Pre-pregnancy / Trying to conceive

Will the vaccine impact my fertility?

Dr. Dixon: The information we know is very reassuring. There is no evidence that any of the vaccines affect fertility. I encourage everyone to get their COVID-19 vaccine when they’re eligible. This includes if you’re actively trying to have a baby or even just thinking about having a baby in the future.

I am 39 and am trying to conceive. Will the vaccination decrease my chances?

Dr. Dixon: I’ve been assuring my patients, regardless of their age, that there’s no evidence the vaccine leads to loss of fertility. While fertility was not specifically studied in the clinical trials of the vaccine, no loss of fertility has been reported among trial participants who have received the vaccines since their rollout.

Is it safe to conceive while awaiting the second dose?

Dr. Dixon: It is safe if you become pregnant at any point around your vaccine doses: immediately before or after your first dose, between your first and second doses, or immediately after your second dose. I advise my patients to get vaccinated as soon as they are eligible to ensure they do not become seriously ill from COVID-19.

Timing of vaccination during pregnancy

Is there an ideal time during pregnancy to get vaccinated? First or second or third trimester?

Dr. Ladhani: The best time to get vaccinated is when you become eligible. We know that COVID-19 in pregnancy can increase your risk of being hospitalized and also cause an increased risk of preterm delivery. Statistics suggest between eight and 11 per cent of people who are pregnant who contract COVID-19 will be admitted to hospital, and between two and four per cent will need intensive care. That’s compared to about eight per cent of all COVID-19 patients who have needed hospitalization and about 1.5 per cent who needed intensive care, so pregnancy puts you at higher risk than the general population. A recent study in the American Journal of Obstetrics and Gynecology found those who were pregnant had a strong immune response after vaccination, suggesting strong protection. The study also showed that COVID-19 antibodies were transferred to babies, and we are going to see the effects of this soon. 

I’m in my third trimester. Should I get the vaccine while pregnant or when the baby is born?

Dr. Ladhani: I would advise receiving the vaccine as soon as you can. You’ll be protecting yourself, as well as your baby, once your immune response begins to kick in (usually two weeks after vaccination). Please be sure to receive your second dose at the scheduled time. The antibodies you produce will be passed on to your baby through the umbilical cord and in the breast milk.

Pregnant and patiently waiting. Is it ever too close to the due date to get the vaccine?

Dr. Ladhani: Close to your due date is absolutely fine. You’ll be protecting two people – yourself and your baby – it’s a win-win situation.

Pregnancy & the COVID-19 vaccine

Can antibodies be passed to baby if vaccinated during pregnancy?

Dr. Ladhani: A recent study showed there was immunity transferred to babies via placenta and breast milk. This evidence points to the strength of vaccination, at any stage of pregnancy, and also for those who have delivered their baby and are breastfeeding.

What effects will the vaccine have on my baby?

Dr. Ladhani: The COVID-19 vaccines available for people who are pregnant don’t contain any live virus and do not put you at increased risk for pregnancy loss or harm to your baby. They will not give you or the baby COVID-19, and will not interact with yours or the baby’s DNA. You may develop a fever after you get the vaccine, but this will not harm the baby.

Does vaccination during pregnancy mount less of an immune response compared to non-pregnant?

Dr. Ladhani: In a recent study, COVID-19 mRNA vaccines generated strong immunity in pregnant and breastfeeding people. The immune response was the same as that observed in non-pregnant individuals. Immune responses from being vaccinated were significantly greater than if you had been infected with COVID-19.

Could post-vaccine symptoms be heightened due to pregnancy?

Dr. Ladhani: There’s no indication that if you’re pregnant you will have more severe post-vaccine symptoms. The vaccine can cause fever in some people (around 16 per cent of those vaccinated) and usually takes places following the second dose. The evidence shows there is minimal risk to your or your baby. A few hours after receiving the vaccine, if you have a fever, you can treat it with acetaminophen/Tylenol.

How do we know the vaccine is safe during pregnancy if trials have just started for that group?

Dr. Ladhani: Early clinical trials for the COVID-19 deliberately did not include people who were pregnant. It’s common practice for clinical trials to exclude those who are pregnant, with concerns about fetal development cited. However, we do know that some vaccine study participants became pregnant and to date there have been no adverse effects reported during pregnancy or related to the health of babies. The COVID-19 mRNA vaccines studied in people who were pregnant, breastfeeding and trying to conceive have been found to be safe.

I received the Tdap (Tetanus, Diphtheria, Pertussis) vaccine and Rhogam today. Do I have to wait two weeks to get the COVID vaccine?

