We have been living with this pandemic for the past 4-5 months and have started looking at things with a COVID attitude. Our thought process, behaviour and actions have all changed drastically after this pandemic started. The idea behind this article is to highlight the importance of fertility and contraception during these difficult times and also to suggest ways to manage them.
Fertility and contraception are two ends of a spectrum. There have been quite a few planned and unplanned pregnancies during this lockdown period.
A few couples who had been trying to conceive, either naturally or through treatment, have conceived spontaneously during this pandemic. Some are very happy, but others are in a state of panic because they are worried that this virus might cause problems for the mother and the baby.
The most cited reasons for pregnancies are that the couple are spending all the time at home and also less stress as there is no travel to work. Stress has a major impact on fertility as all our Hypothalamic and pituitary hormones have to work optimally to stimulate the ovaries to produce follicles with eggs. Similarly, stress has a major effect on male fertility and sexual performance as well.
The couples are concerned about the effect of this pandemic on the health of the mother and the baby. Their main concern is about pregnancy complications due to COVID-19 and any fetal structural anomalies (problems of the internal organs like brain, kidneys, heart, lungs, limbs, etc.) that might happen to the fetus due to this virus.
As of now, from whatever studies and cases that have been reported and described, the effect of this infection on pregnancy is similar to non-pregnant women and no major congenital anomalies have been reported so far. Only time will tell us about the long-term effects as more studies are being done in different populations across the globe.
THERE IS NO EVIDENCE AVAILABLE TO SUGGEST TERMINATION OF WANTED PREGNANCIES JUST BECAUSE CONCEPTION OCCURRED DURING THIS PANDEMIC.
So, couples can continue pregnancies and can have regular antenatal check-ups and care even during this pandemic as we have been doing for the past 4-5 months.
We have seen a considerable rise in unplanned or unwanted pregnancies during this pandemic and many are seeking medical termination of pregnancy. The reasons for unplanned conceptions include the scarcity of contraceptive choices and the inability to seek medical help for contraceptive choices due to the lockdown. As women’s health care providers, we assure you that we are happy to give you contraceptive advice in person as a physical consultation in hospitals or clinics and we even offer telephonic consultations regarding the appropriate choices for the couple based on their medical condition and suitability. Many women are presenting late in pregnancy even though they know that they are pregnant and they are not keen on continuing the pregnancy due to the fear of visiting hospitals. Medical termination of pregnancy can be done with tablets only up to 7 weeks. After 7 weeks, dilatation and curettage might be required.
Medical termination of pregnancies can be avoided if contraceptive methods are used routinely. The couples who intend on undergoing permanent methods of sterilization like tubectomy for females or vasectomy for males can also get them done. All procedures follow hospital protocols for admission and COVID testing.
We have started fertility procedures after a brief lockdown break. Age of both partners is the most important determinant of success for fertility treatment. Age, reason for infertility, medical risks, financial status and readiness matter a lot in seeking treatment. All COVID precautions are being followed during all steps of treatment to ensure the safety of the couples and the health care providers. COVID might not disappear in near future.
PLANNING PREGNACY OR SEEKING HELP REGARDING TREATMENT SHOULD BE THE COUPLE’S CHOICE.
We do counsel them regarding the implications of waiting for treatment and the risk of infection and its implications. Many couples have come forward after understanding completely the pros and cons of getting treated during this pandemic. We support any conscious decision taken by the couple for their safety and well-being.
We have seen a lot of couples seeking help with conception of the second child. The main reason being company for the first child. In many houses, with both parents working and grandparents staying in hometowns, the child is bored after 2 hours of online school classes. Entertaining the child and keeping them away from screens have become a herculean task for the parents. With every extracurricular class like drawing, music and dance happening online, the screen time of our children has increased considerably. The child seeks company from someone of their generation to play with and to be a part of their upbringing.
There have been a lot of changes in our lives after this pandemic started and it has impacted each and every one of our lives in one way or the other. Maternity services have been going on without any interruption adhering to COVID-19 precautions. All other women’s health care services have begun after a brief break. We still emphasize the need for following universal precautions for COVID at all times as we cannot take this pandemic lightly.
STAY HEALTHY! STAY SAFE!
Dr Karpagambal Sairam, DGO, DNB, MRCOG (London)
Consultant Obstetrician, Gynaecologist and Fertility Specialist
Kauvery Hospital, Chennai