Dealing with infertility and undergoing fertility treatments can be an extremely emotional journey. With the additional stressors of the COVID-19 pandemic and now concerns regarding the vaccine we sat down with Associate Professor, Dr. Jennifer Kawwass, Medical Director at Emory Reproductive Center to get answers to some of the most commonly asked questions and to debunk misinformation regarding the COVID-19 vaccine, female sterilization, and safety. About Dr. Kawwass: Dr. Jennifer Kawwass is an Associate Professor in the REI Division of the Emory Department of Gynecology and Obstetrics and is the Medical Director of the Emory Reproductive Center. Dr. Kawwass is a Guest Researcher at the CDC, a member of the SART research and registry committees, and a member of the ASRM COVID19 Task Force. The ASRM Task Force consists of a group of physicians (reproductive endocrinologists, infectious disease experts, and urologists), mental health specialists, and embryologists that was formed in March 2020 when the pandemic began. The Task Force has been meeting regularly, initially every two weeks and now every month, to review available data and publish recommendations regarding reproductive health and COVID 19.
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Intro: You're listening to the Conversations Podcast with Emory Gynecology and Obstetrics. This series is a continuation of our popular video series created to highlight the need for ongoing conversations around women's reproductive health.
Host: Hi everyone. Welcome back to another episode of our podcast here at Emory Gynecology and Obstetrics. Today, I'm very excited to have one of our associate professors on the podcast to answer some really pertinent questions that people may be having about COVID-19, the vaccination, and how it impacts anyone who is currently undergoing fertility treatments. Dr. Jennifer Kawwass is an Associate Professor in the REI Division of the Emory Department of Gynecology and Obstetrics. She's also the Medical Director of the Emory Reproductive Center. Dr. Kawwass is a guest researcher at the CDC, and she's also a member of the SART Research and Registry Committees. And she's a member of the ASRM COVID-19 task force. And that task force consists of a group of physicians, mental health specialists, and embryologists. And it was formed in March of 2020 when the pandemic first began and they meet regularly. Initially every two weeks or so. And now once a month to review available data and publish recommendations regarding reproductive health and COVID-19.
So I feel like she's the perfect person for us to be chatting with today. And just anecdotally, I love anytime I have a chance to talk to Dr. Kawwass, so it's a pleasure for me as well. So thank you Dr. Kawwass for spending some time chatting with me today.
Dr. Jennifer Kawwass: Thank you so much Bryetta for having me. I'm looking forward to talking about this.
Host: So Dr. Kawwass, I wanted to start off with probably the thing that I'm most interested in, which is the fact that if you were to Google pregnancy and fertility and the COVID-19 vaccine, that there seems to be a lot of misinformation around how the vaccine works. So can you help us understand fundamentally, how does the COVID vaccine actually work?
Dr. Jennifer Kawwass: Sure. The COVID-19 vaccine is an mRNA vaccine. Doesn't contain any live virus. It contains messenger RNA, which teaches our cells how to make a protein that then triggers an immune response within our bodies.
Host: So the RNA is teaching our cells how to make this protein that triggers an immune response. So how does the vaccine impact the cell?
Dr. Jennifer Kawwass: Great question. The vaccine never enters the nucleus of the cell. So there is a fair amount of misinformation about the vaccine's potential to affect our DNA. And it's really important to understand that the mRNA is a toolkit for the cell to then make a protein, which our body learns from to make antibodies that can later fight that virus if it's exposed to it. The mRNA itself never enters the nucleus of the cell and actually degenerates and doesn't remain in your system after you have been vaccinated.
Host: Oh, okay. So I understand then that if someone was concerned about the vaccine, because I think that, that probably is a concern. That they're actually being exposed to the virus itself. And what you're saying is that's not the case.
Dr. Jennifer Kawwass: That's correct. If you got the vaccine, you would not test positive for having had the infection itself.
Host: Understood. Okay, great. So then help us understand mRNA and then what that means for someone who is currently undergoing fertility treatments. Are they at an increased risk of being negatively impacted by this mRNA because they're going through fertility treatments?
Dr. Jennifer Kawwass: Yeah, another great question. Well, there's not really any reason to suspect that the mRNA vaccine itself affects current or future fertility. As I mentioned earlier, the mRNA served as a framework for ourselves to make a protein that then triggers our bodies to make antibodies that will later recognize and fight that SARS-CoV-2 virus. Patients undergoing fertility treatments are encouraged to weigh the known risks of getting COVID-19, which we consider to be very high, against the theoretical risks of getting the vaccine, which we consider to be relatively low. To be honest, most physicians are strongly encouraging vaccination, but we certainly all realize that the decision to get the vaccine is a personal choice.
Host: That's one of the things that I think is really interesting. Dr. Kawwass and I were speaking before we were recording, she facilitated along with one of her colleagues a Q&A session for our department. And that was actually something that I took away from it that I thought was really important about weighing the theoretical risks versus the actual risks of getting COVID. And so you're saying that in your opinion, and most physicians, while recognizing that it's certainly a personal choice, it's certainly scary for a lot of people to consider. That most people are saying that you really need to weigh both the theoretical risk of the vaccine versus what we know to be some of the actual risks of actually getting COVID.
Dr. Jennifer Kawwass: Yeah. And something to consider when you think about the actual risks of COVID, are not only the short-term risks, but also these potential long-term sequelae that we're slowly learning more and more about.
Host: Well, one of the number one questions, I think anybody who is considering becoming pregnant right now is going to ask is, should I actually get the vaccine if I'm trying to get pregnant or if I'm going through any sort of fertility treatment? So if I was a patient coming to you and I was in the process of going through IVF or any other fertility treatment, should I get the vaccine?
Dr. Jennifer Kawwass: Well, this is something that I get asked literally multiple times a day. So it's a great and very, very relevant question. And the short answer is yes. Absolutely yes. If I were trying to get pregnant or were newly pregnant or were at any point in my pregnancy, I personally would get the vaccine. The longer answer is while I appreciate the hesitancy that some people feel towards getting the vaccine while trying to get pregnant, or once they're already pregnant, I do think that the balance of evidence favors vaccination. This goes back to what we were just talking about regarding weighing risk and benefits. So when you weigh the theoretical risks of a non-live mRNA vaccine against the real short and long-term risks of getting COVID, the benefit of vaccination seems to outweigh the theoretical risks. And there are a few important facts that I tend to share with my patients that I think can be put into those risk and benefit columns.
Host: Yeah. I would be curious to know when you're balancing out risks versus benefits. What do you have on that list?
Dr. Jennifer Kawwass: Yeah. So I guess the first thing to know and understand is that we've got pretty good data and the CDC has published a few papers on the topic that show that pregnant women are at higher risk of developing serious complications from COVID-19 as compared to non-pregnant women that are of similar ages. So it doesn't mean they're more likely to get COVID-19, but once they get the disease, they are more likely to get more sick and then require more invasive treatment.
Host: Understood.
Dr. Jennifer Kawwass: The other piece of the puzzle is just how prevalent the disease currently is in Georgia and honestly, throughout the United States. So the risk of exposure to the virus remains high. Particularly if you have a job where you're not able to fully socially distance. And as we've been doing this for 10 months now, it gets harder and harder to really isolate yourself completely. So one of the factors that you might consider when weighing the risks and benefit of the vaccine is how realistic it is for you to mitigate or minimize your risk of exposure. And that might depend on other things going on in your life that can vary from one person to another.
Host: Yeah, that's really interesting. So basically you're saying it's looking at your lifestyle and really understanding, are you in a position where you are not able to follow all of those pillars in a way, whether that's because of your employment or lifestyle or how any of those things may impact your ability to, as you said, maybe social distance or et cetera. So lifestyle choice would be a consideration as well.
