Coronavirus Disease 2019 and Human Reproduction: A Changing Perspective

Abstract

Since the outbreak of severe acute respiratory coronavirus 2 (SARS-CoV-2), the coronavirus disease 2019 has had a wide range of effects on human health. This paper summarizes the data related to the effects of the SARS-CoV-2 infection on human reproduction.Both the male and female reproductive tract express high levels of receptors and proteins needed for viral cell entry. There is presently no evidence that gametes are affected by the infection. Male fertility may be temporarily reduced due to inflammatory responses following infection. The endometrium is highly susceptible to SARS-CoV-2 cell entry; however, it remains unclear whether this could alter receptivity and embryo implantation. Menstrual cycle changes were reported in women who experienced severe infection; however, they tended to be reversible. For couples undergoing assisted reproduction treatment, the pandemic led to a significant psychological burden, with changes in lifestyle that could directly affect the success of the treatment. Human reproduction societies recommend screening all patients prior to cycle initiation and avoiding treatment of women with severe comorbidities until the pandemic is under control. Finally, for pregnant women, it is expected that the infection is more severe in women in the third trimester and in those with comorbidities. Those who are symptomatic for SARS-CoV-2 are more likely to have increased rates of prematurity and intrapartum fetal distress than those who are asymptomatic. Vertical transmission cannot be completely ruled out, but neonatal infection rates are low. Vaccination appears to be safe and is indicated for use in pregnant and lactating women because the benefits outweigh the risks.

A relação entre COVID-19 e alterações no ciclo menstrual em um contexto de pandemia: Uma revisão sistemática da literatura

“…Infecções virais podem afetar o sistema reprodutivo feminino e causar distúrbios menstruais, como já demonstrado no caso dos vírus de hepatite B, hepatite C e HIV (Delamuta et al, 2021). A anovulação foi registrada em doenças graves, provavelmente relacionadas à supressão transitória da função ovariana para assegurar a função de órgãos vitais (Lee et al, 2020).…”

“…Um estudo prospectivo de coorte sugeriu que a infecção por SARS-CoV-2 pode estar associada com uma diminuição a curto prazo na fertilidade nos homens, enquanto não foram observadas diferenças nas mulheres ou após a vacinação da COVID-19 em ambos os sexos (Wesselink et al, 2022). Postula-se que a presença do receptor ECA2 e TMPRSS2 em células do trato reprodutivo masculino e feminino favorece a infecção pelo SARS-CoV-2 e, portanto, compromete a fertilidade humana e a gravidez (Delamuta et al, 2021).…”

Male reproductive system alterations by SARS-CoV-2 and its pathophysiology: A review

“…and lower expression of IL-6, a cytokine that characterizes the cytokine storm in COVID-19 inflammation. Finally, estradiol reduces ACE-2, which represents less interaction with the virus, while androgens act as promoters of TMPRSS2 (Navarra et al, 2020;Stelzig et al, 2020;Delamuta et al, 2021).…”

“…Such fever is a direct effect of the inflammatory process, with the action of IL-1, IL-6, TNF… which act on the hypothalamic centers. However, this possibility is controversial, due to the fact that in countries with endemic diseases characterized by febrile signs, such as malaria, male infertility is not so common (Younis et al, 2020;Delamuta et al, 2021;Meng et al, 2021).…”

Telemedicine for Virtual Consultations During COVID-19 Pandemic in a Medically Assisted Reproduction Center: Patients' Perspective

“…2 Another concern in this area is in fact the possible effect that the acquisition of perinatal COVID-19 infection may have on gametogenesis, implantation, embryogenesis, and fetal development. [3][4][5] Owing to these limitations and not least the containment imposed by the legislation to avoid contagion, population growth was destined to decrease. In fact, 0.3% of all children born each year are conceived using ART.…”