Posted on September 30th, 2021by RMANY

Ep 74: Vaccination and Pregnancy with Dr. Lucky Sekhon

Fertility Forward Episode 74:

The COVID-19 vaccine is raising a lot of questions and anxiety, but it is particularly pertinent to those with a special interest in fertility. On today’s episode, we talk to Dr. Lucky Sekhon, OBGYN and fertility specialist based in New York City. We kick off our discussion by acknowledging that pregnant women are a vulnerable population when it comes to COVID before discussing the misinformation crisis that has emerged and some of the myths surrounding pregnancy and fertility. Dr. Sekhon gives us an overview of the three vaccine options available and shares what studies have shown about vaccination during pregnancy: that more than not having a negative impact on pregnancy and fertility, the vaccine will have a positive, protective impact on pregnant women. She touches on some of the risks involved in contracting COVID during your pregnancy and draws us to the disturbing statistic that less than 20 percent of pregnant women are vaccinated in the US. Dr. Sekhon recognizes a parallel in terms of hesitance with the HPV vaccine in relation to fertility and highlights the importance of trusting public health experts, even though politicization makes this harder. In summary, her advice for pregnant women is that, the sooner you get vaccinated, the better. We hope you join us to hear all this and more today.

Transcript of Episode 74

Rena: Hi everyone! We’re Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: We are so, so excited to welcome to Fertility Forward today, our resident vaccine expert, Dr. Lucky Sekhon, to cover this really important and very timely topic. Obviously something that is ever changing and something that's causing a lot of anxiety and questions among people, certainly in our population, as well as the population overall. So we're so excited to have her on today to talk everything vaccine, answer questions, and do a really comprehensive review of what's going on as of now, September 15th, 2021. Obviously things change quickly and we had covered this at the beginning, but things are so different now so we’re so happy to have you on to update all of us on the vaccine recommendations and get the information out there.
Dr. Lucky Sekhon: Thank you so much for having me. As you know, I'm really passionate about this topic. I've said this before. I mean, as a women's health advocate, educato,r physician, you know, this is obviously top of mind because we know now one and a half years into this pandemic, that pregnant women are a vulnerable population when it comes to COVID and they're at increased risk of adverse outcomes to them and their unborn child. And unfortunately, the other side of the coin is even though we now have vaccines as a very effective tool to protect women and people in general from more severe disease and these catastrophic outcomes that we want to avoid, there is a new crisis that has emerged and it's this misinformation crisis. And so, you know, as a doctor, as someone who was pregnant, 18 weeks pregnant at the beginning of the pandemic, I spent a lot of my, actually all my pregnancy, unvaccinated, because it wasn't available to us yet. I just feel so passionate about getting the word out, because I think that we exist in two realities right now and I don't know if it's social media. I don't know if it’s politicization of every issue, including healthcare in our country, but the country is divided and everyone really believes strongly what they believe about the vaccine. There are a lot of myths out there and unfortunately a lot of them involve what we do. People being concerned about the impact of the vaccine on their fertility or the impact of the vaccine on pregnancy and I think a lot of this at the beginning was fueled, you know, rightly so by the fact that there was little information or data because initial trials of any sort of new therapeutic or drug are never going to purposely include pregnant women. But now it's fueled by a lot of competing interests and you know, the anti-vax movement is strong. And I think when they pick on that vulnerable area of fear surrounding fertility and pregnancy, it really sticks. And this is something that we've, we've learned now. And we continue to fight against.
Rena: Let's start maybe by doing a breakdown. Can you talk about the science behind Moderna, Pfizer, J&J because I think that for a lot of people, you know, initially end up getting confused, there's so many questions. So to really break down how each of those work in our bodies.
