Telomeres and oocyte maturation rate are not reduced by COVID-19 except in severe cases

Effects of SARS-CoV-2 infection during IVF treatment on embryo morphokinetics and pregnancy outcomes after fresh transfer: a prospective cohort study

OBJECTIVES

Prior studies have assessed the association between SARS-CoV-2 convalescence and subsequent in vitro fertilization (IVF) treatment, while the outcomes of couples infected during controlled ovarian stimulation (COS) were limited and controversial. The aim of this study was to clarify the effects of SARS-CoV-2 infection during COS on embryo morphokinetics and IVF clinical outcomes with the use of time-lapse monitoring.

METHODS

We conducted a prospective cohort study of 230 couples who underwent IVF cycles between April 2023 and April 2024 in an academic fertility center. Participants were divided into four groups based on the nucleic acid testing for SARS-CoV-2 during COS: both positive (n = 31), female positive (n = 64), male positive (n = 20), and both negative (n = 115). A time-lapse imaging system was used for embryo culture. Multivariate logistic regression and generalized linear models were performed to control for potential confounders.

RESULTS

Compared with the both negative group, the both positive group had a significantly lower cleavage rate (97.4 ± 7.7% vs. 93.6 ± 11.5%; βadjusted = -0.04, 95% confidence interval [CI]: -0.07- -0.01) and blastocyst formation rate (85.4 ± 18.9% vs. 73.0 ± 29.4%; βadjusted = -0.15, 95% CI: -0.28- -0.03). Embryos derived from the both positive group also presented significantly longer time to form 5, 6, 7, and 8 cells (t5-t8), as well as time to start compaction (tSC), time to morulation (tM), time to start blastulation (tSB), time to blastocyst (tB), and time to expanding blastocyst (tEB). No adverse impacts were observed on oocyte- and embryo-related outcomes in female positive or male positive group. The four groups were also comparable in live birth rate and neonatal outcomes after fresh embryo transfer.

CONCLUSION

SARS-CoV-2 infection in both partners affects morphokinetic parameters of embryo development with decreased cleavage rate and blastocyst formation rate, but does not influence pregnancy and neonatal outcomes after fresh embryo transfer. Our study implies that reproductive physicians should pay attention to infertile couples with SARS-CoV-2 infection during IVF treatment and should provide adequate counseling on their embryo and pregnancy outcomes.

Transcriptomic responses of cumulus granulosa cells to SARS-CoV-2 infection during controlled ovarian stimulation

Cumulus granulosa cells (CGCs) play a crucial role in follicular development, but so far, no research has explored the impact of SARS-CoV-2 infection on ovarian function from the perspective of CGCs. In the present study, we compared the cycle outcomes between infected and uninfected female patients undergoing controlled ovarian stimulation, performed bulk RNA-sequencing of collected CGCs, and used bioinformatic methods to explore transcriptomic changes. The results showed that women with SARS-CoV-2 infection during stimulation had significantly lower number of oocytes retrieved and follicle-oocyte index, while subsequent fertilization and embryo development were similar. CGCs were not directly infected by SARS-CoV-2, but exhibited dramatic differences in gene expression (156 up-regulated and 65 down-regulated). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses demonstrated a high enrichment in antiviral, immune and inflammatory responses with necroptosis. In addition, the pathways related to telomere organization and double strand break repair were significantly affected by infection in gene set enrichment analysis. Further weighted gene co-expression network analysis identified a key module associated with ovarian response traits, which was mainly enriched as a decrease of leukocyte chemotaxis and migration in CGCs. For the first time, our study describes how SARS-CoV-2 infection indirectly affects CGCs at the transcriptional level, which may impair oocyte-CGC crosstalk and consequently lead to poor ovarian response during fertility treatment.

