In the second week of March, Emily Robichaux was about to begin her third round of IVF. Her fertility treatments had been put on hold due to a coronavirus. [She was married at 36 and had to have a myomectomy at 38 before starting IVF. She said, "My biggest problem is that I'm 39½ and [the coronavirus] isn't going to go away anytime soon. I know it's hard for all women, but especially for older women. We are in a race against time."

By the following week, most fertility clinics across the country had followed suit and canceled all new treatment cycles, following guidance issued by the American Society for Reproductive Medicine (ASRM) on March 17. The society recommended that its more than 8,000 members cancel all new treatment cycles for IVF, IUI, and egg freezing. It also recommended that clinics consider suspending all embryo transfers, non-emergency surgeries, and diagnostic procedures because of a public health emergency and very limited data on the impact of COVID-19 on pregnancy, especially in early pregnancy. The unknown risk of COVID-19 for pregnancy has made fertility professionals hesitant, especially with the possibility of miscarriages and complications in pregnancies that have taken years to achieve.

The guidelines (which ASRM reviewed on March 30 but made no changes) include several exceptions: women already taking ovarian stimulants in the middle of an egg cycle should be allowed to terminate. Extremely urgent cases, such as egg freezing for a woman scheduled to undergo chemotherapy, also qualify.

"The guidelines were intentionally time-stamped to reduce the stress associated with uncertainty. Jennifer Kawas, M.D., medical director of the Emory University Reproductive Center and a member of ASRM's COVID-19 Task Force, said. 'If at all possible, we want to make sure this situation doesn't continue for much longer. The idea is not to stop all fertility treatments until the coronavirus is gone from the U.S., but to slow this curve."

Unfortunately, the health crisis has become more severe in the past two weeks. For women who have been waiting years to conceive, being told to postpone treatment indefinitely can be painful. Insurance companies often impose additional conditions on women over the age of 40 and may refuse to pay for treatment if they deem a patient's chances too bleak.

Amy Schmidt Zook, a 43-year-old ER physician who lives in Fort Worth, Texas, with her husband and two children, had an egg retrieval two days before the new protocol went into effect. One of the embryos retrieved was viable and will be frozen until embryo transfer is resumed.

"We keep hearing that it's not life or death, but for us it is, in a way. It's the difference between having a living child and not having a living child," she says, adding that at age 43, the egg curve for a fertile egg is like a steep cliff, and a month or two can make a huge difference, and that's when the "life and death" part comes in. Some clinics won't even treat a number like mine."

"They don't say anything about limiting pregnancies," Zook adds.

"But for infertile people, it's about keeping your head down and being a good soldier."

Many other women suffering from infertility also take issue with the fact that pregnancy is not generally advised and there is no evidence that pregnant women are susceptible to COVID-19 (open in new tab). Based on the very limited data currently available, it is highly likely that the disease is not transmitted in utero, during delivery, or while breastfeeding. Indeed, there is much speculation that the shelter-in-place order will lead to a baby boom - a situation that will rub salt in the wound - for women who are forced to discontinue treatment.

Among those opposing the guidelines is Beverly Reed, M.D., a fertility doctor at IVFMD near Dallas, who has started a petition to ASRM asking for changes to the guidelines; as of April 8, over 13,900 people have signed the petition.

Reed, a self-described "rule follower," immediately began calling patients to cancel treatment, but one of those calls made her think twice. 'They asked a lot of good questions,' she said. 'Is it because the coronavirus causes birth defects?' One woman said, 'Is it because coronaviruses cause birth defects? Because coronaviruses cause birth defects? And she said, 'Are all women told not to get pregnant? I said, 'No.' And she said, 'Then why do I have to get pregnant? And she said, 'Then why me?' "And then I saw the coverage of the spring break beach (opens in new tab), and I was so angry," Reed continues.

"Seeing them ignore the guidelines of social distancing made me unable to give even the most basic treatment to my patients."

Reed wants the ASRM to give physicians free reign to consider individual cases and circumstances. Practices are not obligated to follow the guidelines, she argued, but few physicians, herself included, would be willing to disobey the society's recommendations.

"I think we have very mixed feelings as medical professionals. A friend of mine said, 'It's sad to think about the babies that are not born because they don't have access to reproductive health care.'"

Lucky Sekhon, M.D., a reproductive endocrinologist and infertility specialist at Reproductive Medicine Associates of New York, agrees with the guidelines but says, "I shudder to think of my patients."

"I understand the gravity of what is happening in New York City hospitals. We are about to reach a critical shortage of doctors and nurses, and everything has to be directed toward that effort," she says. But I don't see infertility as selective. But I don't see infertility as selective. Giving women the opportunity to conceive is a priority. But it is not essential in the early stages of this crisis."

Even for women who fully agree to abort, the pain is not small. One Boston-area patient who voluntarily agreed to postpone an embryo transfer for which she was already on medication at the urging of her doctor is struggling to see light at the end of the tunnel.

"I was at the hospital right before all this happened and the tent was up, so I know what it's like," she says. 'But it's really hard. We've come so far and we don't know when it's going to end."

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