Study Question Does the administration of the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine have an association with ovarian reserve as expressed by circulating anti Müllerian hormone (AMH) levels? Summary Answer Ovarian reserve as assessed by serum AMH levels is not altered at three months following mRNA SARS-CoV-2 vaccination. What Is Known Already A possible impact of SARS-CoV-2 infection or vaccination through an interaction between the oocyte and the somatic cells could not be ruled out, however, data is limited. Study Design, Size and Duration This is a prospective study conducted at a university affiliated tertiary medical center between February to March 2021. Participants/Materials, Setting, Methods Study population included reproductive aged women (18–42 years) that were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart). Women with ovarian failure, under fertility treatments, during pregnancy, previous Covid-19 infection or vaccinated were excluded from the study. Blood samples were collected for AMH levels before the first mRNA vaccine administration. Additional blood samples after three months were collected for AMH and anti Covid-19 antibody levels. Primary outcome was defined as the absolute and percentage change in AMH levels. Main Results and the Role of Chance The study group consisted of 129 women who received two mRNA vaccinations. Mean AMH levels were 5.3 (±SD 4.29) µg/L and 5.3 (±SD 4.50) µg/L at baseline and after three months, respectively (p = 0.11). To account for possible age-specific changes of AMH, sub-analyses were performed for three age groups: <30, 30-35 and >35 years. AMH levels were significantly lower for women older than 35 years at all times (p = 0.001 for pre and post vaccination AMH levels versus younger women). However, no significant differences for the changes in AMH levels before and after vaccinations (Delta AMH) were observed for the three age groups (p = 0.46). Additionally, after controlling for age, no association was found between the degree of immunity response and AMH levels. Limitations, Reasons for Caution Although it was prospectively designed, for ethical reasons we could not assign a priori a randomized unvaccinated control group. This study examined plasma AMH levels at three months after the first vaccination. It could be argued that possible deleterious ovarian and AMH changes caused by the SARS-CoV-2 mRNA vaccinations might take effect only at a later time. Only longer-term studies will be able to examine this issue. Wider Implications of the Findings The results of the study provide reassurance for women hesitant to complete vaccination against Covid 19 due to concerns regarding its effect on future fertility. This information could be of significant value to physicians and patients alike. Study Funding/Competing Interest(s) The study was supported by Sheba Medical Center institutional sources. All authors have nothing to disclose Trial Registration Number The study protocol was approved by the “Sheba Medical Center” Ethical Committee Review Board (ID 8121-21 -SMC) on the 8th of February 2021 and was registered at the National Institutes of Health (NCT04748172).

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Aim: This study evaluated the competency of oocytes/embryos derived from follicles >15 mm in diameter from obese patients, compared with nonobese patients. Patients and Methods: A cohort study was conducted in a single tertiary medical center between July 2018 and May 2019. Before ultrasound-guided follicular aspiration, follicles were measured and those with maximal dimensional size >15 mm were tracked. Microscopic examination of the follicular aspirates was performed by an embryologist. Each follicle aspirated was evaluated for oocyte maturation, oocyte fertilization, and embryo quality. Results: 457 follicles were measured: 380 (83.2%) in nonobese and 77 (16.8%) in obese patients. No in-between group differences were observed in the causes of infertility, patients’ demographics, or ovarian stimulation characteristics. Oocytes were achieved during aspiration from 277 (72.8%) and 54 (70.0%) of the nonobese and obese groups, respectively (p = 0.67). No in-between group differences were observed in fertilization (2PN/oocyte), top quality embryo (TQE) per zygote (2PN), and TQE per follicle. Conclusion: Oocyte recovery rate from follicles >15 mm is unrelated to patients’ BMI. Moreover, the oocytes recovered from obese patients are competent yielding comparable zygote and TQE per follicle/oocyte, compared with nonobese patients. Further investigation is required to strengthen this finding.