Coronavirus (COVID-19): fertility treatment for unvaccinated patients

Why the Chief Medical Officer has made this recommendation

The priority is to maintain patient safety and for treatment to result in a healthy mum and a healthy baby.

A combination of evidence of increased risk of COVID-19 for unvaccinated pregnant women, increasing virus incidence and uncertainties about Omicron plus the concerns raised by the lead Clinicians in the four NHS Assisted Conception Units in Scotland, led to the recommendation that treatment for unvaccinated women should be temporarily deferred.

For women where vaccination is not possible for medical reasons please see further information given below.

The basis for this recommendation

The Chief Medical Officer recommended a temporary deferral of fertility treatment for patients who are not fully vaccinated against COVID-19.  This recommendation was made in light of:

• representations made by the lead Clinicians in the four NHS Assisted Conception Units in Scotland,
• evidence of increased levels of morbidity and risk of severe illness from COVID-19 amongst unvaccinated pregnant women, 
• increased incidence of pregnancy complications in women with COVID-19,
• ongoing uncertainty around the high transmissibility and unknown impact of the Omicron variant on pregnant women,
• and the high and increasing incidence of the virus in Scotland.

Evidence that pregnant unvaccinated women are at greater risk

The latest evidence from the UK Obstetric Surveillance System (UKOSS) and the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) showed that disproportionately high numbers of unvaccinated pregnant women and their babies have died after admission to hospital with COVID-19 and 98% of pregnant women in ICU with COVID-19 were unvaccinated. 

In addition, recent data reported by Public Health Scotland, shows that pregnant women with COVID-19 have a significantly higher risk of severe disease requiring admission to critical care than non-pregnant women of a similar age. 

With the arrival of the Delta variant increased numbers of pregnant women have been admitted to hospital with moderate to severe COVID-19 symptoms requiring critical care. The Scottish Intensive Care Society Report (SICSAG) Report, published on 13 October,  highlighted that none of the pregnant women who were admitted to Intensive Care Units and general High Dependency Units after testing positive for COVID-19, had received both doses of the COVID-19 vaccine before admission. 1 in 3 of the women required advanced respiratory support and over half required non-invasive respiratory support.

In light of this evidence, on 16 December 2021 the Joint Committee on Vaccination and Immunisation (the JCVI) recommended that, in the context of vaccination, pregnant women should now be considered as a high clinical risk group and part of the priority 6 group within the vaccination programme JCVI advice on vaccinating pregnant women.

In addition to the above, the evidence of the high and increasing incidence of the virus in Scotland, ongoing uncertainty around the high transmissibility and unknown impact of the Omicron variant on pregnant women, were taken into account.

More information about vaccination during pregnancy

Public Health Scotland and the Royal College of Obstetricians and Gynaecologists have both produced information on the importance of vaccination in pregnancy, that can be accessed here:

Pregnancy, breastfeeding and the coronavirus vaccine | The coronavirus (COVID-19) vaccine (nhsinform.scot)

Combined info sheet and decision aid 16.12.2021 (rcog.org.uk)

What does ‘fully vaccinated’ mean

If you have had your first and second COVID-19 vaccinations and your booster, or if fewer than 12 weeks have passed since you had your second dose, then you are considered to be fully vaccinated and should continue your treatment as normal, in line with advice.  

If more than 12 weeks have passed since your second dose and you have not received your booster, you should seek to have your booster as soon as possible to continue your treatment.  As soon as you have had your booster you are fully vaccinated and clinicians will be able to decide next steps with you.

If you are unable to have the vaccine for clinical reasons

There are very few individuals who cannot receive the vaccine.

If you are in this category your treatment should be risk assessed on a case by case basis by treating clinicians but it may be temporarily deferred by them. 

How Fertility Services can help unvaccinated women

If your treatment is temporarily deferred you will have the deferral time added back on to your treatment journey to ensure that no patient loses out on treatment.

Centres can, in some cases, seek to reduce the time between the first and second dose for you if you choose  and as soon as you are vaccinated you can start your treatment.

The Centres will also provide you with advice about vaccination to support your choice.

How long your treatment will be deferred or postponed

This recommendation will be kept under review.  It will be reviewed alongside emerging evidence of risk as well as the prevailing levels of COVID-19 during January and February 2022 to ascertain whether treatment of unvaccinated women should recommence, or whether a further deferral is no longer recommended.

If you have had your treatment deferred, you will be contacted as soon as deferral of treatment for unvaccinated women is no longer recommended.

Women who have had treatment deferred and who then become fully vaccinated will be able to continue on their treatment journey.  

The four NHS Assisted Conception Units across Scotland, and the Chief Medical Officer with the Scottish Government continue to work closely on this issue, in discussion with the patient support group Fertility Network UK.

Why can’t I choose whether to pursue treatment whilst unvaccinated

You can continue to choose whether to get vaccinated.  The recommendation to temporarily defer fertility treatment for unvaccinated women was made on the grounds of:

• safety due to evidence of increased risks of COVID-19 in pregnancy,
• uncertainties about the impact of the Omicron variant
• the high level of virus incidence at the present time  

Fertility treatment for unvaccinated women could put them at increased risk of severe disease from COVID-19 if their treatment results in pregnancy.