Dr. Jennifer Kawwass: Mm-hmm (affirmative). And your job and responsibilities. Sometimes you may want to socially distance, but you might work in a place where it's not feasible.
Host: Yeah. That makes sense.
Dr. Jennifer Kawwass: Another thing to consider is that pregnant women routinely get other non-live vaccines. In fact, there are some vaccinations that we even encourage pregnant women to get because of the fact that the immunity can actually be passed on to your fetus. This isn't something that's been proven yet with the COVID-19 vaccine, but there is some preliminary data to show that it may in fact be the case, even in the case of this COVID-19 vaccine.
Host: I think that's really interesting because we do know that pregnant women get other vaccinations. Do you think that part of the hesitancy around this particular vaccination is just because it's so new and maybe that's what part of that hesitancy is about?
Dr. Jennifer Kawwass: Yeah, absolutely. I think some of the hesitancy comes with how quickly it was developed and the fact that pregnant women weren't included in the original trials, both of which made it through phase one, two and three and have been published in the New England Journal of Medicine. So peer-reviewed and obviously a very reputable source.
And one thing that people may not realize is that no corners were really cut in doing the trials. It's more that we had a tremendous amount of energy and funding compounded with the fact that the trials were done more simultaneously rather than in sequence, the way that they traditionally are. And the prevalence of the disease was so high, that it was easy to compare the two groups and see a difference between those that got the actual vaccine versus the placebo. So there were a lot of factors that actually made it feasible to develop the vaccine quickly. Additionally, this mRNA from which the vaccine is based, it's not that no one had ever studied it or used it before. The framework for thinking this way about vaccines did exist in the past.
Host: No. I think that's really, really good information. And you did mention a little bit, you alluded to it, but maybe you can talk about it a little bit more that no pregnant women were included in those initial trials. So when someone's considering getting vaccinated, how do you speak to that piece of it?
Dr. Jennifer Kawwass: Yeah. I think there are a few things that I think about. One is that although no pregnant women were purposely included in the trials, there were 23 women that ended up getting pregnant that participated in the trials. And from those women, none of the women that were in the vaccinated group reported any adverse events. Additionally, as a physician-scientist, you think is it plausible from the science that we know that the vaccine would hurt the mom or the fetus. And that again is where we can look at all the other vaccines that women get during pregnancy and know that this one... The main vaccines that we do not recommend in pregnancy are those that contain live virus.
Host: Right.
Dr. Jennifer Kawwass: And this one does not contain live virus. So from a physiologic perspective, we as scientists, physicians, obstetricians/gynecologists, think that there's not really a plausible reason to suspect that this vaccine would be dangerous to the mother or the infant.
Host: It's really interesting to me because I hear what you're saying, and it sounds like the benefits certainly outweigh the risks. But there does seem to be this pervasive myth that came out around the same time as the vaccine, which was that the vaccine would in some way lead to female sterilization. And so can you give us some information... How did that get started? How did that rumor or misinformation get started and is there any truth to that claim?
Dr. Jennifer Kawwass: Yeah, absolutely. So this misinformation regarding the COVID 19 vaccine and future fertility stems from a post on a blog, it was called Health and Money News. And it has since been removed. In the post, two European physicians, neither of whom specialize in reproductive health, claim that the COVID-19 vaccine could lead to infertility. They suggested that the vaccine contained a protein that's necessary in the formation of one of the layers of the human placenta.
However, the truth is that the vaccine does not contain this protein. And in fact, it doesn't even contain the mRNA sequence for this protein. And the myth as you suggested, gained so much popularity that a group of reproductive endocrinologists in the US actually published an article just last week. It came out in Fertility and Sterility Dialogue where they go through point by point, the reason that it's not really physiologically plausible. So that would be a great resource if you wanted to read the nitty gritty of the science piece of it.
Host: Oh no. That's really good to hear, and we'll actually get the link to that article and we'll link it in the description for this episode.
Dr. Jennifer Kawwass: Oh, perfect.
