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COVID and affectation of 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 besides 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, as far as 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 possible response to the public on 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 hotel industry, the restoration or tourism 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 reproductive processes have abandoned their expectations of being parents. This decision has been taken above all in view of the employment 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 in global health systems. Reason why cancellation of fertility treatments was justified.

On the one hand, to stop the potential spread of the virus from parents to children, worse 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, due to the extreme ignorance about the extent of the infection, it was officially recommended to avoid pregnancy and it was finally recommended not to start fertility treatments. Finally, after multiple reviews, as of April 23, 2020, the official recommendation from the agency was to resume all fertility treatments, under the adoption of a specific framework for the situation. 

Hard decision

And it is true that the situation was not banal or simple, so the indications, most likely, responded to the complexity of the situation. It has not only been relevant to study the physiological implications of infected parents or a pregnant woman with Covid, which is not unimportant in itself. That is, to know the scope or impact that the virus could have on: seminal quality, on the regularity of cycles, on the quality of the embryos in pairs with the virus, on 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 one-way air flow, hoods and various protective measures. However, some reconditioning of the areas of the clinics have been enabled for the recovery of oocytes or sperm, the ventilation of the waiting and visiting rooms, the products to be used, the training of personnel in specific protocols, etc. Bobbin lace that has taken time ...

How the COVID virus affects fertility and reproduction

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

Even today the impact of the virus in the early stages of embryonic development is not known for sure, that is, from fertilization to blastocyst formation and from implantation to the first trimester. Little by little, more evidence-based information is being obtained on the results of pregnancy in women who have suffered from the Covid virus. Including spontaneous abortions and live birth rates. This will undoubtedly be a very useful tool to be able to develop official guidelines, but these data are not currently available.

According to official statements

To date, from the newsletters 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 the washing steps and the culture and freezing protocols appear to reduce the possible 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 male or female partner has symptoms 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 the reduction of progressive motility in sperm and an increase in sperm DNA fragmentation. So 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.

ECA2 and COVID receptors

On the other hand, taking into account that the Covid virus acts through the receptor for angiotensin converting enzyme 2 (ECA2), a possible direct effect of this virus on follicles / oocytes and sperm cannot be excluded. These ECA2 receptors have recently been observed in human Leydig cells. These cells are found in the testes, which implies a possible direct effect of the virus on the male reproductive system. 

A recent study has shown that the 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. As regards the oocyte, ACE is present in preovulatory follicles, at least in studies conducted in rats. ECA2 receptors have been reported to be expressed in the ovaries as well. However, a possible negative impact of the virus through an interaction between the oocyte and the cells of the body cannot be ruled out. 

And as regards the embryo, different studies have shown that human germ cells and primitive embryos express high levels of ECA2 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 have found no 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. It also takes more time and more cell experiments and field studies to prove it.

COVID-specific 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 the ideal thing would be to wait an average of three months after infection before starting fertility treatment. 

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

La Covid infection did not appear to affect patients' performance or ovarian reserve in their IVF cycle immediately posterior, except for a small 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 it takes to produce new follicles and sperm, 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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