The Impact of the COVID-19 Vaccine and Women’s Fertility with Dr. Blake Evans

I am beyond excited to have Dr. Blake Evans joining me today for another interview. He wrote a pretty amazing article with a team of other fertility experts, some of the most well respected in the country. It’s titled COVID-19 Vaccine and Infertility: Baseless Claims and Unfounded Social Media Panic.

Dr. Evans is a reproductive endocrinology and infertility specialist currently working at the University of Oklahoma as one of the faculty members. They have a fellowship program in which we have three fellows, a first, second, and third year, and there are three other physicians in addition to myself, and we have a physician assistant. He started at UO after finishing his fellowship last June from the NIH.

Dr. Aimee: Thank you for writing this article and for coming on today to talk about it. Let’s talk about the vaccines. There’s lots of big news out there and it’s really exciting that they have great efficacy rates. But there are a lot of fertility myths about how they affect fertility and how they can impact pregnancy. Let’s just get to the basics of the vaccines. What are the two vaccines?

Dr. Blake Evans: The two vaccines that are currently under emergency authorization from the FDA are from Pfizer and Moderna, both of which had very large well-conducted studies, randomized blinded studies. The Pfizer study was about 44,000 volunteers that had enrolled and it was a 1-to-1 ratio of people getting the vaccine or a placebo. Similarly with Moderna, except the study was a little over 30,000 people, so still a very robust, well written, well done study. That’s kind of where we are. Whenever you hear about the vaccine currently, those are the two that mainly people are getting today.

Dr. Aimee: How do they prevent COVID-19?

Dr. Blake Evans: The way they work is quite interesting, actually. They contain what is called mRNA, messenger ribonucleic acid. The way that it works is it’s basically an amino acid sequence of what’s called the spike protein, or the protein that is responsible for the COVID virus to enter into our cells and then start to replicate. The way the vaccine works is it has the mRNA, the sequence of the spike protein from COVID, and it utilizes our body’s own immune system to take this mRNA and then translate that to a protein.

Basically, our body is using our immune cells, our T cells and B cells, what normally would help make antibodies, and it’s making an antibody to this protein that the COVID virus has. Then in the future if, having been vaccinated, we’re exposed to the COVID virus, also known as the SARS-CoV-2 virus, then we would have an army of antibodies waiting to defend the natural infection of COVID.

Photo by CDC on Unsplash

Dr. Aimee: I love that. That’s a very easy way for us to think about the vaccine and how it works. There have been so many false claims out there that the vaccines, and I quote, “could lead to female sterilization.” Where the heck did this come from?

Dr. Blake Evans: It was quite shocking to hear. It has understandably caused a huge uproar and a lot of concern for patients in the infertility world, patients that are trying to get pregnant or who are pregnant already.

This basically came from a blog called Health and Money News. It was a petition that two scientists had put forth, one of which is a previous employee of Pfizer from a little over 10 years ago. Whether there are ulterior motives from them posting this or they left on bad terms, I have no idea. The statement quoted that the vaccine has a spike protein that is called syncytin-1. This protein syncytin-1 is responsible and is vital for the formation of the human placenta. This protein helps form a layer to ultimately help exchange blood and nutrients between the fetal and maternal blood circulation.

They said that this protein, syncytin-1, has a similar amino acid sequence to the spike protein that is on COVID, that it’s in the vaccine. In their words, actually quoting, they said, “the spike protein contains syncytin-1 homologous protein,” so basically saying that because some of the amino acids are similar to the spike protein that our body is going to make an antibody to fight against syncytin-1 and therefore attack a human placenta and therefore lead to sterilization, as they literally quoted.

It was completely baseless. It wasn’t founded on any evidence, they just stated this. It has caused quite the panic in all of our patients.

Dr. Aimee: I know a lot of doctors are going to actually be listening to this, because I’ve had a lot of people reach out to me to say, “When are you going to have Dr. Evans on?” How can we bust this myth with our patients so that they feel comfortable getting the vaccine if they’re trying to get pregnant or if they’re already pregnant?

Dr. Blake Evans: Sure. It’s kind of a multilayered question and answer. Ultimately, more evidence is going to come out eventually. To this day, at this point in time, we don’t have that evidence. What we do know are the fundamental aspects of science and how these vaccines work and the current very large studies from Pfizer and Moderna with a very good safety profile as well.

