While our struggles with infertility only go back two years, it feels like they are ingrained in our four-year marriage as solidly as any of its other defining characteristics. Infertility is a part of who we are now, and I feel that acutely. That the key chapters of our fertility story would hit right in the middle of a global pandemic, and I would test positive for COVID-19 in the middle of our first IVF cycle, is beyond anything that I could have predicted.
1 in 10 women of childbearing age has Polycystic Ovarian Syndrome (PCOS). I am one of those women. And if that didn’t make me feel special enough, I also have complex endometrial hyperplasia which means that the lining of my uterus is unusually thick due to an overproduction of abnormal cells. It’s not cancer, but in certain women, it raises the risk of developing endometrial cancer. I am very high risk. The cherry on this sundae is that I also have a blocked fallopian tube. The only way that we will ever have a family is through IVF, adoption, or a gestational carrier.
Between July 2019 and February 2020, in addition to being on a high, daily dose of Megace, I had four D&Cs to remove polyps that had formed in my uterus and to manually remove the thick lining that my body simply couldn’t shed on its own. Four outpatient procedures that, while relatively routine, are still very real surgeries. Four signatures acknowledging that you know the risks involved and you won’t hold the doctor liable if something goes wrong. Four nurses digging around in your arm to find a vein for your IV. Four teary goodbyes to your family before they wheel you away to the OR.
Thankfully, after the fourth D&C, my hyperplasia was gone, and we were safe to move forward with IVF. That said, we were very aware that the clock was ticking and that we had a narrow window to get pregnant before the hyperplasia came back.
So, in early April, when our country was all but shut down due to COVID-19, we made the decision to move forward with IVF. It was so exciting to finally have a plan. An expensive, injection-riddled chance was better than no chance at all, and in the midst of the general uncertainty of this virus, it gave us something to look forward to. But it was also incredibly conflicting. The world was deemed too dangerous for me to go to the office but we were going to bring a child into the world? It was hard to reconcile. It still is.
Simultaneously, as COVID-19 worsened, the American Society for Reproductive Medicine issued new guidelines advising doctors to avoid starting new treatment cycles for IVF, IUI, and egg freezing; to consider canceling embryo transfers, and to suspend all non-emergency surgeries. Fertility procedures, as elective as they may be, are very time-sensitive. Every month…every week counts. Thankfully, when we asked our doctor if our cycle might get bumped or rescheduled, she very specifically replied that “If the wine shops and the weed stores are still deemed essential services, then so am I.” So onward, we went.
Labcorp OnDemand Women’s Fertility Package (Ovarian Reserve Test)
May and June were a blur. My husband and I were both fortunate to be able to work from home, so I worked, took my supplements each day, and drove across Denver for acupuncture every week. I remember thinking that, ironically, with the frequency of ultrasounds, blood draws, and acupuncture, working from home during the pandemic was a blessing. It made it easier to manage the time that IVF required, this very demanding second job that I now had to schedule and manage alongside my actual career. But now, I didn’t have to duck out of the office with noticeable frequency—I could take a conference call from the car or answer emails while lying face down with acupuncture needles going down the backs of my legs. Thankfully, everything went off without a hitch and our egg retrieval resulted in five strong embryos.
Then July hit. In the middle of the month, two days after a friend of ours had stopped by for a beer on our deck, he let us know that he had just tested positive for COVID-19 and that we should get tested immediately. My heart sunk. This was bad. It was so bad and the worst possible timing. My husband and I immediately drove to a testing center and spent the evening bickering over nothing because stress and uncertainty do not make the heart grow fonder.
Two mornings later I received the call from Urgent Care that I had been dreading. I had tested positive. With zero symptoms and in the middle of an IVF cycle, I had COVID-19.
My initial fear was for my own mortality. Was I going to die? I had seen the CNN specials, and I had watched the first-person accounts on the news; this virus was not a joke. Not only were people dying, but their deaths were also often lonely and painful. I knew right then and there that while my immune system may have been compromised due to the recent hormone injections before our retrieval and the year of surgeries that I’d endured, if I had to, I would fight—hard—for my life. And I would fight relentlessly to ensure we had a chance to bring those healthy embryos into the world.
