sacrifice? Why should I be denied agency over my body and my reproductive choices because of an unproven hypothetical risk?
Pregnant women are allowed to show up for ultrasounds, so clearly, the risk of COVID-19 from medical appointments has been deemed minimal enough that women who already are pregnant are allowed to take that risk to themselves and their fetus. Why should I be denied a similar choice? What about the risk to my mental health, when, on top of the normal mental health challenges we all face during this difficult time, I am expected to struggle with the emotional fallout of being forced to stop my efforts to pursue my lifelong desire to become a mom?
The worst part about having fertility treatments put on hold, is that there doesn’t seem to be an exit plan: If the concern really is about hypothetical risk to a fetus, that is something extremely hard to disprove. You can’t hold a clinical trial and infect one group of pregnant women with COVID-19 in order to compare them to a control group. The testing shortage means that many people with COVID-19 are not being tested and diagnosed for it, which makes it hard to carry out an observational study to see how miscarriage and birth defect rates in pregnant women with Coronavirus compare to rates for pregnant women without Coronavirus. At the moment, those who are tested are those with strong symptoms, which means that studies would have a selection bias towards the women whose pregnancies are more likely to be affected than asymptomatic or mildly symptomatic COVID-19 carriers. Also, the population size of those tested is so small that it would be hard to know the validity that an observational study would have for the general population.
If the fear is that more doctor’s appointments mean more exposure, then that fear is unlikely to go away anytime soon. Estimates at the moment are that it could take up to two years to find a vaccine. For some women, waiting two years could mean completely forgoing the chance of motherhood. The chances of getting pregnant and having a healthy baby go down significantly at 35, and again at 40.
I do think there is one way of minimizing the risk: In Israel, fertility treatments are covered by public insurance for the first two-kids, and partially subsidized for the third kid. If Israel initially brought back treatments for women who either a) did not have any children (i.e. were still trying for their first child) or b) were 35 and older, it would significantly reduce the number of patients. This would make it easier to schedule appointments and reduce risk simply by reducing the number of people coming into the clinic. After there was a system in place for operating at reduced capacity in a risk-minimizing way, fertility treatments clinics could gradually increase capacity, with the goal of being back up to regular capacity within a reasonable time from reopening.
I am asking the medical establishment: What criteria will you use to decide when it is safe to restart treatments? Women like myself understand that this is a global crisis. We are not asking for treatments to resume tomorrow. But we are asking for some hope. If you can’t tell us when treatments will re-start, can you at least assure us that there is a plan for restarting them? Will your plan respect our agency over our bodies and our right to make our own reproductive choices, even if those choices involve risk to ourselves and/or small but unproven risk to our embryos?
For people who have had to stop fertility treatments: This is so extremely difficult. I wish I had words I could say to comfort you. All I can say is: You are not alone. Also, if you live in Israel, please consider signing this petition to the Health Ministry asking them to re-start fertility treatments.