How does COVID-19 affect fertility and fertility treatments?

We’ve been getting a lot of questions from our Ovally community on how COVID-19 might affect fertility, as well as access to fertility treatments in the US and in Europe. But before we dive into this content, we’d like to send our heartfelt well-wishes to you, dear readers, and hope you and your loved ones are healthy and safe. For the purposes of this post, we’ll stay focused on fertility; if you’re looking for more detailed information on COVID-19, here’s the latest from the CDC. We’ll keep updating this post as more information becomes available.

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Should we do intracytoplasmic sperm injection (ISCI)?

With more and more Ovally patients undergoing IVF, we’ve been focusing on how to best support you and ensure you’re fully informed to make treatment decisions that are right for you. Intracytoplasmic sperm injection (ICSI) is often a part of IVF that isn’t discussed much in doctor’s appointments. It is a fertilization technique that has been used during in vitro fertilization (IVF) since the early 1990s. A single sperm cell is selected and injected directly into an egg. ICSI stands in contrast to conventional in-vitro fertilization, when a mature egg is combined with a sample consisting of many sperm, allowing natural fertilization to take place. Many fertility clinics, particularly in the US, now use ICSI for any IVF procedure, or recommend and charge an extra ~$1.7k on average for ICSI to be performed. That’s why we dove into the research to identify when it’s advantageous to use ICSI, and what potential risks or downsides there are to consider.

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The diagnoses behind fertility issues (2/4): Diminished ovarian reserve

Earlier this year we began looking into the diagnoses behind fertility issues, starting with ovulatory dysfunction. In this post, we’ll be digging into the most common diagnosis, “diminished ovarian reserve”, affecting 31% of cases in the CDC’s report, which is based on ~260k IVF cycles performed in the US. Diminished ovarian reserve does not only affect IVF treatment but any kind of fertility (preservation) treatment, making it particularly relevant for the Ovally community.

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How can PCOS affect fertility, and which treatments are most effective?

In our previous post about PCOS, we talked about its common symptoms and diagnostic criteria. One of those symptoms are infrequent or missing periods and irregular or missing ovulation, which interfere with the ability to conceive. According to the CDC, 16% of diagnoses in patients with fertility challenges are due to issues with ovulation. Below we’ve summarized the literature on PCOS and fertility treatments to give you an overview of how issues with ovulation can be overcome most effectively.

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Can I drink alcohol before or during fertility treatment?

The question of drinking before and during fertility treatment tends to bring out strong opinions. It also comes up a lot with our Ovally customers: “Can I have at least a little Spanish wine during treatment?”. For the purpose of this post, we are going to focus on alcohol consumption before and during fertility treatment until conception only, and leave out any research on pregnancy and alcohol. As usual, check with your doctor on their guidance regarding alcohol intake during any fertility treatment. We’re summarizing the findings of high-quality research studies for you, but your doctor may have access to relevant, yet to be published findings.

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How does exercise affect my fertility?

We’re surrounded by positive messages about exercising, yet there are surprisingly few quality studies that have looked at a potential link between exercise and fertility. We know that female athletes often have irregularities with their cycles, and that high levels of exercise seem to be associated with longer menstrual cycles. Research on fertility patients has been inconclusive – one study showed that moderate exercise was correlated with a lower likelihood of having a baby, another showed the opposite.

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How does my doctor figure out if my egg freezing or IVF cycle will be successful?

Doctors perform a series of tests and ask a number of questions as you prepare for and undergo the stimulation phase of egg/embryo freezing or IVF. These tests and questions help determine whether you’re a good candidate for the procedure, whether you’re able to proceed or have any risks, and what your outcomes may be. To make the process a bit more transparent, we’ve included some of these questions below (note that they’re neither comprehensive nor prescriptive). Keep in mind that every doctor will have their own protocols, and we recommend asking them about their process:

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Why might an egg freezing or IVF cycle result in few or no eggs?

It’s always heartbreaking when an egg freezing or IVF cycle does not work, or the outcome isn’t as good as you’d hoped. Even though Ovally patients complete a battery of pre-treatment tests to make sure to the extent possible that they’re a good candidate for the procedure, these tests still cannot rule out some risks that a cycle might be unsuccessful or less successful, with either no or few mature eggs retrieved. Below are some examples of such situations that we’ve observed, backed up by scientific literature. These examples are not comprehensive, and we advise you to always ask your doctor for what risks might exist in your specific case.

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Can my diet improve fertility outcomes?

Relatively clear answers and quality research can be hard to come by in fertility research. However, when it comes to how food relates to fertility outcomes, there are some decent data! The short answer is: Avoid fast food, and instead embrace fruits, vegetables, legumes, fish, whole grains, and foods high in omega 3, such as nuts. This goes not just for women undergoing fertility treatment, but also those hoping to conceive naturally. This “Mediterranean diet” has also been linked to higher sperm count and sperm quality in men. And yes, the literature actually refers to it as a “Mediterranean diet” – we swear we didn’t make it up because Ovally‘s partner clinics are in Spain :)!

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Does drinking coffee or tea affect fertility?

“Can I have caffeine before and during my treatment?” is a great question we’ve gotten from our egg freezing and IVF Ovally customers. As is so often the case, the research on this question isn’t as clean and clear-cut as we’d like: It’s hard to separate out variables besides caffeine that can affect fertility outcomes, and many studies rely on retrospective self-reports of consumption, which can be unreliable. However, high-quality studies looking at a relationship between caffeine consumption and the ability to conceive during IVF treatment suggest that 1-2 cups of coffee per day don’t significantly affect the ability to conceive. Surprisingly, however, 1-2 cups of coffee a day (or the equivalent level of caffeine in another drink) have been found to double the risk of miscarriage during pregnancy.

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