Dr. Ladhani: There is no need to wait between vaccines. You can get both vaccines on the same day or within two weeks of each other.

Will the vaccine cause birth defects, miscarriages, or any other fertility or pregnancy complications?

Dr. Ladhani: From the data we have, there is no increased risk for miscarriage, stillbirth or congenital anomalies with the COVID-19 vaccines. I assure patients that there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications. This is based on the millions who have received the vaccines to date and were trying to conceive or were pregnant.

What happens if I get COVID-19 while pregnant?

Dr. Ladhani: If you begin to feel unwell with symptoms of COVID-19, please contact your obstetrician. Most people who are pregnant will have mild-to-moderate illness if they contract COVID-19. Your obstetrician will provide you with support and resources for managing COVID-19.

High-risk pregnancy & the COVID-19 vaccine

Is the vaccine right for me if I have an autoimmune disorder, asthma and recurrent losses?

Dr. Ladhani: Yes, we would recommend that you get the COVID-19 vaccine. Being pregnant and having asthma are both risk factors for moderate to severe illness with COVID-19. People with autoimmune disorders weren’t included in the vaccine trials, and so the effectiveness and safety profiles aren’t known, but NACI and the Canadian Rheumatology Association are recommending that people with autoimmune disorders are offered the vaccine. Given your risk profile, the vaccine may protect you from the severe forms of COVID-19. It may be worth discussing this more with your health-care practitioner.

I’m having a high risk pregnancy. Should I get the vaccine?

Dr. Ladhani: Yes, in most cases people who are pregnant with high or low-risk pregnancies will benefit from receiving the COVID-19 vaccine and being protected from the disease. Please speak with your high-risk obstetrician about the specific details surrounding your pregnancy to determine if you will benefit from the vaccine.

I’m expecting twins. Is it safe to get the vaccine?

Dr. Ladhani: Yes! You’ll protect yourself and potentially protect both of your babies!

I am pregnant after experiencing a pregnancy loss. Should I get the vaccine?

Dr. Ladhani: A pregnancy loss can be devastating, and it’s understandable you may feel anxious being pregnant again. I would recommend receiving the vaccine for additional peace of mind during your pregnancy, especially as contracting COVID-19 during pregnancy can put you at higher risk of hospitalization and preterm delivery. Please remember there is always support available for pregnancy and infant loss through Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network.

Are there complications with heart arrhythmias?

Dr. Ladhani: COVID-19 can be dangerous for those who have an underlying heart condition. Both of the COVID-19 mRNA vaccines were tested in people with heart problems and found to be safe and effective.There is no evidence that the vaccine has worse side effects for people with underlying heart conditions, and having COVID-19 is much riskier than getting the vaccine, so we would recommend you get the vaccine.

Breastfeeding & the COVID-19 vaccine

Is the vaccine safe for both me and my baby while breastfeeding?

Dr. Ladhani: The vaccine is safe for your and for the baby. There is new data showing antibodies for COVID-19 in breast milk after vaccination. So you’re not only protecting yourself against COVID-19 with the vaccine, but also possibly passing along some immunity to your little one. A huge win!

Fertility treatments & the COVID-19 vaccine

Is the vaccine safe when undergoing fertility treatment, like IVF?

Dr. Dixon: I suggest speaking with your fertility specialist who knows your history and care plan, and can answer your questions to help you make an informed decision. Undergoing IVF can be a stressful time and your fertility team is a wonderful resource to help guide you. Your specialist may suggest waiting a few days between some treatment procedures (for example, egg collection in IVF) and vaccination, so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure. 

Is it safe to get the vaccine if you have a planned intrauterine insemination (IUI) or embryo transfer?

Dr. Dixon: We may consider postponing the start of assisted reproductive treatments – like IUI, ovarian stimulation and embryo transfer after your first or second vaccination. This allows time for the immune response from the COVID-19 vaccine to settle down – this recommendation is purely to help patients cope with potential side effects IF they occur. Please talk to your fertility specialist if you have any concerns about the timing of your vaccine with upcoming fertility treatments.

I did IVF and I’m still in my first trimester. How long should I wait to get the vaccine?

Dr. Dixon: You should take the vaccine as soon as it is made available to you. Please speak with your provider about the specifics of your case. This is consistent with the most recent fertility practice guidelines.

I got pregnant after my second IVF cycle, I’m on my fifth week. Is it safe to receive the vaccine?

Dr. Dixon: It is safe to receive the vaccine in your first trimester. The data from those women who became pregnant immediately after receiving both of the COVID-19 mRNA vaccines showed no adverse outcomes in the pregnancy and the vaccines have thus been deemed both safe and effective. Further, there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications.

