Fertility and Covid-19: What do we know?

As the world is still coming to terms with the consequences of Covid-19 pandemic, a fresh wave seems to have started to strike. The latest victim is Shanghai, a mega-city of over 26 million. The measures announced there have put this nerve centre of global finance into a virtual shutdown.

The economic and accompanying health-related deleterious effects of the pandemic have been well studied, but what has missed the focus is a deeper discussion around its impact on fertility. As more literature seems to emerge, it is becoming clearer that we need to further explore the effect of the pandemic on human fertility.

Dr Parul Katiyar, Co-Medical Director, ART Fertility Clinics, India

- 4 min read

Jul 08, 2022

Covid-19 and Human Reproduction

Ever since the initial research about the impact of Covid-19 on fertility appeared, a range of outcomes seems to be at risk. The UNFPA Report released in July 2021 reported that in 15 countries of the European Union the year-on-year number of births dropped 3.0% in October, 5.0% in November, and 8.1% in December 2020, while in the United States it declined by 7.7%. The same report also concluded that Bangladesh stands out with an increase in births but the number of births generally declined as stated above, also in Spain, Russia, and France

But what this particular report seems to miss is the risk of the deleterious effect of Covid-19 directly on the reproductive and sexual health systems of Covid-19-positive individuals. In addition to assessing the impact of Covid-19 on physical outcomes, It is equally important to explore the psychosocial or societal impact of the pandemic.

Although Covid-19 is primarily a respiratory infection, it may also infect the male reproductive system and several mechanisms have been hypothesized, that includes the impact on testicular architecture and spermatogenesis. Few case-controlled studies suggest that there may be a statistically significant alteration in sperm concentration and motility. Not just males, Covid-19 might affect female fertility and disturb female reproductive functions as well. World Economic Forum quoting global studies on the impact of Covid-19, suggested a link with significant increases in stillbirth, maternal death, and maternal depression during the pandemic.

The impact of Covid-19 on future fertility is now a definite cause of concern among fertility experts and mental health practitioners.

Indian Studies on the impact of Covid-19 on fertility and pregnancy

Almost 50% of infertility, in general, is said to be malefactor related or with some contribution from male factors. The causes for this include genetics, infections/ STDs, previous surgeries, and lifestyle choices. The conditions above can manifest in the form of a lack of sperm production or blockage of sperm transportation within the body.

To understand the impact of Covid-19 on male infertility, IIT Bombay and Jaslok Hospital, Mumbai undertook an interesting study. They analysed the seminal fluid of Covid-19 infected men, for proteins known to be vital for spermatogenesis as well as for the process of fertilisation between sperm and the egg. Covid-19. The study was conducted on men recovering from Covid-19 and was an attempt to get an insight into the long-term impact of Covid-19 infection on the male reproduction. The study established an abnormality in expression of 48 proteins relevant for reproduction, in men recovering from Covid-19 infection. The proteomic analysis suggested, there may be an association between Covid-19 and fall in male fertility soon after the Covid-19 infection. It is therefore suspected that men who have had Covid-19 may have reduced ability to have their own child soon after Covid-19 infection, however, it is not clear, whether this impact lasts long.

Research on the impact of Covid-19 on pregnancy and new-borns

While reviewing the published literature, Dr Baris Ata, a Senior Consultant at ART Fertility Clinics, Dubai, who the is on ESHRE (European Society of Human Reproduction and Embryology) working group on Covid-19 and has co-authored five ESHRE publications on Covid-19 infection in pregnancies or during ART treatments, had said, “Studies have concluded that the outcomes of ART pregnancies are no different from spontaneous conceptions, following Covid-19 infection. Furthermore, these studies suggest that newborns are protected by antibodies from mothers who have had Covid-19 in pregnancy. However, there is also evidence that severe Covid-19 disease during pregnancy may increase the risk of damaging the placenta and consequently increase the risk of smaller and at-risk babies or prematurely born babies”.

Way forward

Of the various medical after-effects of Covid-19 infection, its impact on fertility in general and in males, in particular, can benefit from further study. Amongst fertility experts, there is consensus that a Covid-19 -history should be an integral part of starting any fertility treatment. Current research is leading us to some very interesting findings most of which may become visible to the outside world soon. Amongst the other important effects of Covid-19 is the deleterious impact on mental/psychosocial health.

However, it is important to note that in clinics with experienced and skilled staff, most male infertility can now be treated. This may require a visit to the clinic to identify the cause and subsequently, start the treatment. Clinics or hospitals that undertake proprietary research and focus on discovering the underlying reasons that cause infertility would be able to identify the problem quickly and create a customized treatment plan that is likely to work. Clinics offering ART need to equip their clinicians and treating teams with the latest scientific information. Experienced doctors who practice evidence-based medicine can then ensure that the journey is safe and the couples have the satisfaction of a healthy child of their own.

Fertility