The COVID-19 Pandemic Impact on the Outcome of Medically Assisted Reproduction Pregnancies

Abstract

BackgroundThe impact of the Coronavirus Disease-2019 (COVID-19) pandemic on pregnancy is not well-understood. During the outbreak, the initial approach suggested by the major societies was to postpone all non-urgent assisted reproductive technology (ART) treatments. Nevertheless, the Italian Society of Fertility and Sterility and Reproductive Medicine considered ethically correct to proceed with ART treatments, as the infertility rate is increasing over time, with a consistent decline in the live birth rate. The objective of our study was to assess the impact of the COVID-19 pandemic on the outcomes of ART pregnancies, in terms of early pregnancy loss, overall success rate, and live birth rate.MethodsWe conducted a single-center retro-prospective cohort study. Patients who underwent ART treatments from 1 March 2020 to 28 February 2021 (pandemic ART cohort, pART; n = 749) and from 1 March 2019 to 29 February 2020 (control cohort, CTR; n = 844) were enrolled. The study had a duration of 24 months. Patients underwent baseline severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) nasopharyngeal swab; quantitative serum beta human chorionic gonadotropin (β-hCG) to assess pregnancy; pelvic transvaginal ultrasound; and follow-up until delivery. The study took place at the ART Center of the University Hospital in Florence, Italy.ResultsThere were not statistically significant differences on implantation rate (pART 0.348 ± 0.034 vs. CTR 0.365 ± 0.033, CI = 95%, p = 0.49), clinical pregnancy rate (pART 0.847 ± 0.044 vs. CTR 0.864 ± 0.038, CI = 95%, p = 0.56), and ectopic pregnancy rate (pART 0.008 ± 0.011 vs. CTR 0.01 ± 0.011, CI = 95%, p = 0.79). Neither first trimester miscarriage rate was different between the groups (pART 0.224 ± 0.056 vs. CTR 0.213 ± 0.05, CI = 95%, p = 0.77) nor second trimester miscarriage rate (pART 0.018 ± 0.018 vs. CTR 0.019 ± 0.017, CI = 95%, p = 0.95). Live birth rate remained unchanged during the pandemic (pART 0.22 ± 0.03 vs. CTR 0.239 ± 0.029, CI = 95%, p = 0.37) and stable even when compared to our center rate between 2015 and 2019 (pART 0.222 ± 0.03 vs. general rate 0.224 ± 0.014, CI = 95%, p = 0.83).ConclusionThe COVID-19 pandemic did not cause a statistically significant change in the live birth rate and in the pregnancy loss rate. ART during the COVID-19 pandemic can be considered fair and safe, ethically and medically appropriate. Patients and physicians should be reassured that ART pregnancy outcomes do not seem to be jeopardized by the pandemic state.

Intravenous immunoglobulin use in patients with unexplained recurrent pregnancy loss

“…Second, the control group was identified during the COVID pandemic. One can hypothesize that increased perceived stress could contribute to a heightened miscarriage rate, but this has not been observed in population based studies thus far 38,39 . Third, patients in the IVIg group had both RPL and higher rates of conception through ART; comparing them to a control cohort with a high incidence of natural conception may not be appropriate.…”

The association between COVID-19 and infertility: Mendelian randomization analysis

“…Furthermore, there are also studies indicating that sperm quality may not be related to the severity of COVID-19 infection [39,40] and that COVID-19 is not associated with female infertility. [41] Our research has the following advantages: using MR to evaluate the etiology of diseases effectively avoids unknown confounding factors and reverse causal relationships; the data on risk factors come from the largest and latest GWAS; and the data are limited to major European lineage cohorts to reduce confusion caused by population stratification. More importantly, we studied the correlation between COVID-19 and infertility for the first time so far.…”

“…Furthermore, there are also studies indicating that sperm quality may not be related to the severity of COVID-19 infection [ 39 , 40 ] and that COVID-19 is not associated with female infertility. [ 41 ]…”

Effect of SARS-CoV-2 infection on IVF/ICSI-ET outcomes: A propensity score-matched cohort study

“…Therefore, when the new SARS-CoV-2 virus emerged and spread globally, researchers focused on the impact of infection with this virus on human reproduction and ART outcomes [5]. The effects of SARS-CoV-2 infection on the laboratory and clinical outcomes of ART have not yet been consistently documented in the literature [14,[29][30][31]. An unclear infection status, the inability to correctly measure the time between SARS-CoV-2 infection and ART treatment, and the absence of a strati cation analysis on the time of oocyte retrieval relative to SARS-CoV-2 infection could all be contributing factors.…”

“…An unclear infection status, the inability to correctly measure the time between SARS-CoV-2 infection and ART treatment, and the absence of a strati cation analysis on the time of oocyte retrieval relative to SARS-CoV-2 infection could all be contributing factors. For instance, the pregnancy outcomes of patients who underwent IVF treatment before and during the COVID-19 pandemic were compared in the retrospective studies of Huri et al [30] and Rageh et al [32], but the authors failed to clarify whether the cohorts who underwent IVF treatment during the COVID-19 pandemic were infected with SARS-CoV-2. The largest retrospective analysis of IVF outcomes in SARS-CoV-2 patients to date was reported in a 2022 report from Israel [13].…”