Table 1.

Counseling points and resources

Topic	Counseling points	Additional resources to help guide patient-centered decisions
Menstrual cycle	•Possible menstrual cycle changes owing to COVID-19 infection-related stress in addition to the COVID-19 vaccines have been noted. •Changes may include modest alterations in menstrual cycle length, earlier than anticipated menses in the cycle after vaccination, and potential for heavier menses.	•ACOG. COVID-19 Vaccines: Answers from Ob-Gyns. https://www.acog.org/womens-health/faqs/covid-19-vaccines-answers-from-ob-gyns •CDC. Frequently Asked Questions about COVID-19 Vaccination. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html.
Fertility	•COVID-19 vaccination has not demonstrated an impact male or female infertility. •COVID-19 infection may have an impact on sperm. •Patients trying to conceive should receive the COVID-19 vaccine as soon as possible. •Vaccination should not be delayed until after fertility treatments or after pregnancy.	•ACOG. COVID-19 Vaccines: Answers from Ob-Gyns. https://www.acog.org/womens-health/faqs/covid-19-vaccines-answers-from-ob-gyns •ASRM. COVID-19 FAQs for current and future fertility patients. Available at https://www.reproductivefacts.org/faqs/covid-19-faqs-for-current-and-future-fertility-patients/ •CDC. COVID-19 vaccines for people who would like to have a baby. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/planning-for-pregnancy.html
Pregnancy/lactation	•Infection during pregnancy has been associated with increased severity of disease, adverse gestational outcomes, and increased risk of preterm birth. •No evidence to date demonstrates adverse effects of the vaccine on maternal, gestational, or infant health. •COVID-19-positive individuals should continue breast-/chestfeeding using proper PPE. •Pregnant and lactating patients should receive vaccinations, including a booster, against COVID-19. •mRNA vaccines are preferred.	•CDC. COVID-19 Vaccines While Pregnant or Breastfeeding. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html.
TE	•COVID-19 infection increases TE risk •Patients hospitalized for COVID-19 should discontinue estrogen products •Slightly increased risk of TE with AstraZeneca vaccination compared with Moderna or Pfizer-BioNTech •Slightly increased risk of CVST with J&J vaccine •Benefits of receiving vaccines outweigh risks •Pfizer-BioNTech, Moderna, and Novavax vaccines preferred over J&J and AstraZeneca •Counsel on TE risks and warning signs	•ACOG. COVID-19 Vaccines: Answers from Ob-Gyns. https://www.acog.org/womens-health/faqs/covid-19-vaccines-answers-from-ob-gyns

Abbreviations used: ACOG, American College of Obstetricians and Gynecologists; ASRM, American Society for Reproductive Medicine; CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease 2019; CVST, cerebral venous sinus thrombosis; J&J, Janssen/Johnson & Johnson; mRNA, messenger ribonucleic acid; PPE, personal protective equipment; TE, thromboembolism.