The current outbreak of the novel 2019 coronavirus disease (COVID-19) began in December 2019 in China and has since spread to a number of other countries. The pandemic caused by the COVID-19 virus, also known as the China virus by the previous American President, has wreaked havoc on the world’s socioeconomic fabric. With this devastating global pandemic claiming billions of lives, medically assisted reproduction services were not unaffected, with far-reaching consequences. Dr Gautam Allahbadia, a Mumbai-based IVF expert answers if procreation will ever be the same after COVID-19.
Sexual transmission of the SARS-CoV-2 virus, its effect on male and female fertility, pregnancy, a potential teratogenic side effect, and safe gamete handling in IVF labs are real concerns among IVF physicians, slowing down all ART services worldwide, including IUI, IVF/ICSI, and even routine registration of new patients. “Because of today’s media-generated fear of procreation, the general population has postponed normal procreation, and infertile couples are delaying their plans to seek treatment. Clear evidence of the cause-and-effect relationship between the China virus infection and its impact on human reproduction is still pending,” says Dr Gautam Allahbadia, a Mumbai-based IVF expert.
The spread of misinformation on social media claiming that COVID-19 vaccines will cause sterility in women has increased vaccine hesitancy in young women planning pregnancies. Meanwhile, pregnant women who are offered the vaccine must decide whether to accept it, despite the fact that pregnant women were excluded from the vaccine clinical trials. Data on unintended pregnancies that occurred during the trials, as well as outcomes in pregnant women who received the vaccine, can assist these groups in making informed decisions.
Data from accidental pregnancies in clinical trials of approved COVID-19 vaccines show that vaccination does not harm fertility or increase the rate of miscarriage. Overall, evidence-based medicine will provide us with concrete long-term clinical side effects, if any, only a few years down the road.
The pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in various theories of functional alteration of various organ systems. Dr Gautam Allahbadia explains, “The direct impact of this virus on male urogenital organs was published in China as postmortem studies in 2020. The precise mechanisms of testicular damage are unknown, but it appears that high temperatures caused by persistent fever and triggering a secondary autoimmune response leading to autoimmune orchitis are the most likely involved mechanisms.”
However, due to the biological similarity of the SARS-CoV and SARS-CoV-2, some hypotheses can already be made, particularly in the andrological field. To enter human cells, both SARS-CoV and SARS-CoV-2 use the ‘Angiotensin Converting Enzyme-2’ (ACE2) as a receptor. It was discovered that ACE2, angiotensin, and their MAS receptors are present in the lungs as well as the testes, with a concentration in the Leydig and Sertoli cells. The first theory proposes that the virus can enter the testis and cause changes in testicular functionality. The second theory is that virus binding to the ACE2 receptor can result in an excess of ACE2 and a typical inflammatory response. Inflammatory cells may disrupt the function of Leydig and Sertoli cells. “Both of these hypotheses are currently being investigated in order to confirm and possibly monitor fertility in patients following COVID-19,” Mumbai-based IVF expert, Dr Gautam Allahbadia notes.
An early report in 2020 suggested that female sex hormone levels and ovarian reserve in women of reproductive age did not change significantly after COVID-19 infection. Almost one-fifth of the patients had a decrease in menstrual volume or a cycle lengthening. These patients’ menstrual changes could be the result of transient sex hormone changes caused by ovarian function suppression, which return quickly after recovery.
COVID-19 contains major structural proteins, one of which, the S protein, can promote fusion of viral and cellular membranes and thus facilitate coronavirus entry into host cells. Basigin (BSG) is a key receptor for COVID-19 that mediates its entry into host cells. Basigin is essential for both male and female reproduction. Basigin is a protein that is expressed in the uterus and is required for successful implantation. As a result, any disruption or inhibition of Basigin impairs embryo implantation. Mahdian et al. recommended that infected couples refrain from reproducing until their treatment is complete.
Dr Gautam Allahbadia, a Mumbai-based IVF expert concludes that fertilization and pregnancy can now be separated in the reproductive timeline thanks to medically assisted reproduction (MAR). Although pregnant women infected with COVID-19 have an increased risk of adverse neonatal outcomes, SARS-CoV-2 is not transmitted by gametes. Going ahead with segmented IVF as soon as possible, freezing the generated embryos, and postponing embryo transfer until after the pandemic appears to be the best strategy at the moment.