Photo by Daniel Schludi on Unsplash

One thing I’ll also note is they said that the vaccine contains syncytin-1, but it actually does not. The vaccine does not contain syncytin-1 or the mRNA sequence of syncytin-1.

In order to bust the myth, we have to think about even if the spike protein and the syncytin-1 protein shared similar amino acid sequences, which they don’t, and we talked about that in the paper, they’re not coding for the same protein ultimately, which is what the vaccine is forming antibodies to. In order to make this claim or for them to be able to have proof or background knowledge to claim that it causes sterility, they would have to demonstrate that there would be significant homology between the two, meaning they’re almost identical, and the protein that’s ultimately made is very similar in structure and therefore the antibody that’s made to that protein is going to be identical. For one, they’d have to make that claim. Two, you’d have to demonstrate that there is potential cross-reactivity and binding that’s induced to the antibodies that are made from the vaccine and does it ultimately impair placental formation. Those are just things that are absolutely not evident in any literature at this point in time.

As I mentioned in our article as well, we used this really handy tool that we use commonly in the lab called BLAST. Basically, you take two different sequences, whether it be amino acid or protein structure, and you can compare them and see if there is homology between the two and how similar they are in structure. We found that when we compared the human syncytin-1 protein and the SARS-CoV-2 surface glycoprotein, also known as the spike protein, there was just not any significant homology between the two structures.

So, to say that antibodies would be formed against the two from this vaccine is just irresponsible to say and there is no evidence behind it, and that has caused unnecessary panic in our patients.

Dr. Aimee: Right. So, there is no threat to women or their fertility in taking the COVID-19 vaccine. Correct?

Photo by CDC on Unsplash

Dr. Blake Evans: There is no evidence that it does. At this point in time, not only just based off of what I’m saying, but also the American Society of Reproductive Medicine, in addition to several of the women’s health societies, American College of OBGYN, Society of Maternal and Fetal Medicine, they’ve made statements basically saying that because the COVID-19 vaccines are not composed of live virus, the way that they work, they’re not thought to cause any increased risk of infertility, first or second trimester loss, or any congenital abnormalities.

Dr. Aimee: That was the next myth that I actually wanted to bust is that I’ve also heard so many false claims about them causing miscarriage. You just said it out loud, but can you say it again? Do they lead to an increased risk of miscarriage? What were your findings around the vaccine and miscarriages?

Dr. Blake Evans: Those are very important questions. At this current time, there is no obvious evidence that these vaccines do increase the risk of miscarriage.

You also have to think in terms of even the patients who have COVID, just a natural infection from getting COVID, the one paper in particular that we cited in our article was from The American Journal of Obstetrics and Gynecology, and there were about 220 pregnant patients that they had looked at to see if there was any increased risk in patients who had and who did not have COVID, and there was no increased risk in the two groups of miscarriage in those who had COVID and who did not. That’s one of the few that’s currently available that shows there is no increased risk of miscarriage.

We have to think, if someone who gets COVID has natural antibodies that are forming against the spike protein, you would think that the same way as the vaccine it might increase your risk of miscarriage, and we just aren’t seeing that at this point.

Another thing I’ll mention that’s important is that in the two studies, both Pfizer and Moderna, there were patients that did get pregnant, although neither of these trials intentionally enrolled pregnant women, but patients became pregnant during these trials. In the Pfizer study, there were 23 patients that became pregnant. There was report of one miscarriage in that study, but it was in the placebo group, so they did not receive the vaccine. Similarly, in the Moderna study, there were 12 or 13 patients that got pregnant as the study was being conducted. There was one patient who did have a miscarriage, but she also was in the placebo group.

At this point, there’s just no evidence to believe that it causes an increased risk of miscarriage.

Dr. Aimee: Thank you for that. I’m just going to go through a few myth busting things and you’re going to tell us true or false. Here we go…

I heard that the COVID-19 vaccine might reduce fertility in young women. Is this true?

Dr. Blake Evans: False.

Dr. Aimee: I also was reading that they did animal studies as part of the clinical trials. They gave rats the vaccine while they were either pregnant or before they were allowed to mate, and there were no effects on fertility, pregnancy, or the health of the babies. Is that right?

