Resources

Alemu BK, Wang CC, Li L, Zhu Z, Li Q, Wang Y. Effect of preconception antibiotics exposure on female reproductive health and pregnancy outcomes: a systematic review and meta-analysis. EClinicalMedicine. 2024;78:102935. Published 2024 Nov 22. doi:10.1016/j.eclinm.2024.102935

Shao S, Pan W, Wang B, et al. Association between antibiotic exposure and the risk of infertility in women of childbearing age: A case-control study. Ecotoxicol Environ Saf. 2023;249:114414. doi:10.1016/j.ecoenv.2022.114414

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA,Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008-12.

Women report their use of herbs and supplements to a fertility clinic that assesses their herb-drug interactions.

Resources

Friedman J, Sheeder J, Lazorwitz A, Polotsky AJ. Herbal supplement use among reproductive-aged women in an academic infertility practice. F S Rep. 2022;4(1):104-111. Published 2022 Dec 17. doi:10.1016/j.xfre.2022.12.001

Natural Medicines Database Checker. Therapeutic Research Center. Updated 2023. Accessed April 26, 2023. https://naturalmedicines.therapeuticresearch.com

Does vaginal progesterone prevent miscarriages after early pregnancy bleeding? The research world has yet to agree, but a recently published Australian study (aka "the STOP trial") attempted to tackle this question.

After seven years of recruiting ~300 women, the STOP trial was stopped prematurely based on early results.

Hurdles with study execution plus thinly-disguised jabs at other research made for an interesting paper.

Bordewijk EM, Li W, Gurrin LC, Thornton JG, van Wely M, Mol BW. An investigation of seven other publications by the first author of a retracted paper due to doubts about data integrity. Eur J Obstet Gynecol Reprod Biol. 2021;261:236-241. doi:10.1016/j.ejogrb.2021.04.018

Carmichael SL, Shaw GM, Laurent C, Croughan MS, Olney RS, Lammer EJ. Maternal progestin intake and risk of hypospadias. Arch Pediatr Adolesc Med. 2005 Oct;159(10):957-62. doi: 10.1001/archpedi.159.10.957. PMID: 16203941.

Casarramona G, Lalmahomed T, Lemmen C, et al. The efficacy and safety of luteal phase support with progesterone following ovarian stimulation and intrauterine insemination: A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2022;13:960393. Published 2022 Sep 2. doi:10.3389/fendo.2022.960393

Coomarasamy A, Devall AJ, Cheed V, et al. A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy. N Engl J Med. 2019;380(19):1815-1824. doi:10.1056/NEJMoa1813730.

Devall AJ, Papadopoulou A, Podesek M, et al. Progestogens for preventing miscarriage: a network meta-analysis. Cochrane Database Syst Rev. 2021;4(4):CD013792. Published 2021 Apr 19. doi:10.1002/14651858.CD013792.pub2

McLindon LA, James G, Beckmann MM, et al. Progesterone for women with threatened miscarriage (STOP trial): a placebo-controlled randomized clinical trial [published online ahead of print, 2023 Feb 20]. Hum Reprod. 2023;dead029. doi:10.1093/humrep/dead029

Meurer WJ, Tolles J. Interim Analyses During Group Sequential Clinical Trials. JAMA. 2021;326(15):1524-1525. doi:10.1001/jama.2021.10174

Oripro (progesterone pessary used in clinical trial) accessible at https://www.healthdirect.gov.au/medicines/brand/amt,124041000036109/oripro

Şükür YE, Göç G, Köse O, et al. The effects of subchorionic hematoma on pregnancy outcome in patients with threatened abortion. J Turk Ger Gynecol Assoc. 2014;15(4):239-242. Published 2014 Dec 1. doi:10.5152/jtgga.2014.14170

Yan X, Xu H, Li J, Xu Z, Niu Y, Wang Y. Subchorionic hematoma and risk of preterm delivery: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023;5(1):100791. doi:10.1016/j.ajogmf.2022.100791

This is the first randomized controlled multi-arm trial comparing how three hCG trigger doses impact endogenous progesterone levels in IVF- fresh embryo transfer cycles.

