On March 16, Dr. Vaggelis Sakkas and his small team of IVF specialists made the decision to temporarily close their practice, the Gyn Care IVF center at REA Maternity Hospital in central Athens, citing coronavirus fears. “Unfortunately, we have stopped everything,” Sakkas explained in a phone interview. “The IVF unit, given that it’s not an emergency service—it’s not a matter of life and death—can wait.” But for how long, nobody yet knows.
Around the world, medical teams and professionals are pivoting to the essential care of treating Covid-19 patients. In some places, physicians who recently retired are being called back to work to help ease overburdened healthcare systems. Medical students are being encouraged to graduate early and start treating Covid-19 patients. And non-essential procedures and therapies are being placed on hold while hospitals and medical centers allocate as many resources as possible to getting a hold on the outbreaks.
This makes perfect sense when you consider the potential difference between life and death. But in the case of IVF, it complicates the definition of an essential versus a non-essential treatment, even given the potential risks. For one, IVF is often a time-sensitive treatment. Without a clear timeframe, stopping or postponing treatment can be a devastating loss.
When Sakkas had to tell his patients he was halting treatments, it was difficult, he said. But it could prove lifesaving. “There are no studies, there is no evidence about what happens if you get [Covid-19] in the beginning of a pregnancy,” he explained. Research so far on prenatal risk of coronavirus is murky. What we do have shows that there are no known negative effects on the baby if the mother is infected during the second or third trimester, but for women seeking to get pregnant now, there’s no guaranteed protection for baby or mother in the case of an infection. Sakkas doesn’t want to take unnecessary risks.
Days after closing the center, he received the first sign that coronavirus might have a more lasting effect on IVF than he had initially thought. In a conversation with a patient whose pregnancy results came back negative, Sakkas said he urged her to keep trying once coronavirus risks subside. But her response left him wondering what the future of IVF will look like.
“I tried to encourage her and [to] tell her, ‘You do not have to surrender, and you have to continue in any case,’” Sakkas explained. His patient told him that although she would like to attempt another round, she wasn’t sure she would be able to by the time the global pandemic cleared. “So, it’s something that frightens everybody,” he said.
Another type of crisis
In August 2018, Greece officially exited its almost decade-long financial crisis that ravaged the nation. Many people had put off child-bearing for a decade, causing birthrates in Greece to plummet. As a result, Greece saw a surge in patients seeking IVF treatment who experienced fertility issues related to conceiving in older age.
“Today, the average age is really high just because many women said, ‘Okay, let’s wait to have another job, let’s wait until the situation is more stable.’ So they waited and waited and waited and they arrived at 40, and they are having other problems,’” Sakkas said.
That was the fertility landscape prior to the Covid-19 pandemic. With this new global health threat, and another potential economic crisis looming, Sakkas and his colleagues wonder what this will mean for those who want to have children now, and how it will affect the IVF industry in the years to come.
According to Seraphim Seferiades, a professor of political science at the Panteion University in Athens, this new insecurity patients wishing to conceive in Greece face doesn’t only come from the recent outbreak of coronavirus. “It’s an additional element in this situation, which makes it even worse than it otherwise would be, because the crisis has never really ended [here],” he said. “The coronavirus just underlines the nature of the problem, which [existed] before and is going to continue.”
A new fertility frontier
Prior to the current global pandemic, medical tourism in Greece, which includes reproductive tourism, had been steadily on the rise. Over the past few years it’s seen a surge of business from foreign patients—mostly from neighboring European countries, but as far off as the US and Canada as well—seeking fertility service like egg freezing and IVF.
Several factors have led to this increase: low costs, highly skilled medical staff trained in cutting-edge technologies, complete donor anonymity, and high success rates.
For Zoë, who prefered to only use her first name, the choice to freeze her eggs in Greece came down to two things: The ease in accessing the service and the price tag. Originally from New York City, Zoë hadn’t been considering freezing her eggs until a friend of hers decided to travel to Italy for the procedure, drawn by the lower costs there. Zoë, 35 at the time, was in Greece, and was curious, so she started researching prices in Athens.
“It was a wake-up call for me, actually. Hearing a friend who was my age, considering her fertility […] it wasn’t something that I had given much consideration in the past,” she said. “But then my friend was essentially an advertisement for just doing this thing as an insurance policy.”
Another draw is Greece’s liberal fertility legislation governing who can receive IVF treatment—the country does not restrict IVF to couples, like several other European states do—and what services are provided. “The law in Greece, fortunately or unfortunately, allows us to do many things. The only limit for the time being is 50 years old,” Sakkas explained. This provides more time to receive IFV treatment than some other European countries; the cut-off age for medical coverage of IVF in France is 42, for example. Another advantage to seeking IVF treatment in Greece is that by law two embryos can be implanted into the uterus of a patient under the age of 40, compared to a single embryo that most other countries allow in that age group, potentially increasing the likelihood of conception.
All of this progress, however, has come to a grinding halt, as countries continue to close their borders and strict social distancing protocols have been implemented across the globe due to coronavirus fears. These measures, along with the unknown risk factor, has ultimately affected both local residents and foreigners seeking IVF treatment in Greece.
“Maybe someone will not invest now in [having children] if everything continues, so I think the problem is going to be worse, much worse,” Sakkas said, referring to the uncertainty of how the Covid-19 pandemic will play out. “A typical couple will keep their money in case one day they have a serious disease. I don’t think they are going to spend or invest in IVF treatments now, if this continues.”