Dr. Blake Evans: True. Yes.

Dr. Aimee: I heard that the government is telling people that they should not get the vaccine if they’re pregnant or planning on becoming pregnant within the next few months. Is this true or false?

Dr. Blake Evans: This is false.

Dr. Aimee: Right. There’s no one saying that women should not be getting the vaccine.

Dr. Blake Evans: That’s right. Quite the opposite, actually, of what is being said by all of our women’s health societies.

Dr. Aimee: I’m breastfeeding. The vaccine is something that I should avoid. True or false?

Dr. Blake Evans: False, definitely. It’s not something that you should avoid at this point.

Dr. Aimee: COVID and pregnancy is no big deal. True or false?

Dr. Blake Evans: That is definitely false. We have evidence behind that. Are you wanting me to give any commentary on the side?

Dr. Aimee: Give all the commentary that you’d like to give.

Dr. Blake Evans: Okay. These things are very important questions, and they’re questions that we deal with on a daily basis from all of our patients. Although we’re acknowledging that pregnant women were not enrolled in these trials, once again based off of how they work, animal studies, and the current limited evidence that we do have, it’s a risk-benefits to talk with your doctor about.

Photo by Julian Wan on Unsplash

When we have statements set forth by the American Society of Reproductive Medicine, American College of OBGYN, Society of Maternal and Fetal Medicine, just to name a few, that say that patients who are either planning to conceive, who are pregnant, or who are breastfeeding should not have the vaccine withheld from them, and they encourage patients — patients who at this time are tier one are actually being offered the vaccine at this point, those are the ones who are considered to be at a higher risk of contracting COVID — it is recommended by these societies to get the vaccine because we do know that the risk of COVID when you are pregnant leads to a higher risk of intensive care unit admission, mechanical ventilation, being intubated, having a tube down throat helping you to breathe, and also increased risk of death. These are things that we definitely do know.

Weighing the potential risk, the theoretical risk of the vaccine that is being thrown around by several people, weighing with that the known risk of COVID and being pregnant, the vaccine should be offered to these patients. That’s what all of these women’s health societies are advocating for.

Dr. Aimee: That’s right. I tell my patients to get the vaccine when they can. I feel that the benefits far outweigh any of the potential and minimal side effects. It’s more dangerous for a pregnant woman to get COVID and possibly be on a ventilator than it is to get the vaccine, based on everything that we know right now.

Thank you, Dr. Evans, for everything that you and this society members are doing to put out these types of myth busting articles. I imagine that it’s hard to be on the front line sharing this information, because sometimes people might have a healthy level of skepticism and they still might doubt the medical information that we’re trying to disseminate to them. How does that make you feel, or how do you react when someone provides a commentary that might not be in line with the medical literature?

Dr. Blake Evans: That’s a great question. I think what’s extremely important for patients to hear and understand, as well as providers, is that patient autonomy is always extremely important to us. In no way, shape, or form would we say that you have to get the vaccine and if you don’t you’re a bad person. That’s not in any way what I want to convey. Patient autonomy is very well respected amongst all of us as providers.

It’s part of our job and part of our duty to convey what we do know about the current literature, about the evidence, the potential harms versus benefits, and why we do advocate for the vaccine. If a patient ultimately decides to not get it, then that’s fine. As long as they understand what the current evidence is from trusted sites and not something like TikTok or something on social media.

That’s one of the large drives as to why I wanted to write this paper, because I was just floored by all of the misinformation going around that the vaccine could lead to infertility and it was based off just a blog, just completely baseless, and completely freaking out all of our patients. I felt it was really crucial to just get this message out there that we’re advocating for the patients, we have no reason to believe that it would cause any increased risk to you as a patient, whether trying to get pregnant, are pregnant, or lactating.

Dr. Aimee: Awesome. Thank you, Dr. Evans. We appreciate your time. For those who want to read the article you can go to my website or go to Fertility and Sterility, COVID-19 Vaccine and Infertility: Baseless Claims and Unfounded Social Media Panic by Dr. Blake Evans and his amazing scientific crew. I love all of the docs, they’re all awesome.

Dr. Blake Evans: It was a fantastic crew to work with.

Dr. Aimee: Thank you again for your time. We really appreciate you.

Dr. Blake Evans: Thank you so much.

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Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com