What you need to know about the Covid vaccine, fertility and pregnancy

As the Covid vaccine rollout continues, doctors are reporting hesitancy among young women, concerned about how the vaccine might affect their fertility or their unborn baby should they fall pregnant. Essex GP  Dr Adwoa Danso  told BBC Radio 4's The World at One that ‘will the vaccine affect my fertility?’ was one of the most commonly asked questions among her female patients. And she's not surprised, blaming lack of clear information about the impact of the vaccine for women to draw on. "The messaging from the government and NHS [about the vaccine and fertility] has been confusing and that goes some way to propel hesitancy," she said.

When we asked Dr Amin Gorgy, co-founder of London's  Fertility and Gynaecology Academy , he told the same story, saying "many patients enquire every day [about this]."

A woman in her thirties, who didn't want to give her name, told The World at One that she and many women in her social circle were holding back on receiving the jab. “It was difficult to find clear information online about fertility and the vaccine,” she told presenter Sarah Montague. “I looked on the government website and found that the information directed you to conflicting sources, that were neither clear nor concise. It was full of medical jargon and we don't feel reassured.”

In fact, when we Googled it ourselves, we found what seemed like out-of-date PDF  Guide to Covid-19 vaccination for women of childbearing age, currently pregnant or breastfeeding  from Public Health England, which stated that "the vaccines have not yet been tested in pregnancy, so until more information is available, those who are pregnant should not routinely have this vaccine," although they insisted that it was safe. "The Joint Committee on Vaccination and Immunisation (JCVI) has recognised that the potential benefits of vaccination are particularly important for some pregnant women. This includes those who are at very high risk of catching the infection or those with clinical conditions that put them at high risk of suffering serious complications from Covid 19," it says.

However the  JCVI said this week  that pregnant women should be offered a Covid jab in line with their age group, because "there is no evidence to suggest that other vaccines are unsafe for pregnant women", but given the previous advice from PHE is still online, the new guidance doesn't feel reassuring.

The JCVI says that at the moment the Pfizer and Moderna vaccines are preferable for pregnant women because data from the US in 90,000 pregnant women has not raised any safety concerns. As for the AstraZeneca vaccine, there is a lack of data on this vaccine in pregnancy because pregnant women were not included in trials, but the JCVI says more evidence may be forthcoming in the near future.

What do the the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives advise regarding  the vaccine and fertility?  "There is no evidence to suggest that Covid-19 vaccines will affect fertility. Claims of any effect of Covid-19 vaccination on fertility are speculative and not supported by any data," they say. Still, that may not be reassuring enough for some women.

It's clear that there's a call for more accessible and less confusing information. Conservative MP Caroline Noakes, chair of Women and Equalities Committee, has written an open letter to the vaccines minister Nadhim Zahawi asking the government to take young women's fears seriously. She told the World at One this week that many women received misinformation from Whatsapp groups and social media, but there wasn't a trusted and clear alternative.

"There's real traction online around fertility concerns," she said. "There's been a lack of messaging from the government [around fertility] and any messaging has been vague and compounded by negative discussion online. We need trusted voices to send the reassuring message."

Where does the distrust come from? Harley Street GP and women's health expert  Dr Houda Ounnas  has an idea: "It could be an interpretation of the fact that people are asked before having their vaccine if they are already pregnant, but this is a standard question, asked to anyone who is getting any vaccine, not just the Covid 19 vaccine," she says.

Here's what she and other experts had to say about the Covid 19 vaccine and fertility and pregnancy to help you make an informed choice.

Can the Covid vaccine affect fertility?

In a word, no. "Having looked at the scientific literature, it's very clear there's no evidence the vaccine can harm fertility," Dr Raj Mathur, consultant gynaecologist and chair of the British Fertility Society told Radio 4. "There's no biologically plausible mechanism that the vaccine would be able to affect fertility in men or women."

Dr Adwoa Danso agreed, adding on her Instagram feed that there was "no biologically plausible mechanism by which current vaccines would cause any impact on women’s fertility". She went on to say, "Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.”

What's more, the misinformation surrounding fertility and the vaccine from unverified sources, could prove damaging, says Dr Ounnas. "It has the potential to cause anxiety and on some occasions, put people off having the vaccine. There is absolutely no evidence that Covid vaccines can affect the fertility of women or men."

Can you have the Covid vaccine if you’re having fertility treatment?

Yes. “All fertility patients are encouraged to take the vaccine before their treatment if they are offered,” says Dr Gorgy. However, he does suggest avoiding having the vaccine for three days before or after your fertility treatment (such as egg collection and embryo transfer). This is not because it affects fertility, but because of  possible vaccine side effects , such as chills and headaches, which might make you feel under the weather. “This precautionary measure is only to avoid the confusion between the side effects of the vaccine and infection from the procedure.”

Can you have the Covid vaccine if you’re pregnant?

Yes. All three vaccines are approved in pregnancy, though t he government's vaccine advisory committee, The Joint Committee on Vaccination and Immunisation, says it's preferable to have the Pfizer/BioNTech or Moderna vaccines  because they have been more widely used during pregnancy in other countries and have not caused any safety issues.

The vaccine doesn't cross the placenta or affect the unborn baby, says Public Health England . "The early Covid-19 vaccines do not contain organisms that can multiply in the body, so they cannot infect an unborn baby in the womb."

When is the best time in pregnancy to be vaccinated? Guidance from the  Royal College of Obstetricians and Gynaecologists  says that the vaccine will work at any stage, however before 28 weeks seems best as Covid has more serious implications for both mother and baby after that. Babies are a third more likely to be born prematurely and the mother to become seriously ill if she develops Covid in the third trimester, it says. Additionally, some women may feel they want to delay the vaccine until after the first trimester, the period most important time for the baby's development.

Besides, it's a case of weighing up the risk of catching Covid in pregnancy against any perceived risk of the vaccine itself. “[If you have Covid while pregnant] your outcome from Covid is likely to be worse and babies are more likely to be born prematurely," Dr Mathur said on Radio 4. "The vaccine protects against all of this. It's a case of weighing up very real risk of Covid to a theoretical risk of the vaccine.”

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