Resources

Abdalla HI, Ah-Moye M, Brinsden P, Howe DL, Okonofua F, Craft I. The effect of the dose of human chorionic gonadotropin and the type of gonadotropin stimulation on oocyte recovery rates in an in vitro fertilization program. Fertil Steril. 1987;48(6):958-963. doi:10.1016/s0015-0282(16)59591-0

Pabuçcu E, Pabuçcu R, Gürgan T, Tavmergen E. Luteal phase support in fresh and frozen embryo transfer cycles [published online ahead of print, 2020 Jun 22]. J Gynecol Obstet Hum Reprod. 2020;101838. doi:10.1016/j.jogoh.2020.101838

Svenstrup L, Möller S, Fedder J, et al. Does the HCG trigger dose used for IVF impact luteal progesterone concentrations? a randomized controlled trial. Reprod Biomed Online. 2022;45(4):793-804. doi:10.1016/j.rbmo.2022.04.019

Vuong LN, Ho TM, Pham TD, Ho VNA, Andersen CY, Humaidan P. The early luteal hormonal profile in IVF patients triggered with hCG. Hum Reprod. 2020;35(1):157-166. doi:10.1093/humrep/dez235

This is the first meta-analysis published in seven years to examine dose-response associations between caffeine or coffee consumption and pregnancy loss.

Resources

Blehar MC, Spong C, Grady C, Goldkind SF, Sahin L, Clayton JA. Enrolling pregnant women: issues in clinical research. Womens Health Issues. 2013;23(1):e39-e45. doi:10.1016/j.whi.2012.10.003

Jafari A, Naghshi S, Shahinfar H, et al. Relationship between maternal caffeine and coffee intake and pregnancy loss: A grading of recommendations assessment, development, and evaluation-assessed, dose-response meta-analysis of observational studies. Front Nutr. 2022;9:886224. Published 2022 Aug 9. doi:10.3389/fnut.2022.886224

New World Encyclopedia contributors, "Caffeine," New World Encyclopedia, , https://www.newworldencyclopedia.org/p/index.php?title=Caffeine&oldid=794371 (accessed November 27, 2022).

Sasaki S, Limpar M, Sata F, Kobayashi S, Kishi R. Interaction between maternal caffeine intake during pregnancy and CYP1A2 C164A polymorphism affects infant birth size in the Hokkaido study. Pediatr Res. 2017;82(1):19-28. doi:10.1038/pr.2017.70

White JR Jr, Padowski JM, Zhong Y, et al. Pharmacokinetic analysis and comparison of caffeine administered rapidly or slowly in coffee chilled or hot versus chilled energy drink in healthy young adults. Clin Toxicol (Phila). 2016;54(4):308-312. doi:10.3109/15563650.2016.1146740

Yang A, Palmer AA, de Wit H. Genetics of caffeine consumption and responses to caffeine. Psychopharmacology (Berl). 2010;211(3):245-257. doi:10.1007/s00213-010-1900-1

This is the first study to test the use of vaginal tadalafil on endometrial thickness and pregnancies in women using IVF to conceive.

Resources

Balduyck J, Ameye A, Decleer W. Effect of vaginal/oral tadalafil on endometrial thickness in IVF patients: a double-blind, placebo controlled RCT: a pilot study. Facts Views Vis Obgyn. 2022;14(2):155-161. doi:10.52054/FVVO.14.2.026

Belapurkar P, Jaiswal A, Madaan S. Comparison of Efficacy Between Vaginal Sildenafil and Granulocyte-Colony Stimulating Factor (G-CSF) in Improving Endometrial Thickness (ET) in Infertile Women. Cureus. 2022;14(6):e26415. Published 2022 Jun 29. doi:10.7759/cureus.26415

Cialis. Package Insert. Eli Lilly and Company; 2011.