Host: So anyone who's interested can actually read it. Yeah, because I do think... I mean, listen, we live in a society where people self-diagnose via the internet and so people read things and they get concerned around it. So I do think it's really helpful for people to understand that it's basically unfounded information that really has no realm of truth to it.
Dr. Jennifer Kawwass: I agree. And it honestly has the potential to be dangerous and then cause additional hesitancy among vulnerable individuals that might actually benefit from getting the vaccine.
Host:Yeah. I completely agree. One of the things that I've learned with working with the Emory Reproductive Center is there always tends to be so much focus on the female side of the fertility process, but we definitely want to speak to male infertility. So is there anything to support the idea that the vaccine would in any way impact male sperm production or function in any way?
Dr. Jennifer Kawwass: Yeah. There's no evidence to suggest that the vaccine has any impact on male fertility, which is good news.
Host: Yeah. That's really good news. And I guess one of the biggest questions for anyone who is certainly either beginning the process of fertility treatment or currently maybe undergoing fertility treatment. The treatments themselves, do they put me at an increased risk for getting COVID-19?
Dr. Jennifer Kawwass: A fertility itself doesn't really increase one's risk of getting COVID-19. That being said, among the women that get COVID-19, pregnancy has been shown to increase the risk of developing more severe disease, which we had mentioned a little bit earlier. So the treatment itself doesn't increase your risk and honestly, pregnancy doesn't increase your risk of getting the disease. It's just that once you are pregnant, you might be at increased risk of getting more sick.
Host: Well, that's really important information for people to have because I think that any conversation as it relates to fertility and pregnancy. One of the things I've learned from you and all of the amazing physicians at the reproductive center is that there are so many questions and concerns around fertility, even in a pre-COVID world. There are so many questions and there are so many concerns because it's such a vulnerable time. And so I guess one of the things that I would really be interested in hearing from you is how does someone really have a discussion with their provider about any concerns that they're having? What are some of the questions they should be asking? How do they facilitate a healthy conversation so that they can get these questions and concerns addressed?
Dr. Jennifer Kawwass: Yeah. I think honesty is going to be one of the main factors that can help actually promote education and potentially inform one's decision. I think you shouldn't be shy to ask your physician really anything that you are feeling hesitant about. Only if you share, even if it seems silly, something you read on the internet, something some friend told you, a reason your family member told you not to get vaccinated. If you share that openly, your physician can either say, "Yeah, that has some truth to it." That might be one of the reasons that you consider not getting it. Or they may be able to say, "There's no data to support that. I understand that some people feel that way, but based on the science, that's not necessarily something that I would put in the minus column." But I think being open and honest is going to be the root of making meaningful progress in terms of understanding for yourself where you will fall on that decision.
Host: No. I think that's so important. And one of the things that I really know to be true about all of the physicians at the Emory Reproductive Center, I am not a patient, but I'm always asking questions as well. So I do know that having an honest conversation with your provider, and as you said, something that you said is so important. There's no question that's too silly. There's no question that's too wild or off the table. If you heard something, if you're concerned about something, you should feel free to talk to your provider about that.
Dr. Jennifer Kawwass: Yeah. There's no judgment passed at all. We are happy to answer absolutely any questions.
Host: That's awesome. Well, one of the things that I was thinking about, what about the timing of vaccination? So we know that there's this spaced timing for the vaccination process. And so if I'm going through fertility treatments, what happens if I conceive in the window between the first and the second dose. Does that change anything for me about getting the second dose? Should I be concerned about that?
Dr. Jennifer Kawwass: Not really. We would recommend that you stick with the prescribed regimen, which is three weeks between the Pfizer doses and four weeks between the Moderna doses. After the first dose, about nine days after the first dose, your likelihood of getting COVID is reduced by about 50%. And it's not till about a week after the second dose that you get up to that 95% reduction in risk, which is really incredible. And so there's not really any reason to delay the second vaccine, even if you conceive between the two doses. The aim, really, is to maximize the benefit of the vaccine. And again, because it's not a live vaccine, we think it's okay to take it even if you're pregnant or early pregnant.
