Can COVID‑19 infection or COVID‑19 vaccination cause infertility in a reproductive‑age individual, and what evaluation or management steps are recommended if menstrual or reproductive changes are observed?

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Last updated: September 12, 2026 • View editorial policy

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COVID-19 and Infertility: Evidence-Based Guidance

There is no evidence that COVID-19 infection or COVID-19 vaccination causes permanent infertility in either men or women, though COVID-19 infection may cause transient reproductive changes that typically resolve after recovery. 1

Key Evidence Summary

COVID-19 Vaccination Does NOT Cause Infertility

The most critical point to communicate to patients is that no data exist to suggest COVID-19 vaccines cause male or female infertility 1. This has been explicitly stated in 2022 endocrine practice guidelines and confirmed across multiple studies:

  • Women undergoing IVF showed no difference in ovarian follicle quality parameters between those vaccinated with mRNA vaccines, those recovered from COVID-19, and unvaccinated controls 1
  • Studies involving 3,232 women undergoing IVF found no significant differences in implantation rates or pregnancy rates after full COVID-19 vaccination 2
  • The American Society for Reproductive Medicine (ASRM) and American College of Obstetricians and Gynecologists (ACOG) recommend vaccination for those trying to conceive 3

COVID-19 Infection Effects

In Men:

  • Hypogonadism occurs in approximately 51% of hospitalized men with COVID-19 during acute infection 1
  • Oligo-crypto-azoospermia was observed in 25.6% of recovered men, with severity correlating to disease severity (80% in ICU patients vs. 8.3% in non-hospitalized) 1
  • These changes appear related to disease severity and hospitalization, not the virus itself causing permanent damage 1
  • Sperm progressive motility may be temporarily impaired, particularly after severe infection 4

In Women:

  • Approximately 20% of women with COVID-19 experience decreased menstrual volume or cycle prolongation 1
  • Hormone levels (FSH, LH, estradiol, progesterone, testosterone, anti-Müllerian hormone) show no significant differences between COVID-19 patients and controls 1
  • These menstrual changes result from transient hormonal suppression that quickly resumes after recovery 1

Clinical Management Algorithm

For Men Post-COVID-19:

Routine screening is NOT recommended 1. Only evaluate if:

  1. Documented hypogonadism during acute COVID-19: Recheck testosterone, LH, FSH at 3 months post-discharge 1

  2. New-onset erectile dysfunction or low libido after recovery: Check testosterone, LH, FSH regardless of acute phase status 1

    • If hypogonadism with low/normal LH/FSH: Evaluate for other pituitary hormone deficiencies and check prolactin 1
    • If hypogonadism with elevated LH/FSH: Consider primary testicular failure 1
    • Consider psychiatry referral to exclude psychogenic erectile dysfunction if hormones are normal 1

  3. Men desiring children with documented hormonal abnormalities: Semen analysis may be performed 1

  4. Do NOT perform routine semen analysis in asymptomatic men of reproductive age 1

For Women Post-COVID-19:

Routine evaluation of gonadal function is NOT recommended 1. The guideline explicitly states there is no robust evidence to support routine hormonal assessment in women of childbearing age who have recovered from COVID-19 1.

If menstrual changes are observed:

  • Reassure that changes are typically transient and resolve spontaneously 1
  • No specific hormonal testing is indicated unless changes persist beyond 3 months or other symptoms develop
  • Consider multi-system assessment including psychological factors and lifestyle changes related to pandemic stress 5

Critical Counseling Points

Dispelling Misinformation:

  1. Vaccination is safe and recommended for those trying to conceive, pregnant, or breastfeeding 3, 6
  2. No delay in conception is needed after vaccination 3
  3. COVID-19 infection poses greater risks to pregnancy than vaccination, including preeclampsia (aOR 1.57), preterm delivery (aOR 2.17), and fetal death (aOR 2.21) 7

Timing Considerations:

  • For men with severe COVID-19 infection, consider waiting 3 months before attempting conception to allow recovery of sperm parameters 4
  • Women can proceed with fertility treatments immediately after vaccination 6
  • No pregnancy testing is required before COVID-19 vaccination 3

Common Pitfalls to Avoid

  1. Do not order routine hormonal panels in asymptomatic post-COVID patients—this leads to unnecessary testing and patient anxiety
  2. Do not attribute all menstrual irregularities to COVID-19—pandemic stress, lifestyle changes, and other factors contribute significantly 5
  3. Do not recommend delaying vaccination in those trying to conceive—the benefits far outweigh theoretical risks 3, 8
  4. Do not perform routine semen analysis in men without symptoms or documented hormonal abnormalities 1

The evidence consistently demonstrates that while COVID-19 infection may cause temporary reproductive changes, particularly in severe cases, these effects are transient and resolve with recovery. Vaccination does not impair fertility and should be strongly encouraged in all reproductive-age individuals.

References

1
Guideline

endocrine follow-up during post-acute covid-19: practical recommendations based on available clinical evidence.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologist, 2022

2
Research

Impact of COVID-19 Vaccination on In Vitro Fertilization Outcomes: A Systematic Review.

International journal of fertility & sterility, 2024

5
Research

SARS-CoV-2 infection and female reproductive health: A narrative review.

Best practice & research. Clinical endocrinology & metabolism, 2023

6
Guideline

covid-19 and novel mrna vaccines in pregnancy: an updated literature review.

BJOG : an international journal of obstetrics and gynaecology, 2022

7
Guideline

maternal vaccination: a review of current evidence and recommendations.

American Journal of Obstetrics and Gynecology, 2022

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.