Heger A, Sator M, Walch K, Pietrowski D. Smoking Decreases Endometrial Thickness in IVF/ICSI Patients. Geburtshilfe Frauenheilkd. 2018;78(1):78-82. doi:10.1055/s-0043-123762

Mostafa T. Useful Implications of Low-dose Long-term Use of PDE-5 Inhibitors. Sex Med Rev. 2016;4(3):270-284. doi:10.1016/j.sxmr.2015.12.005

A recent randomized controlled trial compares ovarian stimulation protocols (standard vs. tamoxifen vs. letrozole) for freezing oocytes or embryos used in women diagnosed with breast cancer.

A recent well-designed American trial asked women with PCOS and obesity to take either placebo or GLP-1 agonist. 1/3 of participants were African-American and 2/3 were Caucasian. Most women had a goal of pregnancy.
After 32 weeks, the women were compared for differences in weight loss, menses, and hormones.

Links and study details can be found at www.yourfertilitypharmacist.com
The differences were significant in many ways.

Resources

CDC-State-Specific Assisted Reproductive Technology Surveillance. https://www.cdc.gov/art/state-specific-surveillance/index.html Accessed May 20, 2022.

Herbenick D, van Anders SM, Brotto LA, Chivers ML, Jawed-Wessel S, Galarza J. Sexual Harassment in the Field of Sexuality Research. Arch Sex Behav. 2019;48(4):997-1006. doi:10.1007/s10508-019-1405-x brilliant paper!

Horvath K. Does Bragdon v. Abbott Provide the Missing Link for Infertile Couples Seeking Protection under the ADA?, 2 DePaul J Health Care L. 1999; 819 https://via.library.depaul.edu/jhcl/vol2/iss4/4 Accessed May 20, 2022. Legal background for asserting workplace protection during infertility treatments.

Ikemoto Y, Kuroda K, Endo M, et al. Analysis of severe psychological stressors in women during fertility treatment: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study. Arch Gynecol Obstet. 2021;304(1):253-261. doi:10.1007/s00404-020-05923-6

Imai Y, Endo M, Kuroda K, et al. Risk factors for resignation from work after starting infertility treatment among Japanese women: Japan-Female Employment and Mental health in Assisted reproductive technology (J-FEMA) study [published online ahead of print, 2020 Dec 3]. Occup Environ Med. 2020;78(6):426-432. doi:10.1136/oemed-2020-106745

Spiggle T. Workplace Rights for Those Suffering From Infertility. Law blog published May 2015. https://spigglelaw.com/workplace-rights-for-those-suffering-from-infertility/#:~:text=According%20to%20the%20United%20States,the%20employer%20violated%20the%20ADA. Accessed May 20, 2022. Law blog summarizing legal protections for infertility care.

Volk H, Hadler M. Work Orientations and Perceived Working Conditions across Countries: Results from the 2015 ISSP Survey. International Journal of Sociology. 2018; 48:2, 103-123, DOI: 10.1080/00207659.2018.1446116

Ueda Y, Endo M, Kuroda K, et al. Risk factors for infertility treatment-associated harassment among working women: a Japan-Female Employment and Mental health in assisted reproductive technology (J-FEMA) study [published online ahead of print, 2022 May 13]. Int Arch Occup Environ Health. 2022;10.1007/s00420-022-01872-6. doi:10.1007/s00420-022-01872-6

This study compared efficacy of two r-FSH medications: follitropin alpha (Gonal-F) vs. follitropin beta (Puregon) on the number of live births cumulatively (CLBR). This was looking at patients 21-45yrs doing fresh embryo transfer after their first IVF or ICSI cycle.

Resources

Cao JX, Song JY. Follitropin Alpha versus Follitropin Beta in IVF/ICSI Cycle: A Retrospective Cohort Study. Drug Des Devel Ther. 2024;18:4359-4369. Published 2024 Sep 26. doi:10.2147/DDDT.S479700

Van den Haute L, Drakopoulos P, Verheyen G, De Vos M, Tournaye H, Blockeel C. Follitropin alpha versus beta in a first GnRH antagonist ICSI cycle: a retrospective cohort study. Reprod Biomed Online. 2021;43(4):655-662. doi:10.1016/j.rbmo.2021.06.014

This is the first study to examine the perspectives of mothers whose daughters used fertility treatments to have their first child. This study looked at how the mothers (struggled to) support their daughters.

