Safety of COVID-19 vaccination in women undergoing IVF/ICSI treatment - Clinical study and systematic review

Abstract

BackgroundIt was suggested that vaccination in general might affect reproductive health. Safety of COVID-19 vaccination in women undergoing assisted reproductive techniques (ART) treatment is not well established.MethodsWe performed a retrospective study including 536 women undergoing fresh embryo transfer after IVF/ICSI treatment in a huge IVF center in southern China to investigate the effect of COVID-19 vaccination on oocyte maturation, fertilization rate, blastulation rate, implantation rate, clinical pregnancy rate and miscarriage rate. In addition, we performed a systematic review of existing studies on the safety of COVID-19 vaccination in women undergoing ART treatment.ResultsIn our study, 268 women received inactivated or recombinant COVID-19 vaccination and 268 controls were enrolled based on propensity score matching. We observed a decreased fertilization rate and signs for impaired oocyte maturation in vaccinated women. Besides our study, there were 15 studies analyzing the safety of COVID-19 vaccination in women undergoing ART treatment. For the mRNA vaccines, no adverse signals were reported concerning oocyte maturation, fertilization rate, blastulation rate, implantation rate, clinical pregnancy rate and miscarriage rate. In women being vaccinated with an inactivated vaccine, implantation rate, clinical pregnancy rate and miscarriage rate were not affected, whereas oocyte maturation and fertilization rate were impaired.ConclusionsVaccination against COVID-19 in women undergoing ART treatment seems to be safe especially for women getting mRNA vaccines. The effects on oocyte maturation and fertilization rate of inactivated and recombinant COVID-19 vaccinations might be a safety signal and need further investigation and independent confirmation.

Effect of COVID-19 vaccination on the outcome of in vitro fertilization: A systematic review and meta-analysis

“…We also analyzed data on whether COVID-19 vaccines affected the number of oocytes and MII/mature oocytes, blastocysts rate, and fertilization rate. Data on the number of oocytes from nine studies ( 18 , 19 , 22 , 24 – 28 , 33 ) were combined, and the difference was not statistically significant (MD: 0.12; 95% CI: −0.65–0.88; P = 0.77; Figure 6 ). Moreover, there was no statistically significant difference in the number of MII/mature oocytes between the vaccinated and unvaccinated groups from seven studies (MD: 0.27; 95% CI: −0.36–0.90; P = 0.40; Figure 7 ) ( 18 – 20 , 25 , 26 , 28 , 33 ).…”

“…Data on the number of oocytes from nine studies ( 18 , 19 , 22 , 24 – 28 , 33 ) were combined, and the difference was not statistically significant (MD: 0.12; 95% CI: −0.65–0.88; P = 0.77; Figure 6 ). Moreover, there was no statistically significant difference in the number of MII/mature oocytes between the vaccinated and unvaccinated groups from seven studies (MD: 0.27; 95% CI: −0.36–0.90; P = 0.40; Figure 7 ) ( 18 – 20 , 25 , 26 , 28 , 33 ). The rates of blastocyst formation ( 20 , 24 – 27 , 33 ) and fertilization ( 20 , 22 , 24 – 27 ) were also not significantly different between the vaccinated and unvaccinated groups (MD: 0.01 vs. 1.08; 95% CI: −0.04–0.06 vs. −0.57–2.73; P = 0.70 vs. P = 0.20, respectively; Figures 8 , 9 ).…”

“…Ongoing pregnancy rates were calculated from six studies ( 20 , 21 , 27 , 30 , 32 , 34 ) and were found statistical differences in the vaccinated group than in the unvaccinated group (RR: 0.93; 95% CI: 0.87–0.99; P = 0.02; Figure 4 ). We compared the differences in implantation rate data from six studies ( 21 , 23 , 25 , 30 , 33 , 36 ) between vaccinated and unvaccinated groups, and there were no differences (RR: 1.02; 95%CI: 0.97–1.07; P = 0.41; Figure 5 ). The Q test and I 2 index showed minimal heterogeneity in pregnancy outcomes (clinical pregnancy rate P = 0.46, I 2 = 0%; ongoing pregnancy rate P = 0.33, I 2 = 13%; and implantation rate P = 0.44, I 2 = 0%).…”

“…Quality assessment NOS quality assessment scored more than or equal to 7 as high quality, 5-6 as medium quality, and <5 as low quality (38). Overall, 19 of the 20 cohort studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(32)(33)(34)(35)(36)(37) were of high quality (NOS score ≥7). The remaining study (31) was of relatively poor quality, as summarized in Table 2.…”

COVID-19 Pharmacotherapy in Pregnancy: A Literature Review of Current Therapeutic Choices

“…However, most data derive from mRNA vaccines, and data from early reproductive and toxicity studies have reported similar efficacy and safety [ 75 , 76 , 77 ]. Rare side effects include thrombosis with thrombocytopenia syndrome, myocarditis, and pericarditis, Guillain–Barré syndrome, as in nonpregnant individuals; however, no infertility issues have been reported [ 78 , 79 , 80 , 81 ]. Pregnancy by itself does not represent a cause for increased risks of any adverse outcome, following COVID-19 vaccination [ 82 ], while the overall risk of the occurrence of an acute adverse event requiring medical attention is low (<1%) and similar in pregnant and unvaccinated pregnant patients [ 83 ].…”