Read more: Got your COVID-19 vaccine? What you need to know about infection prevention after getting vaccinated

The post Pregnancy, fertility and the COVID-19 vaccine: Sunnybrook experts answer your questions appeared first on Your Health Matters.

In April 2021, The New York Times reported that 8 per cent of Americans missed their second dose appointment, according to the Centre for Disease Control. The report outlines several reasons behind the no-shows, including a fear of possible side effects, overconfidence in the first shot, and a lack of supply for certain brands of the vaccine.

After a slow start, Canada has officially surpassed the United States in vaccination rates for residents who are fully vaccinated. However, despite the promising increase, Dr. Rob Kozak, clinical microbiologist and scientist at Sunnybrook says we must remain diligent.

“The worst thing that could happen would be for Canadians to refuse or delay getting vaccinated. This will lead to it taking longer to get population level immunity,” he says.

Dr. Kozak offers insight on common concerns surrounding second doses, and why getting fully vaccinated is the best way to protect yourself and the people you love.

Improvement of overall efficacy

“There are so many reasons to get both doses,” Dr. Kozak says. “The second dose of the vaccine is important for building immune memory, and robust antibody and T-cell response against the variants.”

Having both doses of the vaccine also increases overall efficacy, meaning your chance of having an infection is reduced, Dr. Kozak adds.

Furthermore, he says, if you do get infected with the virus, you are more likely to have a milder case, and less likely to spread it to those close to you when you are fully vaccinated.

Increased protection against variants

“There is data coming out that is showing that one dose provides much more limited protection against variants,” Dr. Kozak says.

As the contagious Delta variant continues to increase in prevalence across Canada, you can put yourself at risk by not getting the second dose.

“Plus, we will likely see more variants emerging in the future, and so far all our data is showing that 2 doses is more protective against variants than a single dose,” he says.

Necessary to achieve herd immunity

Herd immunity occurs when enough people have a protective immune response against the virus that will prevent them from getting very sick and reduces the chance of the virus spreading to others. In order to achieve herd immunity, Dr. Kozak says viruses needs a susceptible host to replicate and spread to others.

However, he notes that we cannot solely rely on others around us to be have their shots. In order to protect those who are more vulnerable to infections, we must also ensure we are doing our part.

“It is important to remember that the vaccine will not work perfectly in everyone. For example people who are immunocompromised may not be as well protected if they are vaccinated, and they are relying on all of us to get our shots to help keep them protected,” he says.

By continuing to increase the vaccination rate, we can all contribute to a healthier future. Of this, Dr. Kozak remains optimistic.

“This pandemic has been hard on everyone, but now we can see an end in sight.”

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Along with rising vaccination rates, though, have been stories of vaccinated individuals who have experienced a “breakthrough infection,” which means they contracted COVID-19 at least 14 days after receiving their second dose of a COVID-19 vaccine.

We asked Dr. Rob Kozak, clinical microbiologist at Sunnybrook, to answer some questions about breakthrough infections: why they happen, what the risks are and how they can be prevented. You can read his answers below.

Dr. Rob Kozak is a scientist and clinical microbiologist who has been involved in COVID-19 research since the virus emerged in Canada. In February 2020, Dr. Kozak was part of a team that received a grant to develop genome sequencing of SARS-CoV-2. In March 2020, he was part of a team that isolated the virus. Learn about his vaccine development work in the University of Toronto Magazine.

Can you explain why breakthrough infections occur if the vaccines are considered effective?

It’s a great question. We are still studying the immune response, and are working to fully understand how the different arms of the immune system work to protect you from SARS-CoV-2.

We know the vaccines are very effective, but not perfect. Some individuals will mount a better immune response than others, and that means that a very small percentage of vaccinated individuals will develop an infection. Even in those cases, your immune response is still helping because it is lowering the viral load (amount of virus), helping make the infection much more mild. 

What are we seeing so far with regards to COVID-19 and breakthrough infections? Anything particularly noteworthy?

The number of infections in fully vaccinated people is extremely low. Data from Public Health Ontario has shown that, to date, only 0.02% of fully vaccinated people have become infected.

This means almost all the cases we are seeing of COVID-19 are in people who are partially vaccinated or unvaccinated.

What do you think is important for fully vaccinated people to know about breakthrough infections?

We don’t want anyone to believe that the vaccines don’t work. Even the term “breakthrough infection” is a bit misleading: the job of the vaccines is to train your immune system to be ready to fight the virus so that you don’t get a severe case of COVID-19, end up in hospital, or pass away from the infection.