This study sought to answer how five-year-olds, born from egg donation or biological IVF, perceive their family relationships.

Disposal of Unused Medicines: What You Should Know. Food and Drug Administration Web site. https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know Accessed November 30, 2021.

Drug Disposal: Drug Take Back Locations. Food and Drug Administration Web site. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-drug-take-back-locations. Accessed November 30, 2021.

Foxon G, Mitchell P, Turner N, McConnell A, Kendrew H, Jenkins J. Bemfola® fixed dose pens potentially reduce drug wastage and associated costs of infertility treatment. Hum Fertil (Camb). 2018;21(4):275-280.

Somigliana E, Bertoli M, Caputo A, et al. Wastage of gonadotropins during IVF cycles: Real life data from two Italian infertility centers [published online ahead of print, 2021 Oct 20]. Eur J Obstet Gynecol Reprod Biol. 2021;267:56-60.

Resources

Anderson JW. Orlistat for the management of overweight individuals and obesity: a review of potential for the 60-mg, over-the-counter dosage. Expert Opin Pharmacother. 2007;8(11):1733-1742. doi:10.1517/14656566.8.11.1733

Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Hum Reprod Update. 2017;23(6):681-705. doi:10.1093/humupd/dmx027

Gorgojo-Martínez JJ, Basagoiti-Carreño B, Sanz-Velasco A, Serrano-Moreno C, Almodóvar-Ruiz F. Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: The XENSOR Study. Int J Clin Pract. 2019;73(11):e13399. doi:10.1111/ijcp.13399

Li J, Wang Z, Wei D, et al. Effect of preconceptional orlistat treatment on in-vitro fertilization outcome in overweight/obese women: study protocol for a randomized controlled trial. Trials. 2018;19(1):391. Published 2018 Jul 18. doi:10.1186/s13063-018-2780-7

Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Obesity and reproduction: a committee opinion [published online ahead of print, 2021 Sep 25]. Fertil Steril. 2021;S0015-0282(21)01941-5. doi:10.1016/j.fertnstert.2021.08.018

Roche Laboratories Inc.. Xenical (orlistat) [package insert]. U.S. Food and Drug Administration website. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/020766s035lbl.pdfRevised January 2019. Accessed October 17, 2021.

Wang Z, Zhao J, Ma X, et al. Effect of Orlistat on Live Birth Rate in Overweight or Obese Women Undergoing IVF-ET: A Randomized Clinical Trial. J Clin Endocrinol Metab. 2021;106(9):e3533-e3545. doi:10.1210/clinem/dgab340

World Health Organization. Body mass index - BMI. Accessed October 18, 2021. https://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi

Resources

Barishansky SJ, Shapiro P, Meyman G, Pavone ME, Lawson AK. Reproductive endocrinologists' knowledge and attitudes in the identification of intimate partner violence [published online ahead of print, 2021 Sep 16]. Fertil Steril. 2021;S0015-0282(21)01934-8. doi:10.1016/j.fertnstert.2021.08.011

https://stacks.cdc.gov/view/cdc/60893

Cheng D, Horon IL. Intimate-partner homicide among pregnant and postpartum women. Obstet Gynecol. 2010;115(6):1181-1186. doi:10.1097/AOG.0b013e3181de0194

National Domestic Violence Hotline www.thehotline.org or 1-800-799-SAFE (7233)

Sharifi, F., J. Jamali, M. Larki, and R. L. Roudsari. “Domestic Violence Against Infertile Women : A Systematic Review and Meta-Analysis”. Sultan Qaboos University Medical Journal [SQUMJ], vol. 1, no. 1, June 2021, doi:10.18295/squmj.5.2021.075.

