A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

Abstract

Currently, the world is in the seventh month of the COVID-19 pandemic. Globally, infections with novel SARS-CoV-2 virus are continuously rising with mounting numbers of deaths. International and local public health responses, almost in synchrony, imposed restrictions to minimize spread of the virus, overload of health system capacity, and deficit of personal protective equipment (PPE). Although in most cases the symptoms are mild or absent, SARS-CoV-2 infection can lead to serious acute respiratory disease and multisystem failure. The research community responded to this new disease with a high level of transparency and data sharing; with the aim to better understand the origin, pathophysiology, epidemiology and clinical manifestations. The ultimate goal of this research is to develop vaccines for prevention, mitigation strategies, as well as potential therapeutics.The aim of this review is to summarize current knowledge regarding the novel SARS CoV-2, including its pathophysiology and epidemiology, as well as, what is known about the potential impact of COVID-19 on reproduction, fertility care, pregnancy and neonatal outcome. This summary also evaluates the effects of this pandemic on reproductive care and research, from Canadian perspective, and discusses future implications.In summary, reported data on pregnant women is limited, suggesting that COVID-19 symptoms and severity of the disease during pregnancy are similar to those in non-pregnant women, with pregnancy outcomes closely related to severity of maternal disease. Evidence of SARS-CoV-2 effects on gametes is limited. Human reproduction societies have issued guidelines for practice during COVID-19 pandemic that include implementation of mitigation practices and infection control protocols in fertility care units. In Canada, imposed restrictions at the beginning of the pandemic were successful in containing spread of the infection, allowing for eventual resumption of assisted reproductive treatments under new guidelines for practice. Canada dedicated funds to support COVID-19 research including a surveillance study to monitor outcomes of COVID-19 during pregnancy and assisted reproduction. Continuous evaluation of new evidence must be in place to carefully adjust recommendations on patient management during assisted reproductive technologies (ART) and in pregnancy.

Molecular diagnosis of SARS-CoV-2 in seminal fluid

“…False positives could arise from contaminants or poor test specificity [41]. In any case, the sensitivity and specificity of the RT-PCR methods used to detect SARS-CoV-2 in seminal fluid have not been evaluated [42].…”

Premature ovarian insufficiency secondary to COVID‐19 infection: An original case report

“…It is well established that viruses can cause inflammation of reproductive tissue; indeed, one of the most common clinical manifestations of mumps is orchitis, which can be damaging to testicular function. Furthermore, several case reports have discussed the development of orchitis in patients who have contracted COVID‐19 and small studies have shown pathological changes to testicular tissue 2 . A possible mechanism for this is expressed in Figure 1.…”

COVID‐19: Current knowledge in clinical features, immunological responses, and vaccine development

“…While the data regarding whether SARS-CoV-2 is present in semen of infected or recovering men remains conflicting, most of the studies suggest that it is highly unlikely that the virus is sexually transmitted. 160 Indeed, three studies that examined the sexual transmission of COVID-19 in women by examining lower genital tract via vaginal swab for the presence of SARS-CoV-2 at the time of admission or during the period of hospitalization have reported negative results. [161][162][163] Similar results were reported with vaginal swabs and breast milk from pregnant women.…”