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COVID fertility issues

COVID-19 primarily affects the respiratory system. However, as scientists are finding more about this virus, its systemic effects and extrapulmonary are also being discovered. One such effect, secondary to the localized immune response, is infertility—in both males and females. Studies show that COVID-19 affects both male and female reproductive system, and even young adults can report to health professionals like Gynaecologist in DHA karachi with fertility problems secondary to COVID-19.

Effect of COVID-19 on male fertility

According to research data, the quality of sperms is severely impacted subsequent to COVID-19 infections. In a prospective study, researchers evaluated the semen quality, oxidative stress, inflammatory markers, and activity of angiotensin-converting enzyme 2 (ACE2) in COVID-19 positive patients and control group, for a period of sixty days.

The study reported that the levels of all the inflammatory biomarkers, seminal plasma ACE2 levels (the ACE2 receptor is employed by coronavirus for viral entry), and the oxidative stressors like reactive oxygen species (ROS) were higher in the diseased group in comparison to the control group. In fact, the increase was more than 100 percent in men with COVID-19; the sperm concentration saw a decrease of 516 percent, alteration of cell shape by 400 percent, and mobility by 209 percent. The magnitude of these changes is reflective of disease severity.

Scientists also found that this state of sub-fertility or infertility is transient, and improves over time. Therefore, according to author Behzad Hajizadeh Maleki, research assistant and doctoral student in the department of sports science and psychology at Justus Liebig, Germany, couples who are looking to conceive but recovering from COVID-19 should proceed carefully. Specialists who certify the fertility status of the partners should carefully examine the couple before they conceive. However, the approach to patient care will remain similar to the current management despite this study.

Effect of COVID-19 on female fertility

Presently, the data on vertical transmission of COVID-19, its perinatal infection and impact on fertility in women is limited. Systemic review and meta-analysis from 77 cohort studies of COVID-19 in pregnant women showed a relatively high incidence of the infection in pregnant women. The disease spectrum and the trajectory of disease is similar in pregnant and nonpregnant women. However, pregnant women are more likely to need ICU care.

ACE2, in the female reproductive system is present on the ovaries, and as this receptor is the site for viral entry, the ovaries are potentially at-risk during coronavirus fever. Consequently, there are alterations in the ovarian physiology as well as its development and maturation. The quality of oocyte is thereafter impacted because of the virus and the proinflammatory state in the body. Because of the impact on oocyte quality, as well as other stressors, COVID-19 can be detrimental to female reproductive health.

The COVID-19 virus can also damage the epithelial cells of the innermost layer of the uterus—the endometrium. This can affect the implantation of embryos.

Guidelines for Assisted fertility techniques

For patients undergoing Assisted Fertility Techniques (ART) guidelines issued by the European Society for Human Reproduction and Embryology, Canadian Fertility and Andrology Society American Society of Reproductive Medicine, and the International Federation for Fertility Societies recommended the suspension of new techniques. This meant treatments like ovulation induction, in-vitro fertilization, intrauterine insemination and embryo transfer were all stopped. ART cycles were completely halted to avoid complications of ART in COVID-19 patients as well as to avoid the potential risk of vertical transmission.

The guidelines recommended that couples undergoing ART should either go for gamete cryopreservation or embryo preservation and directed them to their physicians for more help.

Healthcare providers and fertility experts like Gynecologist in Johar Town Lahore need to counsel couples on reproductive health following infection with COVID-19. They should also encourage these couples to vaccinate, as this has no effect on the fertility and all other claims are not backed by research, and follow all other SOPs as recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC).