Following the Government announcement on 4th January of a third COVID-19 National Lockdown, we want to reassure all our patients that the Agora Clinic remains open and continues to offer all investigations and treatments in our COVID-safe environment. In his statement, the Prime Minister has confirmed that all medical treatments will continue as normal.
We continue to monitor carefully all guidance published by the HFEA, The Royal College of Obstetricians and Gynaecologists, The Joint Committee on Vaccination and Immunisation and Public Health England.
Our mission is to ensure we minimise any risk of COVID to our staff and patients and their future babies and also to listen to your queries and concerns so that we can support and guide you in your all your decisions. The arrival of the two new COVID vaccines in the last few weeks has prompted a lot of questions from the TTC community.
Currently the key issues facing patients regarding the COVID vaccine are:
- Should I have the vaccine if it is offered to me?
- Should I delay my fertility treatment if I am offered the vaccine?
We believe in advising every patient/couple according to their individual circumstances so that they can make an informed choice and are fully aware of the pros and cons of that choice. Below we have set out the current guidance from the key bodies, which we will update as guidance changes. We have followed this with our own guidance which we will of course always discuss on a one to one basis with our patients as we understand everyone’s situation is different.
Guidance from the HFEA
On the 5th January 2021 the HFEA released the following statement:
‘As the UK wide regulator of fertility clinics, we consider fertility clinics can continue to safely offer treatment during the latest lockdown.
Treatment at some clinics may be affected by the pandemic due to local circumstances, for example where there are a lot of clinic staff who are ill or isolating, or where staff have been redeployed to other areas within the heath service.
Patients should keep in contact with their clinic who can update them on any changes to their services.
We expect clinics to continue to follow professional and local guidance and let us know immediately if there is a local decision to suspend the services they provide.
We will review any new guidance produced by the Government and devolved administrations, the NHS and Professional Societies and make further statements as necessary’.
Guidance from The Royal College of Obstetricians and Gynaecologists (RCOG)
On the 30th December 2020 the RCOG published their latest advice on ‘COVID-19 vaccination in pregnancy and women who are breastfeeding’:
‘The Joint Committee on Vaccination and Immunisation (JCVI) confirms that although the available data do not indicate any safety concern or harm to pregnancy, there is insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy.
However, the JCVI now advises that if a pregnant woman meets the definition of being clinically extremely vulnerable, then she should discuss the options of COVID-19 vaccination with her obstetrician and/or doctor. This is because their underlying condition may put them at very high risk of experiencing serious complications of COVID-19. The most likely relevant groups of pregnant women are:
- Solid organ transplant recipients
- Those with severe respiratory conditions including cystic fibrosis and severe asthma
- Those who have homozygous sickle cell disease
- Those receiving immunosuppression therapies sufficient to significantly increase risk of infection
- Those receiving dialysis or with chronic kidney disease (stage 5)
- Those with significant congenital or acquired heart disease
Additionally, pregnant women who are frontline health or social care workers, including carers in a residential home, can also discuss the option of vaccination. This is because the risk of exposure to COVID-19 may be higher, even if they have a lower risk of experiencing complications if they are otherwise well.
The benefits and risks of COVID-19 vaccination in pregnancy should be discussed on an individualised basis. This should include a discussion around the lack of safety data for these specific vaccinations for pregnant or breastfeeding women, and an acknowledgement that there is no known risk associated with giving other non-live vaccines to pregnant women’.
Guidance from The Agora Clinic based on the above and other published information
Neither of the vaccines currently available in the UK (AstraZeneca Oxford or Pfizer) are ‘live’ vaccines. Therefore it is unlikely that there would be an adverse effect on a developing fetus following vaccine administration.
However, as the longer term safety data is not yet available for either vaccine (unlike the ‘flu vaccine which has been extensively studied and is encouraged in pregnancy), caution must be observed when considering COVID vaccination in women who are trying to conceive as we know that both vaccines require two doses given 4 – 12 weeks apart to be fully effective.
The main issue if you are having fertility treatment is around whether the second dose might have to be given once you have conceived and are in the early stages of pregnancy.
If you fall into the vulnerable high risk category, or you are a frontline health or social worker, our advice is to have the COVID vaccination and, following the first dose, to delay the start of your fertility treatment until the second dose has been administered. This guidance may change as more data about the safety of these vaccines in early pregnancy becomes available.
The decline in fertility observed over a 2 to 3 month period in any individual, irrespective of age, is relatively small and on balance we believe it is safer to delay fertility treatment if there is a clear benefit of having the vaccine sooner rather than later to protect that individual against COVID. Please note, the Government has not advised those conceiving naturally not to attempt conception if they wish to be vaccinated. However, we are mindful of the huge burden of infertility on our patients and the many difficult decisions many will already have taken. This is why we wish to express caution when advising on this relatively new vaccine on which the long term safety in pregnancy has not been properly evaluated.
If you wish to be vaccinated, and also wish to proceed with fertility treatment before your second dose of COVID vaccine has been given, this would be against the advice of the Medical team at Agora. We cannot take responsibility for any adverse, as yet unknown, effects of the vaccine on either yourself or the developing baby.
For clarity, the advice of the Agora is to be vaccinated if you fall in one of the high risk categories or you are a front line health or social worker and to delay your fertility treatment until the second dose of vaccine has been given. You can then start your treatment without further delay.