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COVID vaccine, fertility and assisted reproduction

covid vaccine and assisted reproduction

COVID vaccine and fertility processes

The outbreak of the coronavirus disease (Covid-19) has wreaked socioeconomic havoc with billions of lives affected by this devastating pandemic. The fertility processes have not been immune to this impact. Couples who were in fertility processes saw their projects slow down and they could do nothing to accelerate them. The best knowledge about the routes of transmission and contagion, as well as the appearance of vaccines have brought good news for these couples. However, the meteoric development of vaccines and the urgency in their application have raised serious doubts among assisted reproduction patients. 

In this post we collect the latest data published by relevant organizations both nationally and internationally. However, the data on the Covid and its repercussions in different aspects are changing very quickly so the following data and official recommendations are valid for this current moment, August 2021.

How do Covid vaccines work?

The first thing to keep in mind is that preventing a disease is not synonymous with preventing its infection. The vaccines developed against COVID-19 to date have shown efficacy to alleviate its most serious effects, but at the moment there is no vaccine capable of preventing SARS-CoV-2 infection. 

But while current vaccines do not prevent SARS-CoV-2 from replicating in the airways, they do reduce the severity of symptoms, which can indirectly cut transmission.

While each vaccine works differently, all COVID-19 vaccines elicit an immune response so the body remembers how to fight the virus in the future.

According to the British Fertility Society and the Association of Clinical and Reproductive Scientists in February 2021, the availability of safe and effective vaccines against Covid-19, offers a way to protect against this disease and access fertility treatment safely. These institutions advise vaccination of people of reproductive age. This includes those who are currently in fertility processes or in the near future or in a few years.

Types of vaccines and differences

Pfizer and Moderna's Covid-19 vaccines use technology pioneered to date in the world of human immunology. An antigen is not used to trigger the immune response but uses messenger RNA from the virus itself, made in the laboratory. Thousands of copies of this mRNA are inoculated into the body as instructions for making antibodies specific to Covid. This mRNA is then easily degraded and does not interact with human DNA. 

  • Advantages: fewer side effects than those based on adenovirus and currently no controversy associated with possible thrombi. 
  • Disadvantages: more expensive and more difficult to store.

The Janssen (Johnson & Johnson) and Astrazeneca (Oxford) vaccines, on the other hand, follow a vaccination method that has been tested for years: inoculation with deactivated, attenuated or directly killed adenovirus but which, despite this, is capable of activating the immune response of our body. In Janssen's case, a genetically modified version of the virus itself is inoculated to deactivate it. When this virus enters the body, it does not cause disease but it does induce immunity against the virus because it expresses its proteins. In this way, for example, smallpox was eradicated in 1980. The Russian vaccine Sputnik V also works this way, although it has not been purchased by the Spanish government. 

  • Advantages: cheap and easy to transport and store both in conventional refrigerators and freezers. 
  • Disadvantages: they can produce side effects such as fever, headache, muscle aches ... more notable than the following. They would not be so recommended for immunosuppressed people or pregnant women.

None of the vaccines contain live viruses, so there is no risk of contracting the virus from the vaccination itself.

Do vaccines affect the fertile capacity of men and women?

Both SARS-COV-2 infection and vaccination with the mRNA vaccine, although they have been shown to cross into follicular fluid, do not appear to have a detrimental effect on follicular function.

In another study, the first to evaluate the impact of the mRNA vaccine on sperm parameters, it did not identify any difference between the results obtained in men before or after vaccination.

The study, dated May 2021, is pending review by external professionals.

So, with these data, and given that SARS-CoV-2 infection can theoretically affect male fertility (COVID and affectation of fertility and assisted reproduction) seems to be recommended that couples who wish to conceive be vaccinated previously. The one that vaccination does not affect sperm, while SARS-CoV-2 infection can affect the sperm parameter.

Vaccines and assisted fertility processes

According to the British Fertility Society, none of the four most commercial vaccines can affect fertility. They state that there is absolutely no evidence, or any theoretical reason, to conclude that vaccines can affect the fertility of women or men.

For this reason, there are no problems with receiving a Covid-19 vaccine during fertility treatments: it is already an IVF, a cryopreserved embryo transfer, ovulation induction processes, intrauterine insemination or egg donation or spermodonation processes . 

In a major Israeli study, all couples who underwent consecutive cycles of ovarian stimulation for IVF, before and after receiving the Covid virus mRNA vaccine, successfully reached the egg collection stage. The stimulation characteristics and embryological variables of the couples who underwent IVF treatments after receiving the SARS-CoV-2 mRNA vaccine were evaluated and compared with their IVF cycles before vaccination. These data did not demonstrate statistically relevant modifications. Thirty-six couples resumed IVF treatment between 7 and 85 days after receiving the mRNA vaccine. With these data, they conclude that, although more studies would be needed to validate their observations, the SARS-CoV-2 mRNA vaccine did not affect the performance of the patients, or the ovarian reserve in their subsequent IVF cycle.

It is possible, however, that you want to consider when to receive the Covid-19 vaccine considering that some people may develop annoying side effects in the days after vaccination such as pain in the injection site fever, headache, pain muscle or feeling tired. In this sense, it could make sense, to the extent that the fertility process allows it, to be able to adapt the dates as best as possible to avoid discomfort on especially delicate days. 

Is it advisable to delay the treatment?

Beyond this described situation, there is no reason to delay or stop any fertility treatment in progress. The only reason to consider delaying fertility treatment until after you have been vaccinated would be to want to be previously protected against the Covid-19 virus before you can become pregnant. 

For younger women, under 37 years of age, it would not be particularly important to delay their treatments for this purpose from 3 to 6 months, however, in women older than this age, it should be taken into account. Delays of several months can end up affecting the chances of success in treatments, especially in women over 40 years of age or with proven low ovarian reserve.

Vaccines and egg donation or spermodonation processes

The Human Embryology and Fertilization Authority in the UK has recommended allowing at least 7 days to elapse between vaccination and egg or sperm donation, especially if the donor feels unwell after vaccination, you should not donate for 7 days after vaccination. appearance of the first symptoms.

Positive test and vaccination

There is no reason to believe that any of the Covid-19 vaccines could be harmful to a pregnant woman, but it is also true that their effects on pregnancy have not yet been fully investigated. 

Although the clinical trials of the vaccines did not include pregnant women, the available data, primarily from vaccine use in the United States, do not indicate any adverse effects on pregnancy. A large US study of 36.591 pregnant women who were inoculated with mRNA vaccines found no safety problem for the health of pregnant women.

Official recommendations

The official recommendations to date in our country is to receive the vaccine. Either in case of being part of a risk category, or due to the possibility of exposure to the virus in the workplace or previous medical problems. 

Pregnant women, in principle, are more susceptible to respiratory infections. This is due to a state of natural semi-suppression during the nine months of pregnancy. For example, a 37% death rate was seen among pregnant women during the 1918 flu pandemic compared to 2.6% in the general population.

However, at the moment the Ministry of Health has not classified pregnant women as a priority vaccination group. From the Joint Committee on Vaccination and Immunization of the J. Craig Venter Institute (JCVI), a world leader in genomic research, has recommended that pregnant women delay their vaccination. JCVI has recommended vaccination after pregnancy if you are not part of a risk group for some other factor.

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