How does the vaccine affect fertility?
Currently, the website of Rospotrebnadzor states: “Russian vaccines against COVID-19 have passed the necessary tests to assess the effect on offspring.
No negative consequences were identified." The Russian Ministry of Health also talks about the safety of vaccines for fertility. Patients can discuss any doubts or concerns regarding risks with their doctor.
Do I need to be vaccinated before pregnancy or IVF?
According to studies, no negative effects of the vaccine on reproductive function have been identified. However, whether to get vaccinated or not is everyone’s voluntary decision. Our clinic performs IVF treatment programs for NON-vaccinated patients. At the moment, there are no legal restrictions in this regard.
Since there is no data on a more severe course of the disease in pregnant women and a rare incidence of transmission of infection from mother to fetus, not a single professional association of obstetricians and gynecologists recommends postponing planning pregnancy and childbirth for the post-Covid period.
Vaccinations during pregnancy: everything an expectant mother needs to know
Families formed in the 1950s and 1960s still remember the loss of children and other relatives to polio, measles, scarlet fever, rubella and other infections. Some representatives of the new generation know very little about the past, since they often prefer panicky fakes and posts from illiterate bloggers to evidence-based and verified sources.
We* asked gynecologist Elena Berezovskaya to prepare for us an educational program on vaccinations during pregnancy in order to tell those who are planning or are already expecting a child about how vaccinations work and why some of them should be done during gestation.
How did vaccines come about?
Edward Jenner (1749–1823), the first English physician who believed that cowpox, which did not cause disease in humans, could protect them from smallpox (smallpox), which killed many people.
But the first to experiment with vaccination was Benjamin Jesty (1737–1816), an English farmer and livestock breeder. He administered the contents of vials from a cow with smallpox to his wife and two sons in 1774. All family members survived the great smallpox outbreak in Europe in 1775. Of course, this was largely a coincidence, but the idea that by administering small doses of infectious agents or their toxins could prevent infection and the development of the disease was already relevant in those days.
Louis Pasteur and his colleagues formulated the idea of vaccination and demonstrated its benefits, first with Pasteurella multocida, which caused diarrhea in chickens, then anthrax in sheep, and then to prevent rabies in humans and animals.
Albert Calmette and Camille Guerin, the creators of BCG, a vaccine against tuberculosis, used bovine tuberculosis bacteria, passing them through artificial media 230 times to produce a weakened strain to protect humans from tuberculosis, also an extremely common and almost fatal infection of the time. In the early 1930s, the first vaccines against tetanus, diphtheria, yellow fever, and influenza appeared.
With the development of science and medicine, not only knowledge about dangerous infections has increased, but protection against them has improved.
What are vaccines for?
Vaccines are designed to create protection for the body against exposure to an infectious agent. Vaccinations do not protect against infection one hundred percent, but they help prevent the spread of viruses and bacteria in the body, causing damage to their cells and tissues.
The main goal of vaccination is to create a protective level of class G antibodies (IgG) to certain types of microorganisms, as well as memory in the human immune system (immune memory), which will respond in time to dangerous invaders by producing even more antibodies.
In the fetus, class G antibodies appear in the second and third trimester, but their levels are 25 to 50 percent lower than in newborns. Maternal antibodies penetrate the placenta after 13 weeks of pregnancy and perform a protective function in the fetus and further in the newborn.
In the first months, the child’s health depends on the level of antibodies that he receives from the mother in utero, and also partly through breast milk.
But through breast milk, the child will receive mainly antibodies of class A, E and M, while class G antibodies are important for stable immunity. During pregnancy, all classes of antibodies increase.
In 2021, WHO created the GAIA (Global Alignment of Immunization Safety Assessment in Pregnancy) project, which monitors the safety of vaccination during pregnancy.
Main types of vaccines
Live viral and bacterial vaccines were among the first to be used at the very beginning of the development of vaccination. Microorganisms are inactive (inhibited), therefore they cannot reproduce in the human body, but allow the defense system to produce antibodies (immunoglobulins).
Modern vaccines with inhibited live microorganisms include rotavirus, chickenpox, measles, mumps, rubella and Bacillus Calmettee Guerin (BCG vaccine against tuberculosis).