How exactly would I do this? I had no idea. There was no playbook to follow. Interestingly, my husband had not tested positive. The doctor from Urgent Care said that as long as he wasn’t immunocompromised, since we live in the same house and slept in the same bed leading up to my positive test, I didn’t need to self-isolate. If he was going to get it, he had already been exposed.
We were to quarantine for 14 days, and I was told to closely monitor my symptoms. I had a list of questions that the doctor tried her best to answer, but there was a lot of “Based on recent cases…” or “Patients have had luck with…” prefaces to each response. She simply didn’t know. In the absence of concrete answers, I had to plot this one on my own. Once again, onward we went.
I immediately called our fertility clinic. I had an appointment four days prior to testing positive and if there was the slightest chance that I was positive then—if I actually didn’t catch it from our friend—I wanted them to know as quickly as possible. I had crushing guilt and anxiety prior to making that call. What if I, unwittingly, passed the virus to other patients at the clinic? To the other women going through IVF? What if I got our doctor or a member of the nursing staff sick and they were unable to provide valuable, time-sensitive treatment to women who needed it as badly as I did?
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When I finally spoke to our IVF nurse, she was incredibly gracious and assured me that they would handle everything on their end and that I should only worry about taking care of myself. She did caution that I wouldn’t be able to come back into the clinic or resume IVF until I had a negative COVID test. No pressure.
So, with a complete lack of resources on what I should eat or what I should do during this very weird time in my life, I went back to the basics. Health 101. Since this was a respiratory virus, I made sure to keep my cardio up and rode my Peloton almost every day. I took hot baths, stayed hydrated, went to bed early, cooked healthy meals, and really tried to stay positive. The latter was easier said than done some days. I had some trouble pulling in deep breaths throughout those two weeks but nothing unbearable, thankfully. I took my temperature twice a day and I kept up with my Lupron shots every night. IVF waits for no one and I was determined to stay on track for our transfer.
I kept a journal throughout quarantine to track my symptoms—I didn’t want to forget or misrepresent anything. As I was largely asymptomatic, after speaking with a contract tracer, I was able to end my quarantine after only 10 days. But even then, I didn’t rush to re-enter the world. Our home felt like the bubble that had kept me safe and I was fearful of leaving it. One week later, I got tested again and thankfully I was negative. Our transfer was back on the calendar! And my husband? He never contracted the virus and is still healthy as a horse.
As I write this, our FET was four days ago and we’re currently waiting to find out if I’m pregnant. While I am so grateful that my experience with COVID-19 was largely asymptomatic—and I know that many others were not nearly as fortunate—there is incredible uncertainty around how it could affect fertility. I have so many questions about how, or if, having the virus could affect our implantation, early development of the fetus, or if it could add to the risk of miscarriage. I have questions—countless questions—and very few answers.
I’m not a medical professional and I wish I had more specific guidance to offer anyone else facing the same situation. All I can share is what worked for me. Being open about this entire process has been so important. Infertility issues are so physically and emotionally draining—there is no way that I would have been able to endure this process by staying silent. The more I lean on those around me and the more I talk about IVF, the more I have been able to learn from others who have gone through the same.
All I can say is to take care of yourself and be kind to your body. Nourish yourself with good food, drink a lot of water and wear a mask everywhere. This is truly the worst club with the best members and we’re all in this together.
Johnna Muscente is a 37-year-old Colorado native who currently lives in Denver with her husband and their very spoiled dog, Nala. She is a Director of Communications in the ski industry and when she's not traveling—something that COVID-19 quickly put a stop to—she's cooking, hiking, or spending time with family. Johnna and her husband Joe have been struggling with fertility issues for the past two years and just completed their first IVF cycle. All of their fingers and toes are crossed for a positive pregnancy test!