The Joint Committee on Vaccination and Immunisation (JCVI) has put pregnant women in a high-risk category.  The Royal College of Obstetrics and Gynaecology, the Royal College of Midwives, the British Fertility Society and the Scottish Government are all strongly advising vaccination, including boosters, for pregnant women.

The COVID-19 vaccines are safe and effective and NHS Scotland strongly recommends people get the vaccine when offered.  There is no evidence to suggest that the COVID-19 vaccines will affect fertility in women or men.  More information is available on this at Pregnancy, breastfeeding and the coronavirus vaccine | The coronavirus (COVID-19) vaccine (nhsinform.scot)

The British Fertility Society also strongly recommends vaccination prior to treatment.

The Human Fertilisation and Embryology Authority (HFEA) who regulate fertility treatment within the UK also recommends that anyone having fertility treatment has a vaccination because of the increased risks to mother and baby of COVID-19 in pregnancy.

It is safe to take the vaccine while having or planning fertility treatment

It is safe to take the COVID-19 vaccine if you are currently having or planning fertility treatment.

The COVID-19 vaccines are safe and effective and NHS Scotland strongly recommends people get the vaccine when offered.  There is no evidence to suggest that the COVID-19 vaccines will affect fertility in women or men.  More information is available on this at NHS Inform Pregnancy, breastfeeding and the coronavirus vaccine | The coronavirus (COVID-19) vaccine (nhsinform.scot).

The British Fertility Society and the Association of Reproductive and Clinical Scientists has said that there is absolutely no evidence, and no theoretical reason, that any of the vaccines can affect the fertility of women or men.

The recommendation to temporarily defer fertility treatment for unvaccinated women was made on the grounds of safety in light of evidence of increased risks of COVID-19 in pregnancy, the uncertainties about the impact of the Omicron variant and the high level of virus incidence at the present time.

Is all fertility treatment being deferred or only IVF

The recommendation is that all fertility treatment is deferred, not just IVF.  This is same for those having treatment with donor gametes, a surrogate and all other treatments including oral medication for ovulation induction.

The exceptions are treatment for fertility preservation for clinical reasons for example prior to commencing chemotherapy and donation of sperm or eggs.

Application of the policy to those self-funding treatment

The recommendation to temporarily defer fertility treatment for unvaccinated women was made on the grounds of patient safety in light of evidence of increased risks of COVID-19 in pregnancy, the uncertainty about the impacts of the Omicron variant and the high level of virus incidence at the present time.

These risk factors are the same for all patients seeking fertility treatment, therefore this recommendation applies to all fertility treatment carried out in NHS Centres or University Centres in Scotland. ​

Fertility preservation before medical treatment

You do not need to be vaccinated to have treatment for fertility preservation before urgent medical treatment, for example chemotherapy.

Providing evidence of your vaccination status

You should make sure you have a record of your vaccination status as this will be checked when you attend a treatment centre.

Accessing your Covid status

You can access your COVID Status through the free NHS Scotland Covid Status app on a mobile device.  For example, a smartphone.

You can also download or request a copy of your vaccination status online or by phoning the COVID Status Helpline on 0808 196 8565.

 

When deferral means you are over 40 when you get treatment

All patients having treatment temporarily deferred will have the deferral time added back on to their treatment journey to ensure that no patient loses out on treatment because of this recommendation.

Further deferrals

The treatment deferral recommendation is temporary and will be reviewed on an ongoing basis. 

Recommendations will be guided by the data and evidence and NHS Centres will keep their websites updated and will inform those patients affected should the situation change.

Shortening the time between vaccinations

It is possible, in certain situations and with clinical support, to reduce the gap between two doses of the Pfizer or Moderna vaccine to a minimum of 3 weeks as an exceptional case based on clinical need but still within the authorised schedule enabling treatment to move forward.  You should speak to your clinician if you wish to explore this.

Encouraging your partner to get vaccinated

We are encouraging everyone to be fully vaccinated although we recommend that treatment be deferred if the intended mother is not fully vaccinated.  The reason partners are encouraged to have the vaccination is because if they get infected, this will increase the intended mother’s risk of infection, even if they are vaccinated.

If you are infected you will need to isolate and will not be able to come to the Centre for monitoring/ treatment, so the advice is based on reducing the risk of disruption to your treatment.

Supporting you if treatment is deferred

We appreciate that this may be difficult news for you and we know that undergoing fertility treatment can be an emotional experience for an individual or a couple.  Each Centre has counselling services available to all patients who require this service. Please contact your Assisted Conception Unit by email for further information.

Taking the vaccine when donating or planning to donate eggs or sperm

COVID-19 vaccines do not contain any virus and so you cannot pass on COVID-19 by receiving the vaccine.  The Human Fertilisation & Embryology Authority state that you must allow at least 7 days from the most recent vaccination prior to donating eggs or sperm.  Ovarian stimulation for egg donors can start once 7 days have passed.  If the donor feels unwell after the vaccination, they must not donate for 7 days after their symptoms have got better Frequently asked questions for patients on Coronavirus (COVID-19) | Human Fertilisation and Embryology Authority (hfea.gov.uk)