Dr. Lucky Sekhon: Right. So all of them do the same thing. They just have slightly different mechanisms. The Pfizer and Moderna vaccines are mRNA vaccines. And I'm pretty sure you have to be living under a rock to have not heard mRNA vaccine in the last year, but basically what mRNA is, it's messenger RNA. It's basically a building block. It's a genetic code, a part of our genetic code that is a translation from the DNA code that we all know about to tell your body how to make proteins. Based on that DNA code. The DNA is like a recipe book and the protein is the actual finished product of what you're, you're making, right? And so you're injecting some mRNA that instructs the cells locally, you know, in your arm muscle cells, on how to make the spike protein, not the actual virus itself and all of its components, but just that outer coat that the virus wears and your cells make that spike protein and small amounts that are rapidly degraded. They don't linger in your system for days on end or weeks or months like some people are worried about and being exposed to that outer coat, that viral spike protein, then exposes your immune system to it. And it teaches your immune system in a small dose, you know, what the coronavirus looks like and that way it will be well-equipped to recognize it and neutralize it if you're ever confronted with COVID. So that's how mRNA technology works. A lot of people are mistaken and think this is a new technology. This is a new vaccine, new equals bad, scary, not tested well enough. But the fact is these vaccines have been in trials since the eighties for different types of viruses, right? COVID is a novel coronavirus, which is why this is new for, you know, in terms of a COVID vaccine. But it's been around for rabies, cytomegalovirus, you know, obscure viruses that no one really thinks about or talks about. So it's not a new technology. The J&J is doing essentially the same thing. It's teaching your body how to make that spike protein so that your immune system then makes antibodies against the spike protein that are long lasting and protective, but it does it in a different way. It delivers the genetic code. Basically it's using a vehicle which is common cold virus that's inactivated and can actually cause you to get sick. So basically they're doing the same thing. There are just slight nuances or differences. And then, you know, in terms of how it's administered - the J&J is very convenient. It's a one-time dose for whatever reason was the way it was developed and studied. The mRNA vaccines where you're injecting mRNA directly require two doses, usually three weeks apart and that's going to give you the amount of immunity that was quoted in all of the initial trials. So one major misconception is that it's better to have one over the other because people don't understand the word efficacy, right? The J&J vaccine was quoted as having around a 60% efficacy and Moderna and Pfizer, you know, we're in the high 80s, 90s, and so inherently, they must be better. But the fact of the matter is, is when you compare all of the different vaccines, whether you're talking, the ones that are available in this country, those three, or even the other ones abroad like AstraZeneca, for example, all of them head to head, have been shown to be equally effective at preventing death, serious hospitalization, needing mechanical ventilation, all of the things that you should actually care about. We've been talking a lot lately about breakthrough infections and yes, breakthrough infections can happen. No one says that wearing a seatbelt means you're never going to get into a car crash or you're never going to get injured in a car crash, right? But wearing a seatbelt is going to protect you from dying in a car crash. It's a similar type of analogy, you know, when you think about how protective these vaccines are. Same with the flu every year, the seasonal flu, we come out with, you know, a slightly different vaccine. You can still get the flu, but it's known that it's going to be much more likely to be a mild infection. And you're at a much lower risk of having serious things happen, like being hospitalized or dying from the flu. So this is not a new concept, but you know, those are the overall differences between the three different vaccines that are available in this country.
Rena: So, okay. That was such an awesome, comprehensive overview and hopefully alleviated some people's concerns. You know, I know, and I hear often is, well, this is a new technology. We don't know how it works, but as you said, mRNA has been around for years. It's not new. So then I think that segues into the question I'm sure many of our listeners are wondering, which is vaccines and pregnancy and vaccines and fertility. Impact? What do we know?