We know we will see mild cases of COVID-19 in a small number of vaccinated people. So, it really isn’t a breakthrough; it is more your immune system preventing the infection from being very serious.

But even in these cases, a vaccinated person is much more likely to have milder illness, and is less likely to transmit the virus to those around them. This is good because it means you are helping to protect those close to you from COVID-19.

Can you talk about how increasing vaccination rates at home and globally could help minimize the risk of breakthrough infections from new variants?

Viruses need a susceptible host (that’s us) to replicate and spread to others. The antibodies and T-cells generated by vaccination will neutralize the virus, which lowers the viral load and helps prevent the virus from spreading to others. This is why it is important to drive up global vaccination rates — it reduces the number of susceptible hosts the virus can infect.

What, if anything, can fully vaccinated people do to further reduce their risk of experiencing a breakthrough infection?

The best way to prevent getting infected is to not get exposed to the virus. Being vaccinated is a layer of protection, but you can always do more. This means following the public health guidelines: wearing masks, maintaining distancing where required, getting tested if you think you were exposed, and staying away from others if you’re feeling sick.

Also, do what you can to convince friends and family to get vaccinated if they haven’t done so already. The more shots we have in arms, the more everyone is protected.

Why is it still important for people to get two doses of a COVID-19 vaccine if breakthrough infections are possible?

There are so many reasons to get both doses. The second dose of the vaccine is important for building immune memory, and robust antibody and T-cell response against the variants, and it increases the overall efficacy of the vaccine. This means your chance of having an infection is reduced when you have both doses.

Furthermore, if you’re fully vaccinated and you do get infected, you are more likely to have a milder case, and less likely to spread it to those close to you. Also, proof of full vaccination will be needed for travel and potentially other things too. By getting fully vaccinated it will mean you will have more things to enjoy this summer!

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This interview has been edited for length and clarity.

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Natasha Salt, Sunnybrook’s director of Infection Prevention and Control (IPAC), talks about misconceptions surrounding public health measures for those who are vaccinated, post-vaccine transmission, and why it’s not the time (yet) to let our guard down.

Can I change my COVID-19 prevention practices after I’ve been vaccinated?

No. Not at all, actually.

Right now, we’re still learning a lot about how the vaccine will reshape our routines. We do know that it is highly effective in preventing or reducing symptoms in those who are vaccinated (as high as 95 per cent). However, at this time, not enough people have recovered and/or been vaccinated to stop ongoing spread. Even though we may be vaccinated, we can still come in contact with COVID and pass it to others, all while never showing signs or symptoms of an infection. As there is still a lot of COVID circulating in the community, it remains important to clean your hands, physically distance, wear your mask and limit your gatherings to your household.

So, I can still spread COVID-19, even if I’m vaccinated?

Absolutely.

I’m fully vaccinated. Technically, I’m one of these people that could be saying, “I am ready to let my guard down.” And sure, maybe my risk — my personal risk of infection — has been reduced substantially. I may or may not develop any symptoms at all if in contact with COVID virus. However, my hands, nose and mouth may come in contact with live virus from an infected person and I can still pass this on to others if I don’t clean my hands or contain my secretions. For this reason, we want to continue to protect ourselves and others by maintaining the same public health prevention measures.

What if I’m vaccinated and hanging out with other vaccinated people? Is that OK?

Hang tight, we are currently riding the third wave of the pandemic and getting together, vaccinated or not, is still not permitted. We are still learning about how much the COVID-19 vaccine will impact transmission.

So, I can still get COVID-19 if I’m vaccinated, but I won’t get as sick?

Exactly. Because I’m vaccinated, my immune system would be kicking into full gear as soon as it’s exposed to the live virus. So, the chances of it multiplying into numbers that make me sick or very infectious to others is pretty low.

If I can still get and spread COVID-19 after getting vaccinated, what’s the point in getting vaccinated?

The more people we have vaccinated or recovered from infection, the sooner we’re going to get out of this pandemic. And more importantly, what everyone is waiting for, public health measures will start to scale back. That’s the real goal here, returning to normal.

When will we be able to slow down with the measures and be able to live “normally”?

If I am being cautiously optimistic, I hope that we will have a quiet summer, but it’s hard to predict when we will return to normal. All pandemics run their course within a couple of years, and so will COVID-19. Vaccine will get us there sooner, with each day closer.

What would you say to people to compel them to continue following public health guidelines?

It’s been a long and arduous triathlon that we didn’t sign up for! Don’t fail me now, team. Decrease your chances of reaching the finish line COVID-19 free by continuing to clean your hands, wear a mask, physically distance and only leave home for essential purposes.

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