COVID-19 Vaccines and Fertility

As the COVID-19 pandemic continues, questions continue to arise about whether the vaccines pose risks to those who are pregnant or who are planning to have a baby. The Centers for Disease Control recommends that everyone age 12 and older get the vaccine. In an interview with Consult QD, Elliott Richards, MD, Director of Reproductive Endocrinology and Infertility Research at Cleveland Clinic, encouraged healthcare providers to underscore the significant risks of contracting COVID-19, especially as the highly transmissible Delta variant sweeps through unvaccinated populations.

What does the most recent data tell us about the safety of the COVID-19 vaccines for pregnant women and those who are trying to become pregnant? Has the science changed over time?

It is a common question in my practice: Is the vaccine safe for pregnancy and fertility?

Many patients have questions and concerns about the vaccine, and in some cases, deep suspicions and fears. But I often will ask them to forget the vaccines for a moment. The better question is to ask: Is COVID-19 safe for pregnancy and fertility? And the answer is a resounding NO!

Even in overall healthy, young populations, COVID-19 can have long lasting effects on one’s lungs, brain, joints, GI tract and, yes, fertility. Pregnant patients with COVID-19 are at increased risk for severe complications, leading to ICU admission, intubation/ventilation and death. In addition, babies born to women who become infected with COVID-19 are more likely to be born premature, have lower birth weights, and experience severe complications including hypoxic-ischemic encephalopathy, blindness associated with prematurity, and intraventricular hemorrhage.

With the rise of super virulent forms of SARS-CoV-2, we are seeing increased hospital admission rates nationwide, even in populations such as young children, who we previously thought were relatively safe in the pandemic. Every discussion about COVID-19 and the vaccines should put the seriousness of this pandemic in context.

Realizing that COVID poses a real threat to pregnancy and fertility, this then leads to a second important question: How can I protect my fertility and my pregnancy from COVID-19?

And the answer is, of course, as many ways as you can.

I have had patients discredit vaccines, masking and social distancing because one or some combination of these measures was not enough to prevent illness for them or a family member. It is perhaps tempting to label these in black-and-white terms as either wholly effective or ineffective. But they aren’t either.

Each of these options confer varying levels of protection. A prior infection with COVID-19 provides some level of protection, but not absolute protection. That is why I recommend vaccination to all my fertility patients, even to those with a prior infection, and I recommend masking even to those who have been vaccinated.

To answer the original question: There was never any scientific basis — or even biologic plausibility — for the idea that the COVID-19 vaccines, including the mRNA vaccines, might cause problems with fertility or pregnancy.

Specifically, it is worth mentioning that neither the mRNA vaccine nor its byproducts have any relationship to syncytin-1, a critical component of syncytriotrophoblast development, which was at the heart of widely distributed misinformation on social media that the vaccines cause sterilization. Being composed of messenger RNA, these vaccines do not contain any live virus particles, are not able to modify DNA, and are only able to provide instructions for the body on how to make a portion of the SARS-CoV-2 glycoprotein.

Compared to other types of vaccines, the mRNA vaccine is a simple, elegant system with an extremely low likelihood of off-target effects. It is a triumph of modern medicine and engineering, and it is not hyperbole to assert that its development is one of the greatest achievements of humanity to date.

During the rollout of the vaccine over the past year, monitoring systems have consistently shown no safety concerns in pregnancy. Studies of semen parameters show no changes following vaccination. Now, with the release of the data from the v-safe pregnancy registry in early August 2021, we can be confident in the assertion that COVID-19 vaccines are safe in early pregnancy.

To put that in context: Earlier this year, many professional societies used somewhat vague language that the vaccine shouldn’t be denied to pregnant patients. This month, the CDC has come out and explicitly stated that pregnant patients should receive the vaccine as soon as possible.

Timing considerations

Are there still questions that remain unanswered or that need to be put to rest? Are there times during fertility treatments that are better or worse to be vaccinated?

Earlier in the pandemic, I would often recommend that patients delay embryo transfer or pregnancy attempts until vaccination was completed (particularly the second dose of the mRNA vaccines) due to the concern that a febrile response to vaccination could theoretically affect early fetal development.

I worry more now that some patients might take this advice to delay vaccination. The best time to get vaccinated is now. It doesn’t matter where you are in your fertility journey, what fertility treatments you are contemplating or taking, get vaccinated now. Especially with the rise of the Delta variant, there are no known downsides to the COVID vaccine and plenty of downsides to the disease.

Future fertility

One of the concerns was about whether the vaccines could affect fertility in the future. Has this concern been shared by physicians as well?

I think it is telling that physicians are among the highest vaccinated groups, and advocates for women’s health and fertility have been some of the loudest voices in support of the vaccine. Given the mechanism of how they work, there is simply no reason whatsoever to suspect that vaccines will affect future fertility. On the other hand, there are many real concerns that COVID-19 can affect fertility in the future.

Are the mRNA vaccines preferred over the adenovirus vaccines for any fertility-related reasons?

Both are safe for fertility and pregnancy.