COVID-19 Vaccination and Reproductive Health: a Comprehensive Review for Healthcare Providers

With all the current misinformation on social media platforms about the COVID-19 vaccine and its potential effects on fertility, it is essential for healthcare providers to have evidenced-based research to educate their patients, especially those who are trying to conceive, of the risks to mothers and fetuses of being unvaccinated. It is well known that COVID-19 infection puts pregnant women at higher risk of complications, including ICU admission, placentitis, stillbirth, and death. In February of 2021, the American College of Obstetricians and Gynecologists (ACOG), the American Society for Reproductive Medicine (ASRM), and the Society for Maternal-Fetal Medicine (SMFM) released a statement denying any link between COVID vaccination and infertility. ASRM later confirmed and stated that "everyone, including pregnant women and those seeking to become pregnant, should get a COVID-19 vaccine". In this review, we aim to provide a compilation of data that denies any link between vaccination and infertility for healthcare providers to be able to educate their patients based on evidence-based medicine. We also reviewed the effect of COVID-19 virus and vaccination on various parameters and processes that are essential to obtaining a successful pregnancy.

Pregnancy outcomes after frozen-thawed embryo transfer in women with COVID-19 history: A prospective cohort study

The clinical effect of Coronavirus disease 2019 (COVID-19) on endometrial receptivity and embryo implantation remains unclear. Herein, we aim to investigate whether a COVID-19 history adversely affect female pregnancy outcomes after frozen-thawed embryo transfer (FET). This prospective cohort study enrolled 230 women who underwent FET cycles from December 2022 to April 2023 in an academic fertility center. Based on the history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before FET, women were divided into the infected group (n = 136) and the control group (n = 94). The primary outcome was the clinical pregnancy rate per cycle. Multivariate logistic regression analysis was conducted to adjust for potential confounders, while subgroup analysis and restricted cubic splines were used to depict the effect of postinfection time interval on FET. The results showed that the clinical pregnancy rate was 59.6% in the infected group and 63.9% in the control group (p = 0.513). Similarly, the two groups were comparable in the rates of biochemical pregnancy (69.1% vs. 76.6%; p = 0.214) and embryo implantation (51.7% vs. 54.5%; p = 0.628). After adjustment, the nonsignificant association remained between prior infection and clinical pregnancy (OR = 0.78, 95% CI: 0.42-1.46). However, the odds for clinical pregnancy were significantly lower in the ≤30 days subgroup (OR = 0.15, 95% CI: 0.03-0.77), while no statistical significance was detected for 31-60 days and >60 days subgroups compared with the uninfected women. In conclusion, our findings suggested that SARS-CoV-2 infection in women had no significant effect on subsequent FET treatment overall, but pregnancy rates tended to be decreased if vitrified-thawed embryos were transferred within 30 days after infection. A 1-month postponement should be rationally recommended, while further studies with larger sample groups and longer follow-up periods are warranted for confirmation.

Effect of prior female SARS-CoV-2 infection on IVF outcomes: a prospective cohort study

Introduction

The clinical impact of SARS-CoV-2 infection on human reproduction remains controversial. This prospective cohort study aimed to assess the effect of prior female SARS-CoV-2 infection on subsequent in vitro fertilization (IVF) outcomes.

Materials and methods

A total of 451 women who underwent fresh IVF treatment between December 1, 2022 and April 30, 2023 were included from an academic fertility center. Participants were divided into the infected group if they had a prior COVID-19 history before cycle initiation (n = 252), while the control group were those uninfected (n = 199). The primary outcomes were the number of oocytes retrieved and clinical pregnancy rate after fresh embryo transfer. Multivariate linear and logistic regression analyses were conducted to control for potential confounders.

Results

The number of oocytes retrieved (11.4 ± 8.3 vs. 11.6 ± 7.7; P = 0.457) and clinical pregnancy rate (70.3% vs. 73.7%; P = 0.590) were similar between infected and uninfected groups, with a fully adjusted β coefficient of 0 (95% confidence interval [CI]: -0.14-0.13) and odds ratio of 0.64 (95% CI: 0.20-2.07), respectively. Consistently, the two groups were comparable in cycle characteristics as well as other laboratory and pregnancy parameters. In both subgroup analyses and restricted cubic splines, different post-infection time intervals to IVF cycle initiation showed no significant associations with treatment outcomes.

Conclusion

Prior SARS-CoV-2 infection in females had no adverse influence on subsequent IVF treatment, regardless of the time interval following infection. Our findings provide reassurance for infected women planning for assisted reproduction. Additional prospective cohort studies with larger datasets and longer follow-up are required to confirm the conclusion.