Abstract

ALMEIDA, Ana Beatriz de; ALVES, Tiago Meneses; MACEDO, Rosa Zulmira  and  BARREIRO, Márcia. Impact of SARS-CoV-2 infection on fertility: concerns in Reproductive Medicine. Nascer e Crescer [online]. 2022, vol.31, n.3, pp.212-219.  Epub Sep 30, 2022. ISSN 0872-0754.  https://doi.org/10.25753/birthgrowthmj.v31.i3.27747.

The coronavirus disease 2019 pandemic brought repercussions on health services providing fertility treatments. Approximately 0.3% of the overall livebirth rate corresponds to infants conceived using assisted reproductive technology treatments every year. Besides its negative impact relative to cycle cancelations, it is thought that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the human reproductive system through angiotensin-converting enzyme 2 (ACE2) receptor, and consequently lead to infertility. The SARS-CoV-2 infection may disrupt the hypothalamus-pituitary-ovary (HPO) axis, and hence oocyte quality. Moreover, the endometrial ACE2 expression raises concerns about endometrial and placental dysfunctions related to obstetrical complications when pregnancy is achieved. Furthermore, an association between COVID-19 and changes in menstrual patterns was observed. However, in men, ACE2 expression levels on testicular cells is low and presence of SARS-CoV-2 mRNA in semen is controversial. Still, imaging signs of orchitis and epididymitis in COVID-19 recovered patients and clinical hypogonadism may be responsible for impairing male fertility during the pandemic. The international recommendations firstly encouraged the gradual re-establishment of fertility treatments by identifying those patients who should be prioritized. Therefore, we assessed the importance of fertility preservation during coronavirus disease 2019 pandemic to urgent subgroups of patients (mainly oncological patients and autoimmune diseases) that are usually submitted to gonadotoxic and teratogenic treatments that cannot be deferred indefinitely awaiting for the pandemic to end. The implications of SARS-CoV-2 effects on assisted reproductive technology (ART) outcomes are also explored in this review.

Keywords : COVID-19; fertility; reproductive medicine.

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