Vector vaccines contain one or more types of living microorganisms (adenoviruses, poxyviruses) that are not dangerous to humans (do not cause disease), but one or more genes are inserted into them that are responsible for the production of surface proteins of dangerous viruses that can be produced antibodies. Viruses that carry these genes are called vectors.
Vector vaccines can be with inactive (inhibited) viruses - a vaccine for hepatitis B, influenza and some for COVID-19 (for example, AstraZeneka and Sputnik V).
Toxoid vaccines contain toxins produced by dangerous microorganisms. These toxic substances are produced in large quantities during infection and the development of the disease - this is destructive for humans.
In small quantities, such toxins are not dangerous, but a sufficient amount of antibodies can be produced against them. These include vaccinations against diphtheria, tetanus, and whooping cough.
Polysaccharide and conjugate (protein) vaccines contain molecules from the outer shell of bacteria or proteins to which antibodies can be produced. These are vaccinations against pneumococcus, type B influenza, and a number of others.
DNA vaccines and RNA vaccines contain genes from viruses or bacteria that are capable of producing a protein characteristic of the microorganism, and this will cause the production of antibodies, that is, a protective reaction. This type of vaccine includes vaccinations against HIV, Ebola, coronavirus infection (Pfizer, Moderna) and others.
DNA and RNA vaccines are among the safest and also among the most effective, which is why they are often used during pregnancy.
What vaccines can be used during pregnancy?
Almost all vaccines that do not contain live active viruses can be used during pregnancy. Live vaccines, for example, against polio and yellow fever, can also be used during pregnancy under strict indications.
It is important to understand that live viruses in vaccines are not able to reproduce, so they do not damage human cells in order to replicate.
There are cases when live vaccines were administered during pregnancy planning or during periods when the woman was not protected from pregnancy and was early pregnant at the time of vaccination. These data do not confirm the negative impact of vaccines on the embryo, fetus and the course of pregnancy in general. However, it is rational not to use such vaccines (we are not talking about vector vaccines).
All other types of vaccines are safe during pregnancy.
Different subclasses of antibodies are produced for different types of vaccines, which is taken into account to obtain the best vaccination effectiveness. There are four subclasses of IgG antibodies that cross the placental barrier differently.
The level of IgG1 immunoglobulins is highest in the blood of the umbilical cord and fetus. IgG2 antibodies, which are most often produced when using polysaccharide vaccines, penetrate the placenta the worst. IgG3 and IgG4 antibodies also enter the child’s bloodstream, in small quantities. This is taken into account when choosing vaccines during pregnancy, but also when choosing the timing for vaccination.
All vaccinations can be divided into those that are carried out before a woman comes into contact with the infection (and this is the best option), and those that are administered after a possible or confirmed infection (in such cases, ready-made antibodies are administered). Vaccinations are also divided into routine and recommended under certain circumstances.
Recommended routine vaccinations include whooping cough, tetanus and influenza vaccinations. There are no clear recommendations about at what stage of pregnancy vaccination against these diseases should be carried out, but a number of factors should be taken into account when planning vaccination.
You need to know that the protective level of antibodies appears three weeks after vaccination. This is taken into account, for example, when vaccinating against flu - it is advisable to get vaccinated before the peak of seasonal colds and flu occurs. In such cases, the gestational age does not play a role.
The whooping cough vaccine is done to obtain a good level of antibodies and to transfer these antibodies to the fetus. Therefore, it is most often performed in the third trimester.
WHO has begun recommending tetanus vaccination in countries with low social standards, as many women have to give birth in poor hygienic conditions. This vaccination also significantly reduces newborn deaths due to tetanus.
In developed countries, tetanus vaccination is carried out in childhood with booster vaccinations every ten years. It is believed that five doses of the vaccine are enough to form stable immunity until old age. However, most women in poor countries are not vaccinated or have not been revaccinated.
You can get a tetanus vaccine at any time during pregnancy, but most often it is recommended to do it at the end of the second or beginning of the third trimester.
All other vaccinations are carried out according to indications, for example, when a pregnant woman travels to a certain region of the world where there is a high level of risk of contracting some dangerous infection.
Why are most vaccines safe during pregnancy?
Taking into account the production technology and composition of modern vaccines, almost all of them pose no danger to pregnant women.
Anti-vaxxers often have arguments that testing vaccines on pregnant women is a manifestation of inhumanity. In fact, no one has ever tested vaccines on pregnant women.
