Controlled Ovarian Hyperstimulation Protocol in Infertile Patients During the COVID-19 Pandemic

Abstract

Objectives: To explore the appropriate controlled ovarian hyperstimulation (COH) protocols in infertility patients who received the in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments during the COVID-19 pandemic.Materials and Methods: This retrospective cohort study evaluated the efficiency of the early follicular-phase long-acting GnRH-agonist long (EFLL) protocol (a new protocol developed by Chinese clinicians), prolonged pituitary down-regulation of EFLL protocol (Pro-EFLL), and the GnRH-ant protocol for couples meeting the study criteria between February 2020 and June 2020 who were treated by the First Affiliated Hospital of Zhengzhou University during the COVID-19 pandemic, and compared the pregnancy rates and miscarriage rates per fresh transfer cycle, number of retrieved oocytes, endometrial thickness on the day of hCG injection and the number of fertilized oocytes, mature oocytes, fertilized oocytes, and transferable embryos among the three protocols.Results: We found that the prolonged pituitary down-regulation during the COVID-19 pandemic by utilizing a full-dose of GnRH-a administrated in infertility patients were no differences in clinical outcomes than other protocols, The prolonged pituitary down-regulation protocol and EFLL protocol were associated with a higher Endometrial thickness on the day of hCG injection (12.67 ± 2.21 vs. 12.09 ± 2.35 vs. 10.79 ± 2.38, P < 0.001), retrieved oocytes (14.49 ± 6.30 vs. 15.02 ± 7.93 vs. 10.06 ± 7.63, P < 0.001), mature oocytes (11.60 ± 5.71 vs. 11.96 ± 6.00 vs. 7.63 ± 6.50, P < 0.001), fertilized oocytes (9.14 ± 5.43 vs. 8.44 ± 5.34 vs. 5.42 ± 5.20, P < 0.001), and transferable embryos (4.87 ± 2.96 vs. 6.47 ± 5.12 vs. 3.00 ± 3.28 vs. P < 0.001) in the GnRH-antagonist protocol.Conclusion: We recommend that patients start Gn injections 33–42 days after a pituitary downregulated full dose (3.75 mg) of gonadotropin-releasing hormone agonist during the COVID-19 pandemic, even a delay of 2–4 weeks does not affect the implantation rate. The study can provide a more detailed estimate and clinical management strategies for infertile couples during the COVID-19 pandemic.

Comparison of semen parameters in the same patients before and after diagnosis of COVID‐19

“…Similarly, there are contradictory findings regarding the effect of COVID‐19 on serum testosterone levels. Some studies have suggested a decrease in testosterone levels after COVID‐19, 14,35 while others have found no postillness changes in testosterone levels 13,37 . Histopathological changes in testicular tissue following COVID‐19 have been proven with many autopsy samples.…”

“…Some studies have suggested a decrease in testosterone levels after COVID-19, 14,35 while others have found no postillness changes in testosterone levels. 13,37 Histopathological changes in testicular tissue following COVID-19 have been proven with many autopsy samples. These studies have shown degeneration in testicular tissue and germ cells, 11 damage to seminiferous tubule cells, lymphocytic inflammation, decrease in Leydig cells, 12,38 increase in the number of apoptotic cells, macrophage infiltration, 29,39 decreased spermatogenesis, and Although there is controversy regarding the histopathological and hormonal changes associated with SARS-CoV-2 infection, existing literature suggests that semen parameters may be adversely affected following infection.…”