Dr. Lucky Sekhon: So we went through this in the first podcast many months ago, that first address this issue, but just a quick review. Why was it even a question, right? When it first came out, this idea that it might impact fertility and it became this viral, you know, source of mass hysteria online. I remember as a fertility doctor scoffing and thinking that made absolutely no sense. And when you look into it deeper as to why this even became an idea, it's because of this lie that was put out there, that there's similarity in the structure between the spike protein and a protein that is vital to placental function. And that has since been refuted by everyone who has studied this. We know that there's actually really no overlapping similarity, but even if there was, it's not enough, it has to be a certain amount for there to be cross-reactivity. And there are similar types of overlap between other proteins that are ubiquitous in our body like collagen, hemoglobin. And we, we now know after millions and millions of people getting vaccinated and all of the studies that have been compiled from the massive amounts of data, that these are not safety concerns. There have been specific studies now looking at the question of whether fertility is affected, whether there are higher miscarriage rates, this data has been released by the CDC. They've been tracking pregnancy outcomes since the vaccine became available. There is a tracking app called The Safe where women who are vaccinated in pregnancy are basically checked on and followed along longitudinally. And they've released that interim data and shown very clearly that there was no increased risk for incidence of miscarriage. There've been independent studies done at fertility clinics. One in particular that got a lot of attention where they compared the rate of success of frozen embryo transfers in women with antibodies, from infection, women with antibodies from vaccination, and those who didn't have antibodies at all because they were unvaccinated and had never been infected. And it showed no difference in outcomes. We ourselves are presenting data from our center at RMA of New York. It's an oral presentation at the American Society of Reproductive Medicine, which is an international conference, you know, with all of the leading experts in our field. And we are presenting our data, which is really compelling because a lot of it came from the first part of the pandemic. So this is outside of vaccines, but I still think that it can be extrapolated to be reassuring. When you think about safety of vaccines and fertility and pregnancy, we looked at just, you know, the overall rate of pregnancy and miscarriage in those first four or five months of the pandemic, where up to a quarter of New Yorkers were thought to be infected, whether it was asymptomatic or symptomatic infections, because we were like, you know, the first place that COVID really took hold in this country and compared it to our retrospective data prior to the pandemic.
And we showed that there was no difference in pregnancy rates, no difference in miscarriage rates. And it was done in a way that was really clean because a lot of our cycles that we do, a good subset of them involve putting back single embryos that are genetically tested and so it's a nice controlled population because a lot of miscarriages are caused by chromosomal errors or egg quality, or embryo quality issues. But this kind of negates all of that because it's looking at a specific population where we know that the embryos are genetically tested and normal. So I think there is a lot of data now, you know, that's come out the New England Journal of Medicine, a lot of really reputable well-respected, high impact factor publications, have actually looked at the data from the, The Safe app registry. And, you know, these are large numbers. Like there was a study that came out in May, which basically looked at vaccinated, pregnant women who had completed their pregnancies and showed no difference in their pregnancy outcomes when you compare them to, what's known to be the rate of these complications in the general population outside of the pandemic. So all of this is very reassuring. Anecdotally, you know, this is what I do day in, day out. I'd say over 90, well, over 95% of my patients are definitely vaccinated. You know, I obviously talk to them all about this, so I'm aware of everyone's status. And people are getting pregnant. There isn't a, a bump in miscarriage rates. Like, we, as fertility, doctors are not concerned. And one thing that I always tell patients, whether they're approaching me on social media to get more information about some of the things I post about when it comes to the vaccine or just in my life in general, if someone comes to me and says that they're talking to their doctor and they're saying, well, maybe we should wait. There's not enough data, you know, a lazy response where they clearly haven't been up to date with the literature and what's actually happening on the ground. Very clearly, we'll recommend that they get a second opinion. I think that they should talk to a different doctor or a different healthcare professional because this is completely not in line with what all of the major international health organizations and societies are saying. You know, what the top experts and scientists in the world are saying, and at the beginning, I wasn't concerned because of my area of expertise and knowing that it didn't make sense, you know, mRNA degrades very rapidly. It can't circulate around your body. How would it even get to your placenta or cause any sort of reaction that way? But people were concerned. And now I think we have the data to back up. All of the things that the fertility doctors, OBGYNs and major health organizations are telling patients which is there is no concern that this is going to cause infertility and it is safe in pregnancy. And it's not just about it not having a negative impact. It will have a positive, protective impact. What we know now is what I knew in my heart, in my gut when I was 18 weeks pregnant in March 2020/ You know, anyone who takes care of pregnant women knows that respiratory viruses in particular hit them harder. They're going to hit pregnant women harder. THeir lung capacities’s reduced. Their immune system is suppressed. So it only made sense that there would be worse outcomes in women who are pregnant. And the data has been shown that very convincingly across the board, if you are pregnant and you get COVID, it could be fine, but there are really staggering statistics, you know, around on the order of like 15%, 15 times higher risk of being hospitalized, mechanically ventilated, needing to be delivered preterm, um, either for your benefit or for the baby's benefit and being preterm has its own host of consequences, right?
