Rachel Shapiro, a Manhattan-based fertility coach who gives advice to women seeking these treatments, said that these discrepancies heighten an already existing “us versus them mentality.” Shapiro says that for women who have difficulty conceiving, there are constant hurdles to overcome and many are filled with health anxiety that is only relieved only when they are holding their baby in their arms. For them, she says, there is “frustration, anger, and a period of reckoning with their newfound challenges of becoming pregnant” that other women don’t experience.

Shapiro herself has also been struggling with infertility for the past five years. This March, she also had the misfortune of being hospitalized with Covid-19. As someone who experienced that illness in New York City, the epicenter of the outbreak, she thinks the moratorium was a good move. “Infertility is painful, challenging, and full of grief, but it will not take your life. Covid potentially could, and for me that’s where the line is,” she says. One of her concerns, Shapiro adds, was that a miscarriage midway through an IVF procedure could divert precious supplies and staff away from dying Covid-19 patients during a surge.

Overall, there’s no clear ruling yet on whether pregnancy carries extra risks in the Covid-19 era. A statement on the website of the American College of Obstetricians and Gynecologists says that “individuals need to make their own decisions based on their unique needs, desires and values.” The statement cautions that the pandemic could result in reduced access to care, and goes on to say that the currently available—albeit limited—data does not indicate that pregnant women are at an increased risk of Covid-19 infection or severe morbidity compared with other women. But it does warn that other respiratory infections have posed serious threats to pregnant women.

Williams echoes these sentiments, and notes that studies of flu infection during pregnancy have shown it can increase the risk of miscarriage, premature birth, and low birth weight. But he points out that despite these known risks, nobody recommends avoiding pregnancy during flu season.

At the Generation Next Clinic in Manhattan, fertility specialist Edward Nejat made the difficult decision to stay open throughout the pandemic, although during most of March he was not offering all services. He tried to prioritize the women with the most need: In general, younger women who have more eggs could afford to wait a couple extra months, but for older women, the delay could diminish their changes of becoming pregnant. Nejat said he had one-on-one conversations with his patients to hear their concerns and explain the risks, both what was known and what was not, so each decision of whether or not to pause was made on a case-by-case basis. But even though he stayed open to suit the needs of those for whom waiting was not an option, he ultimately saw a 95 percent drop in patient volume. “Patients were terrified,” he says. “And rightfully so.”

On April 24, the ASRM updated its guidelines and advised fertility clinics to start reopening with careful procedures in place to prevent the spread of Covid-19. For Williams, this means many changes to the way the Columbia Fertility Clinic is managed. Everyone wears a mask, there are temperature checks for all patients and staff, and patients must take Covid-19 tests prior to the initiation of treatment. If they test positive, their treatment is delayed.

Nejat says he also had to make many changes “almost overnight” to the way his practice is run. Now there are self-check-in stations, appointments are spaced out to avoid crowding in the waiting room, they use telemedicine whenever possible, and patients and staff are required to answer questionnaires prior to entering the office about possible symptoms. “It is amazing how much can be done remotely,” he notes.

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