This is an interview with Dr. Jennifer E. Mersereau. Dr. Mersereau is Professor of Obstetrics and Gynecology and Director of the Fertility Preservation Program at UNC. She is board-certified in both obstetrics and gynecology as well as in reproductive endocrinology and infertility. She has published many peer-reviewed research articles in the field, and has received numerous awards for her research.
Julia Wuench: What is the state of operations for fertility clinics during the Covid-19 pandemic?
Dr. Jennifer E. Mersereau: Most fertility clinics, at least temporarily, have adjusted business operations. Some clinics have halted all fertility treatments, some have slowed down, and some (like Reproductive Medicine Associates Network in New Jersey) have actually kept conducting business as usual. Back in March, the American Society for Reproductive Medicine came out with their first Covid-19 guidelines. First, fertility clinics were asked to complete treatments for patients who were mid-cycle. Second, we were asked not to start any new treatment cycles. Lastly, we were asked to advise people to seriously consider pausing trying to get pregnant due to the unknown risks of pregnancy and Covid-19.
Wuench: Do you think fertility services are medically necessary?
Mersereau: I believe that infertility services are 100% medically necessary. Infertility is a disease. The question then becomes one of urgency. For example, the ORs at UNC shut their doors temporarily due to Covid-19. However, in a true medical emergency (if someone walks in with a gunshot wound and needs to be operated on) they will be treated. That’s level 1. And then there is level two, level three, and level four in terms of how “emergency” is medically defined. I like to think along the same lines in the fertility world.
In the fertility world, an example of an emergency is when a person is about to get cancer treatment. The cancer treatment cannot wait to start, but those cancer treatments will affect the person’s future fertility. In this situation, the patient only has a two-week window to consider banking eggs or embryos. After that, there’s no other option.
The next category would be people who are older, or have a smaller reproductive window. On the very far extreme would be things like elective egg freezing, which is probably not as time crucial.
Wuench: How is Covid-19 affecting infertility patients emotionally?
Mersereau: Infertility is stressful at baseline. It is exceedingly common for all of my patients to have an emotional component to infertility. First, these are generally healthy people that are having an interaction with the healthcare system that they do not want to have. Second, it’s out of their control.
Coronavirus also has both of these features: people are interacting with the healthcare system in ways that they don’t want to. And no one has control over when this will end.
When both of these independently stressful things compound, it becomes a serious problem.
Wuench: What do you make of the “baby boom in 9 months” jokes?
Mersereau: It’s insensitive to make assumptions and say offhanded things when you have no idea where people are in their lives or the choices they’re making. This reminds me of “Aunt Barbara” at family barbecues. She says, “When are you and Joe going to start having babies!? It’s been two years since your wedding!” You don’t say that. And Aunt Barbara should know better, but she doesn’t.
Wuench: I have several Aunt Barbara’s in my extended family.
Mersereau: On a more serious note, there is uncertainty with pregnancy during Covid-19. Whether you’re trying to get pregnant or you’re not trying to get pregnant, everybody should be making an active decision either way. Acting with intention is really important. Family planning in general is especially critical now. We don’t yet understand the effects of Covid-19 and pregnancy.
If patients do decide to resume fertility treatments, or people do get pregnant on their own, they need to understand that they may be giving birth in 9 months during a Phase II or III of Covid-19. There’s no data out there on risks of pregnancy during Covid-19. Patients need to be okay with that.
Wuench: In light of that, are a lot of patients putting off fertility treatments indefinitely, even with talk of clinics re-opening this summer?
Mersereau: No. Even with this warning, I have found that most patients are willing to take the risk. And I think this speaks to how medically necessary fertility treatments truly are.