So we know that that is indisputable at this point. And we're seeing it, unfortunately, especially in other parts of the country with very low vaccination rates. A lot of my colleagues who take care of high-risk pregnancies are seeing an alarming rate of women who are pregnant in the ICU and dying, unfortunately. This is not a drill. This is not, you know, us, over-hyping the statistics, this is real. And it's happening right now.
Dara: It’s devastating to, to hear that. And you know, there's a, there's a lot of fear and it's great to hear your perspective and to hear, you know, coming from an expert on the reasons why it's important. And it makes sense in terms of your immune system. The first thing that, you know, we, we tell and we speak about how your immune system is naturally shared and so it's naturally lowered. So it's no surprise that people, you know, women who are pregnant are at higher risk of other conditions and other issues like respiratory issues because they're sharing their immune system.
Dr. Lucky Sekhon: Yeah. It's, it's a known fact that the fetus is half foreign to you, right? Like half of it's coming from your DNA and, and maybe it's not even half. And if you're a donor egg pregnancy, for example, right? But we know that there is some element of your immune system suppressing its own response in a permissive way to allow an embryo to invade your body essentially, and kind of take root. And so you are vulnerable to infections in general. This is why we tell pregnant women to not eat raw and under-cooked foods because you have a lower defense than what you normally would in a non-pregnant state. And later in the pregnancy there, it's really hard to mechanically ventilate the lungs of a pregnant woman when their uterus is pressing on their lungs. Right? So there are a variety of reasons of why it's like a perfect storm. And a lot of people may be in regions of the country where there's better vaccine uptake and people seem to be more on the same page. I think there's like different pockets of society where you might be in a bubble, but here's something that's alarming. If you haven't heard this statistic, just over 20% of pregnant women in the US have actually become vaccinated. You know, and in May, that number was 16%. So that to me is crazy. Given the fact that I view pregnant women, all the experts are viewing pregnant women, as a high risk group. Can you imagine if only 20% of senior citizens were vaccinated? Like it's a setup for a disaster. And this is something that everyone should be talking about and raising awareness of because a lot of times, you know, I'm seeing it in my office when patients are coming to me and they're actively trying to conceive and that is the sole reason why they have held off on getting vaccinated. And I'm one of the first people having this conversation with them who is for the vaccine because they're surrounded by friends and family member, family members who are well-meaning and thinking that they're protecting them by urging them not to get vaccinated.
Dara: 20%. Wow. I feel like there needs to be more information disseminated. I think it's great at a fertility clinic, but I feel like on a large scale, people need to be informed.
Rena: And I think at times doctors aren't telling, I get so many patients that say their doctor told them they didn't know. Isn't that your responsibility as a physician to be up-to-date on the literature? So I agree with your recommendation to get a second opinion because your physician should be guiding you. Not saying, I don't know.
Dr. Lucky Sekhon: Correct. I think it's a lazy response. I think we, as physicians took an oath to do no harm and we're at this point, the data is very clearly showing us that failure to counsel your patients to get vaccinated or sowing any sort of doubt or feeling of vaccine hesitancy because you, as the expert, didn't provide the right accurate information or you failed to stay up to date on the literature that is by definition, doing harm. You're putting your patient in harm's way and they're entrusting you with their health. And I think, you know, this is why actually, you know, a recent controversy was, medical boards have started to put out statements that they are going to take away the medical license of any health professional that is known to be spreading misinformation. So, I mean, this is, this is where it's gotten to, you know, we can't take this for granted anymore. I think I am the first one to admit that I kind of scoffed when these first suggestions of there being links between the vaccine and infertility came up and we thought this would be a thing that would be very much in our past, like within a month. Let's just get the word out there and people will understand. But one thing I realize now, looking back at the history of misinformation, vaccines, you know, this is not the first time this has happened. This happened with the HPV vaccine too. There were a lot of rumors and lies that were put out about it, potentially affecting your fertility or affecting pregnancy.