How relevant are a woman's feelings on getting pregnant to her sexual satisfaction? This study attempted to find out.

Resources

Byers ES, MacNeil S. Further validation of the interpersonal exchange model of sexual satisfaction. J Sex Marital Ther. 2006;32(1):53-69. doi:10.1080/00926230500232917

Daniels K, Daugherty J, Jones J. Current contraceptive status among women aged 15-44: United States, 2011-2013. NCHS Data Brief. 2014;(173):1-8.

Johnson, David R. The National Survey of Fertility Barriers, 2010 [United States]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2017-11-02. https://doi.org/10.3886/ICPSR36902.v1

Shreffler KM, Gibbs L, Tiemeyer S, McQuillan J, Greil AL. Is Reproductive Orientation Associated with Sexual Satisfaction Among Partnered U.S. Women? [published online ahead of print, 2021 Aug 3]. Arch Sex Behav. 2021;10.1007/s10508-021-01984-z. doi:10.1007/s10508-021-01984-z

A July 2021 study compared the differences in GoFundMe campaigns related to infertility based on whether or not the campaign started in a US state that requires healthcare coverage of fertility treatment.

More details can be found in the shownotes at www.yourfertilitypharmacist.com

More details can be found in the shownotes at www.yourfertilitypharmacist.com

For more details on the research and for other related links, please head to the shownotes at www.yourfertilitypharmacist.com

A recent study looked at the use of Enbrel (etanercept) in women with multiple failed attempts to transfer good quality IVF embryos. This is the largest study to date that has looked at using Enbrel in women with recurrent implantation failure; the results were quite promising.

More details found in the shownotes at www.yourfertilitypharmacist.com

The first study to look at what happens when a physician talks about uncertainty with infertile couples during assisted reproductive technology (ART) consultations.

More details and a link to this fertility research are available in the shownotes at www.yourfertilitypharmacist.com

This episode is about the Iranian research paper called “Resilience as the predictor of quality of life in the infertile couples as the most neglected and silent minorities.” This research was published online in November 2020 in the Journal of Reproductive and Infant Psychology.

Beyond the research, this episode provides historical context of the roles of Iranian wives and examines how that context might impact the research results.

More details and links to the studies mentioned in this episode can be found at www.yourfertilitypharmacist.com

The 20th podcast episode of “Your Fertility Pharmacist” is a bit different. With guest speaker Melsa Maher, fertility acupuncturist, this episode places a special focus on traditional medicine. The audio was recorded over Zoom.

Traditionally, letrozole has been taken for five days in IUI. What happens if, instead, those five days of letrozole are taken all at once?

For additional study details, please head to www.yourfertilitypharmacist.com

The podcast brings up key points of the study. Scientific details and links are in the show notes at www.yourfertilitypharmacist.com

More details available at www.yourfertilitypharmacist.com

Resources

Bronson R. and Kruljac I, Butorac D, Vrkljan M. and Legro RS, Zhang H; Eunice Kennedy Shriver NICHD Reproductive Medicine Network. Letrozole or clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med. 2014;371(15):1463-1464. doi:10.1056/NEJMc1409550

Centers for Disease Control and Prevention. PCOS (Polycystic Ovary Syndrome) and Diabetes. https://www.cdc.gov/diabetes/basics/pcos.html. Accessed April 21, 2024.

Franik S, Kremer JA, Nelen WL, Farquhar C. Aromatase inhibitors for subfertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2014;(2):CD010287. Published 2014 Feb 24. doi:10.1002/14651858.CD010287.pub2

Franik S, Le QK, Kremer JA, Kiesel L, Farquhar C. Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2022;9(9):CD010287. Published 2022 Sep 27. doi:10.1002/14651858.CD010287.pub4

Legro RS, Brzyski RG, Diamond MP, et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome [published correction appears in N Engl J Med. 2014 Oct 9;317(15):1465]. N Engl J Med. 2014;371(2):119-129. doi:10.1056/NEJMoa1313517