Host: Okay. Well, one of the questions that I see floating out there on the internet is about what precautions someone should take. And we know that there are the top three pillars of precautions. But if I am someone who is currently undergoing fertility treatments, should I be taking greater precautions to mitigate the risk of getting COVID?
Dr. Jennifer Kawwass: Another great question. To be honest, I mean, as tired as all of us are of social distancing, masking, being hyper-aware of our hand hygiene and how much we touch our face, we really are still in the midst of a global pandemic. And we haven't really reached a point where we can let down our guard. Whether you're undergoing fertility treatment or not, it's really important to continue to take these precautions to mitigate the risk of getting COVID. The risk of the disease itself and the potential secondary sequelae are really worth avoiding, even if it means a few more months of feeling isolated. I think we're almost there, but we've got a little bit more of this ahead of us.
Host: It's really hard. It's definitely difficult, and I could imagine that again, the emotional strain of trying to be consistent with all of those things must be really hard. And then you add on top of that, how emotional the fertility process could be for someone. So I can imagine that's really, really hard.
Dr. Jennifer Kawwass: Yes, you're so right. I mean, there's no doubt this time has had an emotional toll really on everyone and that we're all ready to get back to normal. Experiences like undergoing fertility treatment that are stressful at baseline have only become more so in the midst of the pandemic. And as providers, we're really acutely aware of how hard it is to undergo fertility treatment and then simultaneously endure a pandemic. There's so much in fertility treatment alone, that's out of our control and out of our hands. Things that you want desperately to work that are not necessarily able to be controlled. And then you add on top of that, the uncertainty and the stressors of the pandemic.
We, as providers have really been encouraging patients to make use of some of the mental health resources particularly those that are focused and geared towards patients with infertility. There are counselors and support groups that can also provide additional support beyond just that those within our clinic.
Host: Well, I think that's something that is really helpful for people to understand, which is that to make a concerted effort to acknowledge the additional stress of going through a global pandemic while going through the fertility process. And to your point, providing resources for whether that's counseling or support groups or meditation, or anything that you can do in order to help address some of the stress that someone might be feeling. So it sounds like that we're in a forward momentum. We have the vaccine, that's a good thing. And I know that it brings up a lot of questions, but I think that's the part that we definitely want to underscore, right? It's a good thing we have the vaccine available to us. And it sounds like we're getting close to turning the corner on this.
Dr. Jennifer Kawwass: Absolutely. I'm so hopeful that we're getting close to turning the corner. And I really think that vaccination is one of the most effective tools that we have to turn the tide of the pandemic so that all of us can return to normal life.
Host: I know, fingers crossed. Well, I really appreciate you so much Dr. Kawwass, you taking the time to answer these questions. I think it's going to be really helpful for anyone who's interested in understanding, not just the fertility process in the time of COVID, but also really getting some more guided information about the vaccine and how it impacts someone going through fertility. So I really, really appreciate you taking the time to answer these questions.
Dr. Jennifer Kawwass: It was a pleasure. I'm so glad that you invited me.
Host: Well for everyone who's listening, I'm biased because I think that all of our providers that Emory Reproductive Center are amazing. But we are so happy to provide this information to you. We're going to link all of these questions and answers in the description for this episode. That way that you can have access to not just this information, but also information on how to connect with the Emory Reproductive Center. If you're someone who is currently seeking fertility treatments, we can't recommend enough reaching out to our providers at the Emory Reproductive Center. And for everyone who's listening. Thank you all so much for taking time to spend a few minutes with myself and Dr. Kawwass as we endeavor to provide you some really great information and we can't wait to chat with you again. Thanks so much everyone. Bye.
Outro: Thank you so much for joining us for the Conversations Podcast with Emory Gynecology and Obstetrics. We hope you enjoyed this episode. Please visit us online at www.gynob.emory.edu, and follow us on social media @EmoryGYNOB.