Rena: Well, it's so frustrating, like I'll get on my soapbox for a second and say like, I hear so many like 20 something girls, or like 18 year old girls going off to college, not getting the vaccine because they're afraid it's going to impact their fertility. And so I just want to say, well, have you even done your fertility checked? Instead of worrying about this which is a fallacy, get the vaccine, but why don't you go, go get your fertility checked, go do some blood work, you know, see if everything's checked out so that you don't come to us, you know, 10, 15 years down the road, whenever you're ready to conceive and find out you had, you know, diminished ovarian reserve or whatever's going on. That's what you should be focusing on if you want to think about your fertility, not this.
Dr. Lucky Sekhon: Yeah. I just think that it's such a random lie or myth that took hold. And it's because unfortunately this is a vulnerable area in our mind, right? It's just like a human need to protect their ability to procreate and get pregnant one day. And I get it, listen as a fertility doctor, I get it. As someone who, you know, helped my patients get through the pandemic where there were some delays and there was a pause to treatment, you know, that's when you see like the desire is very strong to continue on that journey regardless of the world crumbling around you and I, and I get that. And I, and I understand why people are concerned because if anyone puts that thought in your mind, you need to triple, you know, quadruple check that it's not true. My advice is, you know, think about the source and go to good sources for information, talk to your doctor. And that's why it's so frustrating when doctors aren't having this conversation with patients or doing the appropriate work and really understanding the latest research and data. But I think if you're not getting a straight answer or your concerns aren't being addressed, then you need to talk to someone else, you know, and there are a lot of amazing healthcare professionals that will have this conversation with you. And I think we have to look towards public health experts. You know, I think that there's, and the hard part about that is, is the politicization of all of this makes it hard to trust regulatory bodies, the government, right? So there's a lot of things fueling this crisis, but it's a real shame because I think the first half was the tragedy of just COVID itself. And now it's the tragedy of unvaccinated people filling ICU and dying unnecessarily. And, you know, there's a lot of vaccine regret and people who, not to sound dramatic, on their deathbed are, you know, scrawling on pieces of paper, get the, get the shot because they realize it, but it's, it's a little too late and it's not just about dying. I mean, obviously that's what we want to prevent first and foremost, but we still don't know anything about long COVID and how, you know, people are going to fare in the long term in terms of disability, lung scarring. There are so many long-term effects to be worried about, but people really fixate on, on fertility, even though there's no data to suggest that this is going to have any negative impact on fertility.
Dara: And now also with all the variants that are, you know, Delta and I’ve heard Lambda, and there's just a lot of fear.
Dr. Lucky Sekhon: Yeah. But this whole time it's been unknowns, right. There was a time where we were all, you know, wiping down our groceries and focusing on that because we thought that that's the one thing we can control or should be controlling. I think lack of control has become like a norm for most of us going through this. Now, I feel like I have learned so much as a human being, but as a clinician because prior to the pandemic, I had the luxury of just, you know, really being able to look to data for all of my decisions and being able to very, in a calm, collected fashion, you know, look up the answers and, and have data to support everything that I was recommending to my patients. And this has been a constant barrage of questions that we don't have all of the clear answers to, but I've learned to trust my gut on a lot of this too, you know, and I think if you have good training and you understand biology, and you understand the physiology of getting pregnant, staying pregnant, you do have the expertise to make judgment calls, even in the face of not enough data to stand behind those decisions. And I've gained a lot of confidence in my decision making ability as a clinician through this pandemic because it hasn't steered me wrong to take that approach. You know, and I've got no hesitation in telling any patient or shouting it from the rooftops, being on a podcast and saying it There is no link between COVID vaccines and fertility issues and this is not going to harm you or your pregnancy or your baby if you get the vaccine while pregnant or while breastfeeding. The primary reason anyone should get the shot is to protect themselves. Just like when you're on a plane, put your own oxygen mask on first, but there are potential secondary benefits. And it's very compelling. We have data where they've checked the cord blood, which specifically is blood coming from the fetus at time of delivery. And any vaccinated moms at time of delivery, the babies have antibodies in their cord blood. Now, do we know how long the protection lasts, how protective it is and how we verify it? If it's protective? No, we don't have that data yet, but it makes sense that it would be, and same with breastfeeding. We have lots of data now that shows the presence of antibodies against COVID in the breast milk of vaccinated moms whether they were vaccinated in pregnancy or postpartum. I was vaccinated postpartum. I got it as soon as it was available to me. I still remember that moment on like a Sunday afternoon. I just dropped everything and ran to Mount Sinai and got my shot. And it motivated me to keep breastfeeding probably longer than I would have otherwise, because I was like any precious antibodies I can transfer it to my, my child. That's what I'm going to do. So first reason is, you know, for your own health, but there could be secondary benefits. There very likely are. And again, none of this is new information. This is how our immune systems work in pregnancy. This is one of the reasons we say to get your flu shot in pregnancy. This is why breastfeeding is strongly recommended because it protects newborns from a lot of things when their immune system is naive and unprotected. So these are all, you know, basic principles of science, biology, and medicine, and we're just applying it to a new disease.