Legro RS, Diamond MP, Coutifaris C, et al. Pregnancy registry: three-year follow-up of children conceived from letrozole, clomiphene, or gonadotropins. Fertil Steril. 2020;113(5):1005-1013. doi:10.1016/j.fertnstert.2019.12.023

Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015;7:745-763
https://doi.org/10.2147/IJWH.S70314

World Health Organization. Polycystic Ovary Syndrome. World Health Organization; 2023. Accessed April 21, 2024. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

Zhang H. Pregnancy in Polycystic Ovary Syndrome II (PPCOSII). ClinicalTrials.gov identifier: NCT00719186 . Updated June 14, 2018. Accessed April 20, 2020. https://classic.clinicaltrials.gov/ct2/show/NCT00719186

This pioneering study is the first to focus on how adults, raised by lesbian moms, feel about their sperm donors. Study originally published on July 4, 2020 in the journal Fertility and Sterility.

A new Harvard-affiliated study explores whether intramuscular progesterone or vaginal gel progesterone (Crinone 8%) more effectively leads to live births after single frozen embryo transfer. Will their results change IVF practices in the U.S.A.?

A newly published study found that fathers from reproductive assistance (IVF or ICSI) had higher IQ scores than fathers who naturally conceived. This podcast discusses the flaws in the study.
More at www.yourfertilitypharmacist.com

For even more details on this study, head to www.yourfertilitypharmacist.com

This podcast episode summarizes the study. For even more study details, head to www.yourfertilitypharmacist.com.

This is the first study to look at how socioeconomic factors play into women’s awareness about ectopic pregnancies. Since ectopic pregnancy is still the leading cause of maternal death in early pregnancy, ALL potentially pregnant women need to be able to recognize the seriousness of an ectopic pregnancy and how to access care

A 7 year old girl underwent hormone therapy and surgery to have a chance at fertility. Here were the outcomes from her two egg freezing cycles.

Some of the questions on the questionnaire included: smoking and drinking habits, self-rated physical fitness, self-rated health, socioeconomic factors (education and occupation), diseases, previous diagnosis of depression, and erectile dysfunction.

To learn what differences in stress were found in men with more and less fertility, check out the full show notes on www.yourfertilitypharmacist.com

More information can be found at www.yourfertilitypharmacist.com

This study followed three women who were 28, 38, and 32 years old. All three had sought reproductive assistance (ART) and could produce a low quantity of oocytes. The quality of their eggs was low and none could produce a viable embryo. After two key interventions, all three women made top quality embryos and two had babies!

A new study examines the associations between COVID-19 infection with pregnancy and miscarriage rates, looking at the first ten weeks after fresh embryo transfer.

A few months ago, a study was published in Fertility and Sterility that looked at whether or not there is an association between how a baby was conceived and the impact this mode of conception has on serious infections through childhood. This episode reviews the results and what they may mean for women using fertility treatments to conceive.

This episode centers around the drugs being used experimentally to treat COVID-19 and what we know about how these drugs impact pregnant women. The links to the studies and drug information discussed on this episode can be found at “yourfertilitypharmacist.com.”

Before delving into the drugs, let’s touch base on the limited information we have on how pregnant women are impacted by coronavirus, which is the virus manifesting as the respiratory illness called “COVID-19.”The good news is, there have not been any confirmed cases of mothers transferring coronavirus to the baby in utero. Having said that, the limited information we have about delivery outcomes is concerning. A recent article in the Journal of Infection detailed the delivery outcomes from thirteen Chinese women who were pregnant and tested + for coronavirus. They ranged in age from 22 to 36 years old. They had no other pre-existing health conditions. Two women were in their second trimesters, and the other 11 were in their third trimesters. Six of the eleven women who were in their third trimester went into early labor related to fetal distress, premature membrane rupture, and even one stillbirth. The two women who were in their second trimesters did NOT go into early labor or have any other fetal consequences noted – I really hope that the researchers keep close tabs on those two pregnancies so we can learn more information on the impact of second trimester coronavirus infections. Since a lot of these pregnancies had complications, having a treatment for COVID-19 could improve the health of infected mothers and babies.

