COVID Vaccine Study on IVF & Early Pregnancy Outcomes

A group of physicians reported their findings on whether COVID mRNA vaccines affected IVF (in vitro fertilization) or FET (frozen embryo transfer) cycle outcomes. They included 222 vaccinated patients and 983 unvaccinated patients undergoing IVF, and reported no difference in fertilization rate, number of eggs retrieved, number of mature eggs, blastocyst formation rate, or euploidy rate. They also looked at 214 vaccinated and 733 unvaccinated patients who went through single PGT-tested embryo transfer and saw no difference in implantation rate or pregnancy loss.

This is important information to have just at face value. I was actually a bit surprised at the ratio of vaccinated to unvaccinated patients in the study given that the center providing the data is in New York city. This made me think about the experience of the infertility patient during the last 2 years, as opposed to the general middle adult population. The medical community has stated previously that there is no evidence to support the concern that the mRNA vaccines affect fertility, and 2 previous studies showed no effect on sperm quality. But this may not have sufficiently addressed the fear of someone already experiencing infertility. Patients ask me all the time about diet, exercise, medications, environmental exposures, and various other things they read online ¬could have an impact on fertility. And while there is some evidence that supports some of these things having a degree of impact, we all know people with terrible diets, who smoke, who ride bikes, etc., and still have a spontaneous conception. And people are still willing to cut all those things out on the possibility that it might improve their chances of having a baby just a little bit. And so I can see where the fear that even though there’s no evidence that mRNA vaccination harms fertility, if there’s even the slightest possibility that it might, perhaps our infertility community has been more afraid to consider it than Average Joe. If that’s the case, this publication is wonderful for providing concrete numbers showing even in this specific subgroup, the COVID vaccine did not affect outcomes of IVF or FET.

However, the scientist in me feels compelled to nit-pick a little. It’s great that the data demonstrates no change, but they didn’t present any information on whether the male partner was vaccinated. (To be clear, based on all the data we have, I don’t expect that to change outcomes). More importantly, they excluded people within 14 days of their second dose, or between the first 2 doses of the primary series. Including this data could have provided us with additional information about how to time booster shots. Considering that COVID infection has a higher rate of hospitalization with severe complications during pregnancy when compared to women in the same age bracket who are not pregnant, perhaps booster prior to pregnancy will be recommended in the future, as we do in cases of waning immunity to rubella. Knowing if there is an acute inflammatory effect triggered by the immune response to vaccination and whether this impacts outcomes would help people decide how long prior to IVF or FET to schedule their booster doses.
Lastly, J&J vaccinated patients were excluded from the study. Because this vaccine utilizes a different mechanism of action than the Pfizer and Moderna vaccines, I understand why scientists feel this data may confound results. But it seems like most studies exclude this population, and people who received these vaccines could benefit from information about their scenario as well.

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