Dara: Dr. Sekhon is there any time throughout fertility cycle that would not be great to get it, or in terms of pregnancy, is there an ideal time to get it or a time to perhaps hold off?
Dr. Lucky Sekhon: This is such a great question. I'm so glad you brought this up because I get asked this every day. So in terms of fertility treatment, there's no safety concern or biologic concern that it needs to be at a certain part of your cycle or anything like that. The ASRM came out with a really nice, practical guideline or guidance for us, and it's nice to just all be on the same page, right, where they said, get it whenever, whether you were getting treatment, whether you're pregnant or not, but we advise that you wait at least three days after the shot or before the shot. Because we know that not everyone, but some people will get fevers, you know, for the first day or so. And you never want to be in a situation where you just had an egg retrieval and now you're calling your doctor saying, oh, I have a fever, but we don't know if it's from the vaccine or if it's because of a rare complication, like an infection after an egg retrieval. So you just don't want to muddy the waters and make it difficult to interpret what's going on. If it's not, you know, within that three day window before or after procedures like an embryo transfer, IUI, or egg retrieval, or any other surgery that you're going in for, it's not, you know, then it's not going to really interfere with that process. And so it's more so just like, about the scenario of, you know, checking in for your procedure and then having a fever and then us not knowing if you have COVID or not, like, it just makes things confusing. And so it's best to avoid that three-day window, but there's really no concern about safety when it comes to that recommendation. When you think about when to get it in pregnancy, I tell patients, get it as soon as you can. As soon as soon as you're willing and you have access to it and can do it, do it. You know, the, the earlier the better, there are some studies and again, I want to stress the fact that we don't understand the meaning of high levels of antibodies versus lower levels of antibodies. But I will say there is data that I looked at the relationship between when the vaccine was given in pregnancy and the level of antibody found in cord blood at time of delivery and women who were either vaccinated earlier in pregnancy, like the first trimester versus the third trimester and even those who caught COVID earlier in the pregnancy versus later all had much more robust antibody levels in their newborns.
Rena: So there really is no data that if you get.You know a lot of people want to wait and think, okay, let me get further along in their pregnancy, the safer, but there's really no data.
Dr. Lucky Sekhon: There's no data. Early on, I, what I was saying to patients, and this was like, I'm talking January, like when I had patients who were teachers or cops, and they were in that first wave that were eligible for vaccination alongside doctors. I was saying, you know, I think that it's fine to get whenever and, you know, it's, it's really crucial to get that protection on board as soon as possible. But I also understand people being worried about getting fevers in the first trimester. I understand people being worried about organ development and so many things being so crucial in the first trimester, you know, trying to avoid any sort of exposures. I think that is now no longer something that anyone is saying. First off any sort of theoretical link between fevers in the first trimester and birth defects, it's a very weak association and it's been widely debated. But anytime you have fever, whether it's in the first trimester at any point, you should treat it aggressively. You know, and I would say, just be prepared to treat a fever aggressively with Tylenol, which is safe in pregnancy, but, you know, there really is no concern that this is going to cause birth defects or problems with organ development or any of the things that are happening in the first trimester. We have patients who have been vaccinated in the first trimester at this point and they've delivered already. So, you know, I really don't have, we don't have any concerns about that.
Rena: And then I guess another question I'm getting is about the boosters and okay. If I got the J&J vaccine, can I get a Moderna or Pfizer booster?
