On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. A little over three years later, on May 5, 2023, the WHO Director General accepted that COVID-19 no longer fits the definition of a pandemic - the disease is now well established and ongoing.
One might think COVID-19 vaccinations are no longer needed. In fact, the USA CDC and UK NHS continue to recommend pregnant patients remain updated with their COVD-19 vaccinations. Especially in colder climates when people spend more time indoors, OBGYNs will want to speak with their pregnant patients about COVID-19 risks.
Although research has found no risk to fertility for vaccinated people, OBGYNs and fertility specialists may be asked to explain the science behind the COVID vaccines, answer patient questions and debunk common myths.
Advising Patients on COVID-19 Risks
Thoroughly informing patients about COVID-19 symptoms and how it spreads is one of the best strategies for avoiding — or at least slowing down — transmission.
When an infected person breathes, coughs, sneezes or speaks, the virus spreads in respiratory droplets to smaller aerosols. Remind patients that if they are sick, it is critical to adopt respiratory etiquette — such as coughing into a flexed elbow — and self-isolate until fully recovered.
In general, advise patients, including those who are vaccinated, to stay at least 3 feet away from others, wear a well-fitted mask and wash their hands frequently. OBGYNs and other physicians can also play a role in helping patients overcome vaccine hesitancy. Advise all patients to get fully vaccinated, including the booster.
COVID-19 Vaccine Overview
Many patients do not understand how vaccines work, and fear of the unknown is incredibly powerful. Remind patients that various available vaccines aid in the development of immunity without transmitting COVID-19 itself.
Currently, the Centers for Disease Control and Prevention (CDC) reports there are three types of vaccines approved, permitted for use. Each provides protection in different ways, but all leave the body with B-lymphocytes and T-lymphocytes that help fight the virus in the future.
An mRNA vaccine contains material from the virus that causes COVID-19, which instructs the cells to manufacture a harmless, virus-specific protein. After making copies of the protein, cells destroy the vaccine's genetic material.
Protein subunit vaccination, instead of the full germ, contains harmless proteins of the virus that causes COVID-19. Once vaccinated, the immune system recognizes the protein should not be there.
Finally, a vector vaccine contains a viral vector — material from the virus that causes COVID-19. Once the viral vector enters cells, the genetic material instructs the cells to produce a protein specific to the COVID-19 virus. Cells create copies of the protein using these instructions.
It is important to note that no vaccine completely prevents infection. However, they reduce the likelihood of severe outcomes.
Myths Surrounding COVID Vaccines and Fertility
Some patients worry the COVID-19 vaccines or boosters will lead to loss of fertility. According to a survey on vaccine misinformation conducted by Indiana University, about a quarter of respondents believe the CDC is "definitely or likely" covering up a supposed link between the vaccines and female infertility. There is no evidence the CDC hides any medical information, about vaccines or any other topic.
The origin of fertility and vaccination myths is complex. Some patients may have developed concerns after they experienced irregular menstrual periods after receiving the shot, according to NPR. Others may have come across a viral article spreading the rumor that exposure to vaccinated people was responsible for complications of the reproductive system in someone else. A competing myth claimed that the vaccine also attacks the syncytin-1 protein in the human placenta.
Even patients who do not believe these specific myths may be anti-vaccination or waiting for more studies and testing on COVID-19 vaccines to come to light. Physicians can play an important role in offering their patients the facts on vaccines to counter any misinformation they may have heard or read.
Discussing Vaccine Myths With Patients
In February 2021, the American Society for Reproductive Medicine (ASRM), American College of Obstetricians and Gynecologists (ACOG), and Society for Maternal-Fetal Medicine released a joint statement reassuring the public that no loss of fertility has been documented in human or animal clinical trials and is "scientifically unlikely."
OBGYNs and fertility specialists can prepare a short primer for debunking the most common myths with patients.
Myth #1: mRNA Vaccines Are New Technology
mRNA vaccines are not new; the first human study of an mRNA vaccine began in 2006. Although newer than other delivery methods, they have been used to fight Ebola, Influenza, HIV-1, rabies and Zika long before the COVID-19 pandemic. During all this time, no effects on fertility have been reported.
Myth #2: mRNA Vaccines Change DNA
mRNA never penetrates the nucleus where DNA is stored and therefore cannot impact your DNA. mRNA stays in the body only long enough to deliver instructions and is then destroyed.
Myth #3: Vaccines Have Not Been Tested on Pregnant People
Both the CDC and Canadian COVID-19 Vaccine Registry maintain voluntary counts of pregnant people who have been vaccinated. Neither shows long-term adverse effects. Further, an August 2021 article published in JAMA confirms that any impacts are short term. As of September 2021, the CDC reports that 31 percent of pregnant people in the U.S. have received the COVID-19 vaccination.
Myth #4: Vaccines Cause Miscarriages
Studies published in the New England Journal of Medicine and Nature Reviews Immunology have shown no increase in the number of miscarriages in the general population.
If patients are still not convinced, ASRM reports that symptomatic COVID-positive pregnant women have a 70 percent increased risk of death compared to those who are not pregnant.
Myth #5: Vaccines Damage the Placenta
The protein used in the COVID-19 vaccine cannot be mistaken for the syncytin-1 protein by the immune system. These proteins are physically distinct. Instead, the mRNA causes local immune cells to produce antibodies, which circulate and protect the fetus after birth.
Myth #6: Vaccines Decrease Sperm Count
A small study published in the June 2021 issue of JAMA found that the vaccine did not decrease sperm count — and in fact, some participants produced more sperm after receiving the second dose of the vaccine. Sperm motility and semen volume were also increased.
Vaccination, Fertility Treatment and Pregnancy
Healthcare providers should advise anyone who is trying to conceive, already pregnant or breastfeeding to get a COVID-19 vaccine and any booster they are eligible for.
Both ASRM and the European Society of Human Reproduction and Embryology suggest patients will want to consider receiving the vaccine prior to starting fertility treatments.
Additionally, ACOG's Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group recommends anyone 18 years or older who is pregnant, will want to consider ensuring they have received a COVID-19 vaccination or booster. It can be administered at the same time as routine pregnancy vaccinations, such as influenza and Tdap. Boosters should be two months after the Johnson & Johnson single-dose vaccine and six months after an mRNA vaccine.
Evidence-based patient education should be a top priority for all healthcare providers. To make it easy, ACOG offers a guide for OBGYNs. Stay updated on the latest information and proactively share it with patients.
