Both planning for pregnancy and raising children can create stress for parents and parents-to-be during normal times, but taking on either of these roles during a pandemic can be even more taxing.
Many couples looking to have children during the COVID-19 crisis are worried about the risks associated with getting pregnant at this time, but they are also concerned about waiting too long to conceive.
"It's age-related. It's another huge gender inequity, but if the woman waits very long, then her chances go down. We don't think waiting a month or two is a big difference, but this isn't ending any time soon," said Dr. Julie Lamb, a board-certified reproductive endocrinology and infertility specialist at Pacific Northwest Fertility in Seattle, Washington, and a member of the Medical Advisory Board for Modern Fertility, where she takes care of patients who are struggling to become pregnant.
Of her patients who had not yet started treatment before the pandemic, Lamb said that some were "just anxious enough that they would rather wait... until the world seems safer." But, a larger portion of her patients took her by surprise and opted to continue fertility treatments. "I guess we expected it to be more common to delay treatment," she said.
Though the pandemic may be challenging women who are feeling pressured by their biological clocks, it has helped those feeling pressured by challenging work environments or other stigmas.
"A lot of patients have said they feel like this is a really safe time for them to be pregnant because they're quarantined at home already," Lamb said. "It makes it easier for them to do this process undetected." She even has some patients who "are so stressed out about missing work and making appointments and want to come in when it's still dark outside." An upside of the pandemic is that "they can fly under the radar better and be undetected."
Experts are learning more every day about the new coronavirus. The American College of Obstetricians and Gynecologists (ACOG) is following the situation closely and updating its guidance on any increased risk to pregnant women and their babies.
A June report from the Centers for Disease Control and Prevention (CDC) says pregnant women who have COVID-19 may require more specialized care than nonpregnant women, but they are not more likely to die. Although they may be at risk of needing more hospital care and experiencing a more severe illness caused by the virus, the overall danger is still low for pregnant women.
Researchers have found a few cases of COVID-19 being passed from mother to baby during pregnancy, but this seems to be rare.
More research is needed to understand the effects of the virus before birth. After birth, a newborn can get the virus if he or she is exposed to it.
"I haven't seen anything in terms of evidence that COVID-19 is negatively impacting a woman's ability to conceive," said Dr. Melanie E. Watkins, a mother of two and an OB/GYN with Women's Specialists of Northside Gwinnett in Lawrenceville, Georgia.
Even if the virus does not have a biologic impact on conception, Watkins still believes that "we are potentially going to see decreased pregnancy rates, likely because of increased stress levels." In her own practice, Watkins has noticed "an increased volume of anxiety and depression" among patients, "and along with that comes the hypoactive sexual desire disorders that involve decreased libido," she said.
In addition to the biologic impact that stress might have on fertility, Watkins said that her patients who are trying to conceive are "just nervous and scared." Some of them are "delaying their plans to start conceiving." She attributes this worry to the fact that "there is so much involving pregnancy and COVID that we just don't know."
Patients who are having problems conceiving may decide to see an OB/GYN who specializes in more intensive fertility treatments. These specialists put patients on very specific medications and procedure schedules. Patients undergoing these intensive fertility therapies have had their care impacted significantly by the pandemic.
In March, Dr. Lamb said that the American Society of Reproductive Medicine "sent out a guideline that recommended pausing or stopping all fertility treatments." This measure was primarily intended to preserve critical PPE, but it meant that "people had their cycles canceled and had to stop treatment for almost a month and half," Lamb said. Overall, this led to many patients being forced to delay their pregnancies.
For women who are already pregnant, the pandemic can create isolation. With less contact and support from family and friends, many moms-to-be feel that their babies are growing without the love they would have felt prior to the pandemic.
And with pregnant women having a majority of their prenatal visits virtually, they lose the experience of seeing their baby grow and hearing their heartbeat via ultrasound. One pregnant woman, who asked to stay anonymous, told ABC News that pregnancy during the pandemic "has been tough, but the most frustrating was the impact on what should be normal health care."
While making the decision to start or grow a family during the pandemic is not an easy one, Watkins reassures her patients that "other than the unknown that all of us are experiencing every day of our lives, I don't think there is a reason to tell a healthy couple to delay efforts to try to conceive."
Stephanie E. Farber, M.D., is a plastic surgeon in Atlanta, Georgia and a contributor to the ABC News Medical Unit.