Dr. Lucky Sekhon: So the whole concept of boosters is based on data that is showing immunity does start to wane at a certain point. And so the latest recommendation, and it hasn't gone live for everyone yet, but it is a current recommendation for those who are immunocompromised because that specific subset, the population is known to have a lower chance of actually mounting an appropriate immune response. And because they're immunosuppressed, maybe their immune system didn't even initially make enough antibodies. So that's why they're recommending the booster first to those individuals to kind of give them, their body a reminder of how to make the antibodies so that they're, you know, double covered. But in general, there's data from other parts of the country and even data from the US looking at vaccinated healthcare workers who were in that first wave, and now they're approaching, or their path that eight month mark after the second dose. And they're showing increased rates of breakthrough infections and lower levels of antibodies present at this point. So there's a lot of data that suggests that there is a benefit to getting a booster shot. Right now, the data is based on Pfizer and Moderna only. And so the suggestion is to get a third dose at least eight months after the second dose was administered. And this is probably going to be something that's recommended across the board for everyone. So I anticipate that it will be live for healthcare workers in that first wave fairly soon. So, you know, the data hasn't come out about J&J yet and that's something that's being actively looked at. I would not panic. I, you know, I think that breakthrough infections aren't only happening because of waning immunity. It's also because we have the Delta variant and we know that that's more contagious and, you know, it may be easier to catch Delta, even if you're vaccinated, but it doesn't mean the vaccine's not protective. There's catching it and having mild or asymptomatic infections. And then there's, you know, catching it and actually having severe manifestations or outcomes like death or hospitalization being vaccinated is still protective against Delta, whether or not you get a breakthrough infection or not. So, you know, I think it's important for all of us to just wait patiently for the data to come out when it comes to the J&J because we just don't know yet, no one is suggesting that you should cross cover yourself and get a different vaccine. Right now, the current recommendation is if you've had two shots of Pfizer, you can get that third booster shot of Pfizer whenever it's recommended to do so. And this is not surprising information. We all knew when we first got vaccinated and it was first available to us that this wasn't going to be like a one and done type thing and most vaccines aren't, right? Case in point, the influenza vaccine. We're getting that every year and it's always being tweaked because there's different strains of the flu virus. So this is likely going to be part of our toolkit, you know, in terms of all the different types of vaccines that we get routinely, you know, to boost our immunity against specific diseases.
Rena: I think this was so, so helpful and so timely. And we will certainly do another episode, you know, as we talk that things are rapidly unfolding. And so I think this is today, the most current up-to-date reliable information. And, you know, as things unfold, we will keep everyone updated and these were great recommendations, great information. And so I hope this was helpful to many listeners who are struggling with anxiety. You know, as we touched upon a lot of this, you know, anxiety, control. It's a lot, but we just hope everyone is well informed. And, you know, our primary goal is to keep everyone safe and healthy.
Dara: And Dr. Sekhon, are there any great resources for our listeners? I mean, I feel like they should check out your Instagram because you are constantly updating everyone, but what are some other great places to, to look, look at?