Doctors and scientists obtain information about the safety and effectiveness of vaccines during pregnancy through carefully collected information about the side effects of vaccination through public registries of such information. And often women don't know they're pregnant when they get vaccinated.
Nearly 70 years of vaccination in developed countries, where 80 to 98 percent of people have been vaccinated during their lifetime, has produced a wealth of data on the effects of vaccines, including on the fetus and pregnancy.
And so far there is no reliable data that vaccinations cause pregnancy disorders, malformations and other abnormalities in the mother and fetus.
Vaccination against coronavirus infection during pregnancy
Against the backdrop of the pandemic, many women who are planning a pregnancy or are already pregnant are concerned about the issue of vaccination against coronavirus. Of course, existing Covid vaccines have not been tested on pregnant women. Many important facts were taken into account before they were used in pregnancy.
Two groups of vaccines have been studied on the modern market - DNA and RNA-containing vaccines (Pfizer, Moderna) and vector vaccines (AstraZeneka, Sputnik V and others), which have already been tested on a large number of people and have shown good levels of effectiveness.
Immunity is developed for genetic molecular vaccines in 97-98 percent of cases with the correct vaccination regimen, for vector vaccines - up to 70 percent of cases. Symptom levels when infected with coronavirus infection are also significantly reduced.
Both groups of vaccines are not contraindicated during pregnancy, since the first group does not contain viruses, and the second group contains non-pathogenic (non-infectious) adenoviruses, which are also not dangerous for pregnant women. Preference is given to DNA and RNA vaccines, as their effectiveness is higher.
The remaining groups of vaccines are still being developed or tested and are not yet widely used, especially during pregnancy.
Since the technology for making these vaccines is no different from the technologies used to produce other vaccines, quickly creating a vaccine was not a problem.
The study on volunteers, although short-term, was large-scale, and did not show any additional complications that were not known in medicine before.
Vaccination of pregnant women began in Europe, the United States, Canada and Israel in May 2021, when reported cases were analyzed in which a woman was vaccinated during the planning stage or early in pregnancy, either with her consent or ignorance of her situation.
In these cases, no negative consequences for the mother and fetus were found. Plus, taking into account the mechanism of action of vaccines and their composition, it was known that these vaccines do not contradict the mechanism of action and composition of already widely used vaccines against other infections.
Large-scale vaccination against coronavirus infection has allowed many countries to lift quarantine, remove the mask regime, open public institutions, as well as borders for tourists. New cases of coronavirus infection have also decreased significantly, as has the rate of complications when an infection occurs. On the contrary, countries with low vaccination rates are seeing an increase in coronavirus cases and also an increase in deaths due to this infection.
Vaccination is not only about taking care of your own health, but also about taking care of the health of all other people. In the information era and in the era of new technologies, one cannot think in terms of the Middle Ages without understanding and accepting the fact that epidemics of dangerous infections have destroyed more of the world's population than all wars combined.
*for the site nen.ru
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How much time should pass between vaccination and conception/IVF program?
Women are recommended to begin IVF treatment programs or attempts to conceive on their own no earlier than 30 days AFTER receiving the 2nd component of the vaccine. As a rule, after 2-3 weeks the acute immune process, the response to the vaccine, stops, and immunity begins to form in the body.
Men can donate sperm for IVF 3-5 days after ANY component of the vaccine. However, there is still very little statistical data on the effect of the vaccine on spermatogenesis. It is possible to pre-freeze the sperm BEFORE vaccination; this procedure takes a little time and will allow vaccination to be completed in a timely manner.
Covid and the fetus
The effect of coronavirus on the fetus has not yet been fully studied. According to the operational headquarters, the infection does not have a negative impact on the unborn child. Gynecologist-reproductologist Maria Milyutina also said that a mild form of the disease does not pose a threat to the development of the fetus.
Other doctors believe that there are still possible risks. Chairman of the Council of Mothers, doctor Tatyana Butskaya warned that Covid in the second trimester of pregnancy can lead to slow development of the fetus. This may be due to respiratory failure, since in later stages a woman’s stomach puts pressure on her lungs and reduces their volume, Gazeta.ru wrote.
Kamil Bakhtiyarov, an obstetrician-gynecologist at the Semeynaya clinic, has a different opinion. The doctor is confident that only those women who suffer from moderate to severe illness, and during the second or third trimester, can face such risks.
