What happens to people with infertility during a pandemic?

knitted baby shoes on an outside step

By Mimi Sager Yoskowitz
@mimisy4

Dr. Eve Feinberg helps people become parents. As an infertility specialist, she’s used to dealing with uncertainty and overcoming obstacles. Yet like so many of us, Dr. Feinberg has had to reimagine how she works in the new world order brought about by Covid-19. I spoke with Dr. Feinberg about how she’s navigating the ever-changing world of Covid-19.

Mimi Sager Yoskowitz: Right now, healthcare is at the forefront of the battle against the novel coronavirus, but your specialty has really had to alter its structure. How have things changed for you? 

Eve Feinberg: Dramatically. On March 17, the American Society for Reproductive Medicine (ASRM) came out with guidelines on how to provide care for infertile patients in the era of the Covid-19 pandemic. The recommendations were pretty firm and really adherent to the principles that are outlined by the CDC: a pause in fertility treatment, except the most urgent, was recommended. I was one of 17 members on the Covid-19 task force.

IVF is a huge part of my practice. I typically operate once or twice a month. My surgeries had been postponed with the exception of cancer patients or those who require surgery to remove their reproductive organs. We typically do face-to-face visits. I have gone from seeing patients in a busy downtown academic medical center to seeing patients electronically from the privacy of my own home.

The ASRM has now subsequently revised the recommendations to release the pause and to resume care safely and methodically to mitigate the risk of disease. This means a slower pace of practice and continued telehealth for the foreseeable future. So needless to say, lots has changed. 

MSY: You work with a population where time is of the essence. What was it like for your patients when you told them that their plans had to be put on hold? 

EF: There’s the emotional reaction to that, and then there’s the factual reality of it. Emotionally, this was an incredibly difficult guideline to share with our patients. Infertility is a huge priority. Many patients felt like this is unfair. But the data-driven answer is that fertility doesn’t change that rapidly, and a three-month delay is not truly going to impact someone’s likelihood of achieving a pregnancy. There have been multiple studies comparing women going straight to IVF versus women who are doing less aggressive therapy for three months or for six months. Ultimately the success of IVF was no different between those groups. I think it’s really important to explain to patients the actual difference in data over time as well as the rationale for recommendations both to pause and slowly resume.

MSY: How have you been helping to manage any disappointment your patients might be feeling during this surreal period? 

EF: With patients, a lot of it is maintaining expectations, which as a fertility specialist is a lot of what I do anyway. I take care of an incredibly thoughtful population of patients and for the most part they have endured this additional hurdle remarkably well. This is a group that is very used to adversity and they are very skilled in dealing with adversity; I have been really touched by the tenacity, willingness to work together, and the overall positive attitude of my patients. Part of what I love about my field are the extraordinary people I take care of, which has continued to really inspire me as I’ve had these conversations about next steps, staying healthy and enduring through this additional challenge. 

MSY: Is there anything patients can do right now as they navigate this additional waiting period in their journey to have a baby? 

EF: This should be short term and the capacity for practices to care for patients is slowly increasing, and it’s a good time to optimize health in other ways. So for patients who may need to lose weight before pursuing fertility treatment, this can be a really good opportunity to get some exercise and focus on weight loss, something that we often think about but don’t have the time to devote to it. It can be a good opportunity for patients to learn a little bit more about the field of reproductive medicine. There are some good online courses that are offered through the American Society of Reproductive Medicine or there’s a Web Site called fertilityiq.com, and they’re offering a lot of educational courses. It’s a good time to get some basic information on fertility and to get more of an understanding of what it entails. 

MSY: As a physician, what is your biggest fear right now during this pandemic? 

EF: Dying. I mean really. I’m young-ish, I’m 45, I’m healthy, I’m a runner, I’m fit. But I have colleagues who are equally healthy and fit, who have gotten very sick. I took the time over the weekend to go through my will and my life insurance, and make sure that our finances were in order, and make sure that my husband knew all of my passwords to everything. As a physician and as a health care professional, while I’m not on the front lines in the emergency room taking care of many Covid patients, I am in the emergency room taking care of gynecology patients, and may have exposure to Covid there. Also, as our offices have re-opened, I will likely be exposed to patients who are asymptomatic carriers. While we take lots of measures to prevent transmission, being a physician is a very real risk.  

MSY: You mention your husband and making sure you have your affairs in order. Being the mother of three kids, how has this whole situation affected your role as mom outside of the medical world? 

EF: I’m trying to maintain a sense of optimism, trying at home to maintain a sense of normalcy and routine. I try to get my kids to bed at a reasonable hour, and get everyone up at a reasonable hour. As much as possible, I’m trying to keep everybody eating well, exercising, feeling well and just consistency in our daily activities. 

Dr Feinberg practices clinically at Northwestern Memorial Hospital in Chicago where she is on faculty as an associate professor at the Feinberg (no relation) School of Medicine. She serves on the national level as the President for the Society for Reproductive Endocrinology, and is on the Executive Board of both the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine. She is a member of the Society’s Covid-19 Task Force. Dr. Feinberg and her husband of 20 years reside with their children, a teenage daughter and 10-year-old twins, in a suburb of Chicago.

Mimi Sager Yoskowitz lives outside of Chicago where she and her husband raise their four kids. When not tending to them, she writes and conducts interviews, connecting with people through their words and her own.

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