The Impact of Post Embryo Transfer SARS-CoV-2 Infection on Pregnancy in In Vitro Fertilization: A Prospective Cohort Study

Abstract

Importance: Limited knowledge exists on the effects of SARS-CoV-2 infection after embryo transfer, despite an increasing number of studies exploring the impact of previous SARS-CoV-2 infection on IVF outcomes. Objective: This prospective cohort study aimed to assess the influence of SARS-CoV-2 infection at various time stages after embryo transfer on pregnancy outcomes in patients undergoing conventional in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI) treatment. Design: The study was conducted at a single public IVF center in China. Setting This was a population-based prospective cohort study. Participants: Female patients aged 20 to 39 years, with a body mass index (BMI) between 18 and 30 kg/m2, undergoing IVF/ICSI treatment, were enrolled from September 2022 to December 2022, with follow-up until March 2023. Exposure: The pregnancy outcome of patients was compared between those SARS-CoV-2-infected after embryo transfer and those noninfected during the follow-up period. Main Outcomes and Measures: The pregnancy outcomes included biochemical pregnancy rate, implantation rate, clinical pregnancy rate, and early miscarriage rate. Results: A total of 857 female patients undergoing IVF/ICSI treatment were included in the analysis. We observed the incidence of SARS-CoV-2 infection within 10 weeks after embryo transfer. The biochemical pregnancy rate and implantation rate were lower in the infected group than the uninfected group (58.1% vs 65.9%; 36.6% vs 44.0%, respectively), but no statistically significant. Although, the clinical pregnancy rate was significant lower in the infection group when compared with the uninfected group (49.1%vs 58.2%, p < 0.05), after adjustment for confounders, this increased risk was no longer significant between the two groups (adjusted OR, 0.736, 95% CI, 0.518-1.046). With continued follow-up, a slightly higher risk of early miscarriage in the infected group compared to the uninfected group (9.3% vs 8.8%), but it was not significant (adjusted OR, 0.907, 95% CI, 0.414-1.986). Conclusions and Relevance: The study's findings suggested that SARS-CoV-2 infection within 10 weeks after embryo transfer may have not significantly affect pregnancy outcomes. This evidence allays concerns and provides valuable insights for assisted reproduction practices.