Effects of the early phase of the COVID-19 pandemic on natural and ART-mediated birth rates in Lombardy Region, Northern Italy

Somigliana, Edgardo; Esposito, Giovanna; Viganò, Paola; Franchi, Matteo; Corrao, Giovanni; Parazzini, Fabio

doi:10.1016/j.rbmo.2021.07.017

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…The ART clinics resumed their services in April 2020, which may have led to a compensatory increase in ART-conceived births and in multiple pregnancies. Our results are consistent with a prior study 35 that also showed an 86.6% drop in ART-conceived births in December 2020 in the Lombardy region in Italy.…”

Section: Discussionsupporting

confidence: 93%

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

Lisonkova

Bone

Muraca

et al. 2022

Paediatric Perinatal Epid

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Background The initial COVID‐19 pandemic response−related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre‐pandemic period, have been understudied. Objectives To examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART‐conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period. Methods Population‐based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015–2019. Results Overall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART‐conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART‐conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non‐ART group. Maternal characteristics of women who conceived in the early pandemic versus pre‐pandemic period differed and included an increased prevalence of pre‐pregnancy obesity class 3 and chronic hypertension. Conclusions The early pandemic closure of ART clinics resulted in a substantial decline in ART‐conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART‐conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.

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Section: Discussionsupporting

confidence: 93%

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

Lisonkova

Bone

Muraca

et al. 2022

Paediatric Perinatal Epid

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“…They suggested that such findings should be viewed in the context of stress-related outcomes triggered by this pandemic. [ 25 ] We noted similar live birth rates in ART cycles compared to those conducted in the pre-COVID times.…”

Section: Discussionsupporting

confidence: 57%

Impact of COVID-19 pandemic on clinical and embryological outcomes of assisted reproductive techniques

Banker¹,

Arora²,

Banker³

et al. 2022

J Hum Reprod Sci

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“…The significant impact on cumulative live birth rates due to the delay in fertility treatment was specifically significant in older women (>40 years old) ( Smith et al , 2020 ). In contrast, a study in Italy reported a decrease of 5.1% in the monthly birth rate in 2020 as compared to 2019, but calculated that this could be largely attributed to a decrease in natural conceptions while the closing of ART centres only played a marginal role ( Somigliana et al , 2021 ). Others have suggested that the pandemic may increase the importance of family and increase family building ( Lambalk et al , 2020 ).…”

Section: Introductionmentioning

confidence: 96%

SARS-CoV-2, fertility and assisted reproduction

Ata

Vermeulen

Mocanu

et al. 2022

Human Reproduction Update

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BACKGROUND In 2020, SARS-CoV-2 and the COVID-19 pandemic had a huge impact on the access to and provision of ART treatments. Gradually, knowledge of the virus and its transmission has become available, allowing ART activities to resume. Still, questions on the impact of the virus on human gametes and fertility remain. OBJECTIVE AND RATIONALE This article summarizes published data, aiming to clarify the impact of SARS-CoV-2 and the COVID-19 disease on human fertility and assisted reproduction, as well as the impact of vaccination, and from this, provide answers to questions that are relevant for people contemplating pregnancy and for health care professionals. SEARCH METHODS PUBMED/MEDLINE and the WHO COVID-19 database were searched from inception to 5 October 2022 with search terms focusing on ‘SARS-CoV-2’ and gametes, embryos, reproductive function, fertility and ART. Non-English studies and papers published prior to 2020 were excluded, as well as reviews and non-peer reviewed publications. Full papers were assessed for relevance and quality, where feasible. OUTCOMES From the 148 papers included, the following observations were made. The SARS-CoV-2-binding proteins, angiotensin-converting enzyme 2 (ACE2) and type II transmembrane serine protease (TMPRSS2), are expressed in the testis, but co-expression remains to be proven. There is some evidence of SARS-CoV-2 RNA in the ejaculate of COVID-19 patients with severe disease, but not in those with mild/moderate disease. SARS-CoV-2 infection can impair spermatogenesis, but this seems to resolve after one spermatogenic cycle. Testosterone levels seem to be lower during and after COVID-19, but long-term data are lacking; disease severity may be associated with testosterone levels. COVID-19 cannot be considered a sexually transmitted disease. There is no co-expression of ACE2 and TMPRSS2 in the myometrium, uterus, ovaries or fallopian tubes. Oocytes seem to have the receptors and protease machinery to be susceptible to SARS-CoV-2 infection; however, viral RNA in oocytes has not been detected so far. Women contemplating pregnancy following COVID-19 may benefit from screening for thyroid dysfunction. There is a possible (transient) impact of COVID-19 on menstrual patterns. Embryos, and particularly late blastocysts, seem to have the machinery to be susceptible to SARS-CoV-2 infection. Most studies have not reported a significant impact of COVID-19 on ovarian reserve, ovarian function or follicular fluid parameters. Previous asymptomatic or mild SARS-CoV-2 infection in females does not seem to negatively affect laboratory and clinical outcomes of ART. There are no data on the minimum required interval, if any, between COVID-19 recovery and ART. There is no evidence of a negative effect of SARS-CoV-2 vaccination on semen parameters or spermatogenesis, ovarian function, ovarian reserve or folliculogenesis. A transient effect on the menstrual cycle has been documented. Despite concerns, cross reactivity between anti-SARS-CoV-2 spike protein antibodies and Syncytin-1, an essential protein in human implantation, is absent. There is no influence of mRNA SARS-CoV-2 vaccine on patients’ performance during their immediate subsequent ART cycle. Pregnancy rates post-vaccination are similar to those in unvaccinated patients. WIDER IMPLICATIONS This review highlights existing knowledge on the impact of SARS-CoV-2 infection or COVID-19 on fertility and assisted reproduction, but also identifies gaps and offers suggestions for future research. The knowledge presented should help to provide evidence-based advice for practitioners and couples contemplating pregnancy alike, facilitating informed decision-making in an environment of significant emotional turmoil.

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Effects of the early phase of the COVID-19 pandemic on natural and ART-mediated birth rates in Lombardy Region, Northern Italy

Cited by 9 publications

References 7 publications

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

Impact of COVID-19 pandemic on clinical and embryological outcomes of assisted reproductive techniques

SARS-CoV-2, fertility and assisted reproduction

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