Navigating assisted reproduction treatment in the time of COVID-19: concerns and considerations

Abstract

The COVID-19 pandemic has fueled numerous debates in the field of assisted reproductive technology (ART) as the effect of SARS-CoV-2 on pregnancy and infancy is still considered uncharted territory. Various theses and recommendations on what optimal practice is have emerged, as evidenced by surveys, webinars, and recent publications. ART specialists are faced with dilemmas in light of the lack of concrete scientific evidence required to pave the way towards future safe practice. Meanwhile, infertile couples were similarly left in limbo unable to exercise their reproductive autonomy unlike fertile couples-where achieving a pregnancy via natural conception is a matter of decision. ART treatment being classified as non-essential has only recently restarted , facing new challenges while enabling pregnancy at a time of uncertainty. This article highlights matters of bioethical nature to be considered in the ART world at the time of COVID-19 while presenting an all-inclusive critique of the current status. When pursuing pregnancy through IVF treatment during the pandemic, distancing and caution have the lead role in an effort to defend the health of the intended parents and future children. To promote patient autonomy along with our ethical, moral, and legal duty towards our patients, emphasis should be given on ascertaining shared decision-making, and ensuring that an appropriate all-inclusive informed consent is signed prior to initiating any IVF treatment.

Expression map of entry receptors and infectivity factors for pan-coronaviruses in preimplantation and implantation stage human embryos

“…Considering the high rate of human-tohuman transmission and viral shedding from both symptomatic and asymptomatic individuals [39], high asymptomatic to symptomatic patient ratio [40] and ability of the viruses to survive on inanimate objects for extended periods and at sub-zero temperatures [41,42], the clinics offering assisted reproduction services are at risk of spreading COVID-19 [43]. With the resumption of services for assisted reproduction in many parts of the world [44,45], the clinics must be aware of the risks that the virus poses on gametes and early embryos. Indeed, we and others have demonstrated that ACE2 is expressed in the different types of embryonic and trophectodermal cells [14][15][16][17][18].…”

Multiple regression analysis of perinatal conditions, physical development, and complications in assisted reproduction singletons

“…Although most children conceived using ART are healthy, individual differences still exist, which has resulted in concern about ART and the health of mothers and babies (7). Therefore, exploration of the factors affecting perinatal and infant health after ART has important clinical value in paving the way for targeted intervention measures and reducing the impact of ART on mothers and infants (8).…”

The Current Evidence Regarding COVID-19 and Pregnancy: Where Are We Now and Where Should We Head to Next?

“…It is of paramount significance to ensure that publications of research on COVID-19 are more regulated. Until this informational overload that bombards the scientific community is effectively managed, clinicians should abide by an ethical, moral, and legal duty towards their patients regarding shared decision making, while prioritizing patients’ safety [ 105 ].…”