COVID-19 infection unlikely to hinder IVF success

COVID-19 infection does not appear to adversely affect ovarian reserve, and thus, the chance of success from assisted reproductive treatment likely remains the same as before infection, suggests a small study presented at ESHRE 2021.

As receptors for SARS-CoV-2 are widely expressed in the ovary, there have been concerns about the effect of COVID-19 on reproductive function.

Researchers thus looked at 46 women who underwent in vitro fertilization (IVF) across 11 clinics in Spain in a cohort study. Their anti-Mullerian hormone (AMH) levels were compared before and after having COVID-19.

The researchers found that AMH levels, a biomarker of ovarian reserve which is predictive of response to ovarian stimulation in IVF, were comparable before and after the women were diagnosed with COVID-19 (1.73 vs 1.61 ng/mL). [ESHRE 2021, abstract O-079]

“Generally, the data showed no variation in AMH levels before and after SARS-CoV-2 infection, and we could assume that the chances of success in their fertility treatment remained intact,” said lead author Dr Maria Cruz Palomino from IVI Madrid Fertility Clinic, Spain.

When the analysis was stratified according to baseline AMH status — ie, low ovarian reserve for AMH <1 ng/mL (n=16, mean age 39) and normal ovarian reserve for AMH ≥1 ng/mL (n=30, mean age 35) — there appeared to be a slight decline in AMH levels from 4.6 to 3.1 ng/mL after COVID-19 among women with normal ovarian reserve.

However, this decline, according to Palomino, was not a “radical decrease” and hence, unlikely to compromise ovarian reserve. “[Nor] can we attribute this variation to SARS-Cov-2 infection,” she added.

Among women with low ovarian reserve at baseline, the levels of AMH remained similar after falling ill with COVID-19 (0.8 vs 0.7 ng/mL).

“Ovarian reserve status [was not affected by previous COVID-19 illness] … but the degree of the variation of AMH levels depending on the patient were low or high responder,” observed the researchers. 

As this is an observational study, the findings are limited by potential residual confounders and more studies with larger study population are needed to validate the data, the researchers suggested.

“[Nevertheless,] we could assume that the chances of success of fertility treatment remain intact,” said Palomino.

These findings were consistent with those from a previous study in Wuhan, China, which showed that women with COVID-19 had similar levels of sex hormone and AMH as age-matched controls. [Reprod Biomed Online 2021;42:260-267]

In addition, results from several previous studies on the effect of COVID-19 on women fertility have been reassuring and the current cohort study adds on to the topic by providing further reassurance for those who are planning to undergo IVF treatment, according to the researchers.

In view of the presence of SARS-CoV-2 receptors in the ovary, experts explained that infections in newborns are unlikely to have occurred through intrauterine transmission by placental or congenital routes. Rather, they believe that perinatal infection during or after delivery presents a more likely explanation for infections in newborns.