Ovarian granulosa cells from women with PCOS express low levels of SARS-CoV-2 receptors and co-factors

The effect of COVID-19 and COVID-19 vaccination on serum anti-Mullerian hormone: A systematic review and meta-analysis

OBJECTIVE

The current study aims to evaluate the impact of COVID-19 infection and vaccination on ovarian reserve by detecting the anti-Mullerian hormone (AMH) level.

METHOD

PubMed, Embase, Web of Science, and Scopus has been searched for studies assessing the effect of COVID-19 infection and/or vaccination on AMH levels up to February 27, 2023. Based on PRISMA 2020 statement criteria, a systematic review and meta-analysis of included studies were performed. The studies' quality was assessed by the National Institute of Health (NIH) quality assessment tool. The standardized mean difference (MD) of the AMH level was used and the quantitative values of each study were pooled separately by using a random effect model.

RESULTS

Out of 246 studies screened, 18 were included in the systematic review and 14 in the meta-analysis. Included studies were published between 2021 and 2022 and were conducted in different countries, including the USA (n = 3), China (n = 2), Russia (n = 2), Turkey (n = 5), Israel (n = 3), Czech (n = 2), and Spain (n = 1). Eight studies investigated the effect of SARS-CoV-2 infection on AMH levels, and ten studies investigated the possible effect of COVID-19 vaccination on AMH levels. The pooled analysis showed a statistically significant decrease in AMH levels after COVID-19 infection (SMD: -0.24; 95% CI: -0.36 to -0.11; I2 = 0%; p = .0003). Vaccination analysis showed a nonstatistically significant change in AMH levels after COVID-19 vaccination (SMD: -0.11; 95% CI: -0.25 to 0.04; I2 = 35%; p = .14).

CONCLUSION

COVID-19 infection can result in ovarian reserve injury by reducing the AMH level but getting vaccinated against COVID-19 has no impact on the AMH level.

Does Coronavirus Disease-19 Infection Affect Ovarian Reserve in Infertile Women? A Retrospective Study

Background

Previous studies have revealed menstrual changes following coronavirus disease-19 (COVID-19) disease. The potential impact of COVID-19 on female reproductive organs, ovary in particular, has not been investigated thoroughly.

Aims

The aim of this study was to evaluate changes in serum levels of follicle-stimulating hormone (FSH), luteinising hormone (LH) and oestradiol (E2) following COVID-19 disease as a surrogate for the detection of ovarian vulnerability to SARS-CoV-2 infection.

Settings and Design

In this retrospective study, hospital records of unexplained infertile women between 21 and 40 years old who have attended our institution's reproductive medicine unit for evaluation and/or treatment of infertility have been evaluated.

Materials and Methods

Menstrual cycle day 2-5 serum follicle-stimulating hormone, luteinising hormone and E2 levels of 28 infertile women have been studied both before and after the COVID-19 disease to evaluate ovarian reserve before the ovulation induction treatment cycle.

Statistical Analysis Used

The demographic characteristics and hormonal results of these 28 unexplained infertile women have been compared. The Shapiro-Wilk test has been used to evaluate the normal distribution of variables. Comparison of ovarian reserve markers which were established before and after COVID-19 infection has been performed using paired samples t-test.

Results

All patients except one have shown mild COVID-19 symptoms and their infection courses have resulted in uneventful recovery. Serum FSH, LH and E2 levels of 24 (85%) and serum anti-Müllerian hormone (AMH) levels of 4 (15%) patients have been evaluated before and after COVID-19 disease is statistically similar.

Conclusion

COVID-19 disease or inflammatory response of the infection itself does not seem to affect pituitary gonadotropins and ovarian hormones in infertile women based on menstrual cycle day 2-5 serum FSH, LH, E2 and AMH levels. Further studies including higher patient numbers are urgently needed to clarify the potential effects of COVID-19 disease on the gonadal function of women.