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COVID and impact on fertility and assisted reproduction

covid fertility and assisted reproduction pregnancy test

Covid and fertility

It is well known that the arrival of the Covid 19 virus in our country has been fatal in many aspects in addition to health. Governments and other regulatory bodies have been decreeing containment measures progressively and adapted to the severity of each moment. These changes have always been with the idea of safeguarding, to the extent possible, the safety of citizens. 

Thus, against the clock, scientific experts, managers and communicators have had to go hand in hand to provide the most agile response possible to citizens about what they should or should not do and how to do it.  

And it is also known that the Covid virus (SARS-CoV-2) It has especially paralyzed the hospitality, restaurant and tourism industries, among many other sectors, but other sectors, such as assisted reproduction, have not been an exception.

The measures adopted have had multiple implications for infertile couples: from delays in urgent treatments, to the paralysis of ongoing processes or unequal access to cross-border care within Europe.

LINK Link to buy covid antigen test

 

Current situation

Looking back, it has been possible to analyze how a high percentage of couples in the process of reproduction have abandoned their expectations of being parents. This decision has been made above all in the face of the labor and economic uncertainty of the new panorama drawn by the pandemic. 

It is true that the decision to suspend all medical procedures related to infertility treatment has not been based on scientific evidence, since this information has been non-existent. However, the trajectory of the virus has created a unique challenge for global health systems. Reason why the cancellation of fertility treatments was justified.

On the one hand, to stop the potential spread of the virus from parents to children, but also to avoid contributing additional stress to health systems.

When IVF has been continued

However, for couples who, despite having passed the virus, have been able or have decided to continue with the fertility processes, the added difficulty of ignorance has arisen. The confusion about the impact that the Covid virus could have on fertility processes. Initially, the statements issued by the ESHRE (European Society of Human Reproduction and Embryology) from March 19 to April 2, 2020.

At the beginning, given the extreme lack of knowledge about the extent of the infection, it was officially recommended to avoid pregnancy and it ended up being recommended not to start fertility treatments. Finally, after multiple reviews, as of April 23, 2020, the official recommendation from the organization was to resume all fertility treatments, under the adoption of a specific working framework for the situation. 

Hard decision

And it is true that the situation was not banal or simple, so the instructions, most likely, responded to the complexity of the situation. Not only has it been relevant to study the physiological implications of infected parents or a pregnant woman with Covid, which is not unimportant in itself. That is, knowing the scope or impact that the virus could have on: semen quality, the regularity of cycles, the quality of embryos in pairs with the virus, its transmission to the fetus, etc... Yes Not that, in addition, it has been necessary to adapt all the protocols and guidelines for action both in the clinic and in the laboratories.  

The simplest part is that IVF laboratories are already very clean, highly decontaminated areas, with unidirectional air flow, hoods and various protective measures. However, some reconditioning of the clinic areas has been enabled for the retrieval of oocytes or sperm, the ventilation of the waiting and visiting rooms, the products to be used, the training of staff in specific protocols, etc. A bobbin lace that has taken its time…

How the COVID virus affects fertility and reproduction

Once the logistics of clinical practice seem to be resolved, research has focused on analyzing, especially in an observational manner, the extent of Covid virus infection at the reproductive level. 

Even today, the impact of the virus in the early stages of embryonic development is not known with certainty, that is, from fertilization to the formation of the blastocyst and from implantation to the first trimester. Little by little, more evidence-based information is being obtained about pregnancy outcomes in women who have suffered from the Covid virus. Including spontaneous abortions and live birth rates. Without a doubt, this will be a very useful tool to develop official guidelines, but this data is currently not available.

According to official statements

To date, from the news bulletins and statements on the ESHRE website (European Society of Human Reproduction and Embryology) it has been announced that There is a low probability of contamination of gametes or embryos by the Covid virus. It is believed that Washing steps and culturing and freezing protocols appear to reduce the potential viral load, although they do not eliminate it. The possible absence of Covid virus receptors in gametes (sperm, oocytes) and embryos would strongly support this assumption. 

However, it is not uncommon for health professionals to advise couples to postpone fertility treatment when the man or female partner is symptomatic or has recently recovered from any common flu. The reason is because any virus can cause infertility, as in the case of Zika, for example. Based on recent global experience, the Covid virus appears to be much more aggressive in terms of severe illness, morbidity and mortality compared to common flu.

Viruses and fertility

At the cellular level, common influenza (flu) viruses are capable of increasing the oxidative load of sperm. This oxidation increases certain male infertility through a reduction in progressive motility in sperm and an increase in sperm DNA fragmentation. Therefore, it does not seem unreasonable to assume that the Covid virus could also have these same effects on reproductive potential. Along the same lines, the Covid virus could affect the performance of female oocytes through mechanisms that also increase oxidative stress.

ACE2 and COVID receptors

On the other hand, taking into account that the Covid virus acts through the angiotensin-converting enzyme 2 (ACE2) receptor, a possible direct effect of this virus on follicles/oocytes and sperm cannot be excluded. These ACE2 receptors have recently been observed in human Leydig cells. These cells are found in the testicles, which implies a possible direct effect of the virus on the male reproductive system. 

A recent study has shown that testicular ACE appears to be crucial for the early stages of embryonic development. The reason is that it has been found to play a significant role in sperm function. Regarding the oocyte, ACE is present in preovulatory follicles, at least in studies carried out in rats. It has been reported that ACE2 receptors are also expressed in the ovaries. However, a possible negative impact of the virus through an interaction between the oocyte and the body's cells cannot be ruled out. 

And as far as the embryo is concerned, different studies have proven that human germ cells and primitive embryos express high levels of ACE2 and it has recently been discovered that these levels are reinforced by infection with the Covid virus. 

Despite these data, more theoretical than empirical, two recent field studies indicate that They have not found evidence that the Covid virus is present in the semen of patients who had recently recovered from the infection. So, taking these facts together, it may theoretically be true that there is a direct effect of the Covid virus on sperm or follicles/oocytes. Likewise, more time and more cellular experiments and field studies are needed to prove it.

Specific COVID study and assisted reproduction: three months of safety

Among the little scientific evidence that can be referenced, specific studies on fertility and Covid are coming to light. In this sense, an Israeli observational study concluded, at the beginning of 2021, that it would be ideal to wait an average of three months from the infection before starting fertility treatment. 

All couples in the study underwent ovarian stimulation for an IVF process. Both before and after recovering from Covid infection, they reached the egg collection stage successfully. The stimulation characteristics and embryological variables of couples who underwent IVF treatments after recovering from Covid infection were evaluated. They were compared with their IVF cycles before infection without providing substantial differences, except for a significantly lower proportion of high-quality embryos. 

The Covid infection did not appear to affect the patients' performance or ovarian reserve in their IVF cycle immediately afterwards, except for a reduced proportion of high-quality embryos. For this reason, the study ends up suggesting postponing IVF treatment for at least 3 months after recovering from Covid infection. Three months is just the time that the production of new follicles and sperm lasts, with the aim of recruiting healthy gametes that were not exposed to Covid infection during their development.

As of today, these would be the most up-to-date recommendations. Three months is not that long, and in any case, couples can choose to spend three months taking special care of themselves and preparing for their next treatment. 

 

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