Can Covid-19 (Coronavirus disease 2019) infection affect fertility?

COVID-19 and Fertility: Current Evidence and Recommendations

COVID-19 infection may temporarily affect male fertility, but there is no evidence that it causes long-term fertility problems in either men or women, and COVID-19 vaccination does not impair fertility. 1

Effects of COVID-19 on Male Fertility

COVID-19 may potentially impact male reproductive health through several mechanisms:

• The angiotensin-converting enzyme 2 (ACE2) receptor, which SARS-CoV-2 uses to enter cells, is present in the testes 2
• However, the lack of co-expression of the TMPRSS2 modulatory protein (required for viral cell entry) in testicular cells and sperm argues against direct infection of reproductive cells 2
• Male SARS-CoV-2 infection has been associated with a transient reduction in fertility, with recovery observed after 60 days post-infection 1
• COVID-19 may affect male reproduction by potentially:
  • Inducing orchitis
  • Decreasing testosterone levels
  • Reducing sperm counts and motility 2

Effects of COVID-19 on Female Fertility

• Current evidence does not suggest that COVID-19 infection significantly impacts female fertility
• Female SARS-CoV-2 infection was not strongly associated with reduced fecundability (probability of conception per cycle) in research studies 1
• While ACE2 receptors are present in the ovary, vagina, and uterus, there is no evidence of direct infection of oocytes 2

COVID-19 Vaccination and Fertility

• Multiple studies have demonstrated that COVID-19 vaccination does not impair fertility in either men or women 1, 3
• A prospective cohort study found no association between COVID-19 vaccination and fecundability in either partner:
  • Female fecundability ratio = 1.08 (95% CI: 0.95,1.23)
  • Male fecundability ratio = 0.95 (95% CI: 0.83,1.10) 1
• The American Society for Reproductive Medicine (ASRM) recommends that pregnant women, lactating women, and those undergoing fertility treatment be vaccinated against SARS-CoV-2 4

COVID-19 and Pregnancy

• COVID-19 can manifest in severe forms during pregnancy 4
• Unfavorable pregnancy outcomes reported in pregnant women with COVID-19 include:
  • Premature labor
  • Myocardial injuries
  • Preeclampsia
  • Perinatal death
  • Potential vertical transmission to the fetus 4
• Pregnant women are at higher risk of COVID-19-related complications including ICU admission and death 3
• There is a rare but concerning increase in placentitis and stillbirth associated with COVID-19 infection 3

Key Recommendations

1. For individuals concerned about fertility:

   • COVID-19 vaccination is recommended and does not affect future fertility 3
   • The benefits of vaccination outweigh the theoretical risks, especially for those planning pregnancy 3

2. For pregnant women:

   • COVID-19 vaccination is recommended during pregnancy 4
   • The mRNA vaccines are considered safe and are approved for use in pregnant women 4
   • Vaccination during pregnancy can provide passive antibody transfer to newborns, especially if administered in the third trimester 4

3. For those undergoing fertility treatments:

   • COVID-19 vaccination is recommended before starting fertility treatments 4
   • There is no need to delay conception attempts after COVID-19 vaccination 3

Common Misconceptions and Pitfalls

• Misconception: COVID-19 vaccines cause infertility

  • Reality: There is no evidence supporting this claim, and studies show no impact on fertility 3, 1

• Misconception: COVID-19 is sexually transmitted

  • Reality: Studies have shown that 98% of seminal fluid samples and 98.3% of vaginal fluid samples tested negative for SARS-CoV-2 2

• Misconception: Waiting to conceive after COVID-19 infection is unnecessary

  • Reality: For males, there may be a temporary reduction in fertility for up to 60 days after infection 1

In conclusion, while COVID-19 infection may temporarily affect male fertility, there is no evidence of long-term fertility problems in either men or women. COVID-19 vaccination is safe for those planning pregnancy and does not impair fertility. For those concerned about reproductive health, vaccination is recommended as the benefits outweigh the potential risks of COVID-19 infection.