Regarding medications to treat COVID-19, there are a few drugs that seem promising for an illness that doesn’t yet officially have a cure.

A drug that’s been receiving a TON of press lately is chloroquine, as reports from China and France suggest that it’s effective against COVID-19. Chloroquine was originally approved by the FDA in 1949 to treat malaria, and it was later approved to treat lupus and rheumatoid arthritis. Since chloroquine has been used and tested for so many decades, we have information on how this drug impacts pregnant women and their babies. Chloroquine does go through the placenta and into breastmilk; in mice and monkey babies, this crossing led to vision problems and blindness. These eye problems were not seen in human studies conducted a decade ago in Thailand and in New Guinea on pregnant moms requiring malaria prophylaxis. Thus, the reference book Drugs in Pregnancy and Lactation considers chloroquine to be the unlikely cause of birth defects in humans. It also states that the benefits of preventing and treating malaria outweigh the risks. This permission could potentially be extrapolated to treatment of COVID-19… but before getting too gung-ho about stockpiling chloroquine, a more promising sister drug to chloroquine should be considered.

Hydroxychloroquine is chloroquine with a slightly different molecular structure that makes it less toxic yet just as effective as chloroquine for malaria and for immune-mediated disorders. It was FDA approved in 1955 and also goes by the brand name Plaquenil. Scientists, and therefore the mainstream media, have gotten very excited about using this drug because of a small study from southern France on treating coronavirus. In this study, 14 infected patients received hydroxychloroquine alone, 6 patients received hydroxychloroquine plus an antibiotic called azithromycin, and 16 patients, serving as the control group, who didn’t get hydroxychloroquine at all. After six days, the virus was cleared from the system of all six patients taking both hydroxychloroquine and azithromycin, from 8 out of 14 patients taking hydroxychloroquine alone, and from just two of the sixteen patients who didn’t receive hydroxychloroquine. Those encouraging results were only published five days ago. Since then, hoarding of the medication has become a national issue. It’s such an issue that the FDA is permitting a factory in India that was recently cited for quality issues to ramp up supply of hydroxychloroquine to import to the U.S.

This study inspiring the hydroxychloroquine shortage specifically excluded pregnant women. Given that it is safe to use in pregnancy in other conditions, plus it is generally considered to be a safer drug than chloroquine, it would be reasonable to assume that it would be safe in pregnant women infected with COVID-19. Of the drugs being tested to treat COVID-19, hydroxychloroquine is the drug I feel most confident endorsing for safety and efficacy in pregnant women at this time. I’d also recommend taking it with azithromycin to increase chances of clearing the virus.

Though I’ve given my endorsement, I would be remiss as a pharmacist if I didn’t discuss another promising drug that’s gotten a lot of attention lately. It’s an antiviral called remdesivir, which is NOT officially FDA approved for any illness in the U.S. It is allowed for “compassionate use,” meaning that a patient may be able to gain access to the drug if in a life-threatening condition and there isn’t a good alternative treatment available. The manufacturer of this drug has seen such a surge in requests to use remdesivir during this pandemic that they just cut off new requests to use this drug EXCEPT for pregnant women and in children.

So, while it remains available for pregnant women, is it actually safe and effective? In 2018/2019, remdesivir was given to six pregnant Congolese women infected with Ebola who were enrolled in a clinical trial looking at four investigational drugs to potentially treat that illness.

This trial was published in Dec 2019 in the New England Journal of Medicine; unfortunately, after looking over the study and all of the published information, there is very little detail on how these six pregnant women responded to remdesivir. We don’t know their ages, how far along they were in their pregnancies, etc. One reason that the trial may have given so little focus to so few pregnant women taking remdesivir is because two other drugs in the study were found to be more effective at treating Ebola, so they stopped giving remdesivir in favor of other drugs. I gleaned the study for details and read in the supplementary index about the adverse events broken down by patient and drug. One of the other experimental drugs mentioned one baby born with hydrocephalus and one with a shortened umbilical cord. Because these adverse outcomes were mentioned in a drug that was NOT remdesivir, can we assume that remdesivir does not cause fetal harm?