Dr. Lucky Sekhon: So definitely the CDC. I think that's a great resource. They're constantly updating their site with reports coming from their registry. And, you know, if there's any late breaking updates are gonna see it on there. Specific to fertility and pregnancy, the American society of Reproductive Medicine or ASRM. Their website has a lot of very patient friendly material, um, and educational pamphlets. And you could even have access to their taskforce, their COVID taskforce recommendations and see the things that your doctors are reading. Right? And be in the know that way. So I think going to the ASRM website will never steer you in the wrong direction. They've been pro-vaccine from day one and at the helm of trying to dispel any misinformation about the vaccine and fertility. I also think that ACOG, the American College of OBGYN and Society of Maternal Fetal Medicine, especially for women who are concerned about the vaccine in pregnancy, COVID in pregnancy, there's a lot of free access to all of the latest studies on there. I also want to mention, because this is something that came up recently. I think that the focus of so much of what we talk about is female centric or, you know, on, on individuals who have ovaries and eggs and carry pregnancies. But I think, you know, we should be focusing on men as well, because there's a lot of data that people aren't talking about, and maybe that's a topic for a different day, or maybe you want to do that with our urologist, Dr.Bar-Chama. But we know now that, and this is a lesser known or lesser publicized fact, that COVID infections in men while it doesn't always have an effect, there is a significant association with reduced sperm parameters, probably a transient effect. I wouldn't panic if you've had COVID that you're now infertile as a male, but I think there's a transient dip in concentration of sperm, the motility, we know that the testes have receptors that allow invasion, you know, of the COVID virus into your body. And it's been isolated in testicular tissue. And actually there are case reports of men with erectile dysfunction after COVID. I bring all of this up because this is an issue that's pertinent to men as well. And there's been a lot of misinformation, especially recently on Twitter with, like, celebrities saying different things about it. And people being worried that it's going to cause impotence, you know, to be vaccinated is going to cause impotence. It's going to cause issues with sperm. And it's actually protective. There's no association between the vaccine and male fertility issues, but there is an association between COVID infection and male infertility. We're still learning more about it. It's not a very clean relationship, but I will say across all populations, across both sexes, I think all individuals can benefit from vaccination. And as it relates to fertility, there is no adverse impact. You know, I think the biggest thing is to protect yourself from these severe outcomes.
Rena: I’m so glad you brought that up because actually when we were talking before, I wanted to say, you know, it's, it's interesting that there's been all these myths about fertility and women in the vaccine, but I haven't really heard nits about, you know, the vaccine,affecting men.
Dr. Lucky Sekhon: Oh, no, people are talking about it. I just, I, you know, I, I commented on it because a celebrity with a huge following just, you know, randomly threw out this anecdotal things saying like my cousin's friend had this problem. And so it is something that is going to be topic of conversation, I'm sure in coming weeks, but a lot of people aren't talking about the fact that the infection has been shown to be associated with sexual dysfunction and reduce sperm parameters. I mean, like that's huge, you know, but unfortunately that hasn't been brought to the forefront.
Rena: Well, I'm so glad you brought that up. I think that's really important to know.
Dara: Well, as you know, we end our sessions with gratitude. So Dr. Sekhon, what are you grateful for today?
Dr. Lucky Sekhon: I am grateful to be at this point in the pandemic where we have a vaccine. I think like I try to block out the pre vaccine era of the pandemic because that was just so difficult, so frightening, so anxiety-provoking on so many different levels. I feel like it allows me to come to work and do my job and really focus on the day-to-day of treating patients and helping them achieve their family building goals without worrying about my own wellbeing, you know, and, and that is huge. And my hope for the future is that the eligibility continues to expand. And that those with young children, you know, can also feel rest assured that their kids are also protected as they head into the school year. So that's what I'm grateful for - vaccines. I know that's not really that creative or shocking.
Dara: It's perfect. I feel the same way. Rena?.
Rena: Yeah, I guess it's a piggyback on that. I mean, I'm grateful for wherever at, in the pandemic. You know, I was really happy my daughter started school in school this year, and similar to Lucky, I blocked out many things of the past year because it was just very difficult to try and juggle being a working parent with a child at home. So I'm just grateful for where we're at and I really hope it continues. That we can all do our jobs, kids can go to school and we can regain a sense of normalcy. I see anxiety kind of spiking again in my patients. It was really crazy for a while and then things kind of tapered off and I see it kind of anxiety spiking back up again. I think people are a little bit nervous for the fall, but hopefully this episode in, in getting this information out there and will help everyone, you know, keep safe and informed
Dara: Since it's the Jewish new year, I'm grateful for this new year. And, you know, and for all the reflection over this past year on how wonderful, you know, looking at the positives and how much I've learned and the support I've had and people I get to work with and grateful for what I do and, and coming here and learning and growing as a person it's pretty remarkable. And today is a perfect example of, I've really, I've learned so much from you, Dr. Sekhon and I know our listeners will also take so much from this session. And if there's any questions, please feel free to reach out to us. And we can always do an update down the road with you. And thanks for being on.
Dr. Lucky Sekhon: Thank you for having me and for lending this wonderful platform to this important topic.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram at fertility_forward and if you're looking for more support, visit us at and tune in next week for more fertility forward,

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