COVID-19 and immunomodulation treatment for women with reproductive failures

Highlights • Pregnant women with a history of reproductive failures with immune etiologies (RFI) are vulnerable to COVID-19 infection. • In pregnant women with RFI, including mild COVID-19 patients, low dose prednisone, heparin, tacrlolimus, plaquenil, and IVIg can be continued. • There is no clear evidence that anti-TNF drugs and intralipid infusion cannot be used in pregnant women with RFI during COVID-19 pandemic. • Those with severe COVID-19 infection, immunotherapy for RFI should be curtailed unless indicated for the management of COVID-19. • The current recommendation is based on observational studies with limited data, and validation studies are needed. COVID-19 pandemic is affecting various areas of health care, including human reproduction. Many women with reproductive failures, during the peri-implantation period and pregnancy, are on the immunotherapy using immune modulators and immunosuppressant due to underlying autoimmune diseases, cellular immune dysfunction, and rheumatic conditions. Many questions have been raised for women with immunotherapy during the COVID-19 pandemic, including infection susceptibility, how to manage women with an increased risk of and active COVID-19 infection. SARS-CoV-2 is a novel virus, and not enough information exists. Yet, we aim to review the data from previous coronavirus outbreaks and current COVID-19 and provide interim guidelines for immunotherapy in women with reproductive failures.