We still have too little information - six pregnant women taking a drug is simply not enough to draw useful conclusions. In the short-term, we will have to look at press releases for pregnant women who took remdesivir through compassionate use. According to upcoming U.S. studies listed on clinicaltrials.gov, only one of the three remdesivir trials is specifically excluding pregnant women from participating, so hopefully we will have some concrete data once the two inclusive trials have ended. To see the studies included in this podcast, please check out “yourfertilitypharmacist.com.”

Today’s episode centers around the impact on fertility treatments due to coronavirus, which is the virus manifesting as the respiratory illness called “COVID-19.”

On St. Patrick’s Day, the American Society for Reproductive Medicine (for short known as ASRM) released recommendations for managing fertility treatments during the pandemic. These recommendations came from the evidence we currently have on COVID-19. ASRM will update their position by March 30th or earlier as more information comes in. The link to the recommendations is available on my website, “yourfertilitypharmacist.com”

After listing their major recommendations from the eight-page document, I’ll go over the rationale for these momentous statements.

#1, no more new treatment cycles for the foreseeable future. By new treatments, they explicitly call out ovulation induction, in vitro-fertilization – including retrievals and frozen embryo transfers, intra-uterine inseminations, and non-urgent gamete cryopreservation.

#2, in quotes, is “consider cancellation of all embryo transfers whether fresh or frozen.”

#3, keep caring for a patient is already “in cycle” or requires urgent stimulation for cryopreservation. Now, caring for is a gray area, which I will come back to later in this episode.

#4 stop any non-urgent diagnostic procedures and elective surgeries.

And the last one, #5, minimize in-person interactions in favor of telehealth.

These recommendations are… extreme, but not shocking, given the surreal times that we are now living in. ASRM laid out how COVID-19 is more contagious and kills 10-15 times more people compared to the flu. There is a scary shortage of personal protective equipment for healthcare workers, so there is a suggestion that the gloves, masks, and other personal protective equipment used by the staff at fertility clinics could be rerouted to healthcare systems directly addressing COVID-19. Since the U.S. is severely deficient in testing and screening capabilities for coronavirus, staff at reproductive centers could unknowingly come into contact with the infection; if reproductive staff come down with the illness, this could easily impair the quality of care needed to treat patients. Most importantly, we still don’t know how COVID-19 infection will impact pregnant women; it’s unclear if a mother can directly pass the virus onto a baby in utero. A recent publication discussed the outcomes of nine pregnant Chinese women who tested positive and showed symptoms for COVID-19. Six out of ten babies born to these COVID-19 infected moms experienced intrauterine fetal distress and met criteria for critical illness. (More details about this publication from China can be found on the study link located on this episode’s webpage).

With the concern for negative impact to babies, women, and healthcare staff, ASRM’s recommendations to stop any non-urgent fertility treatments makes sense. I live in an area where coronavirus has really taken hold, and I’m seeing the uptake of the ASRM recommendations vary based on the local reproductive clinic. Deciding what is urgent and what is not is such a gray area. While a couple of sites haven’t seemed to alter their practices significantly, others are going on a case-by-case basis on whether or not to proceed with a stim cycle or transfer. Many women are feeling heartache over having to delay treatment in the face of a ticking biological clock. Other women are nervous that their cycle will be cancelled at the last-minute as more restrictions come into play. My advice to any active patients at a reproductive clinic would be to touch base with your clinic to know their stance on treatment during this pandemic and how they personally plan to attend to your case. For women who may have the possibility of conceiving naturally, please practice social distancing and keep taking your prenatal vitamins!

That’s the end of today’s episode of “Your Fertility Pharmacist.” In the next episode, I’ll discuss the medications being used experimentally to treat COVID-19 and what we know about how they impact pregnancy. All related links discussed in these episodes will be posted on the website “yourfertilitypharmacist.com.”