O-019 COVID – Impact on reproduction and reproductive practice
Authors: Cedars M 
Published: August 2021

Abstract text
A highly infectious novel coronavirus (now referred to as SARS-CoV-2) was first noted in December 2019 in Wuhan, Hubei Province, China, and by March 11, 2020, was declared a global pandemic by the WHO. The widespread community transmission of a virus, new to our species, continues to raise urgent questions about implications for pregnant women and those considering conception. Almost immediately, international committees, including ASRM and ESHRE, drew up guidelines to protect the public and our patients. Across the globe, clinics were closed, patients turned away and questions regarding spread of the virus, safety during early pregnancy and potential impact on fertility and pregnancy began to arise. Where are we now? What have we learned? And what more do we need to know to improve our ability to care for and counsel our patients?
Clinic Practice – While there was considerable controversy in the U.S., closing clinics was the correct course of action when an unknown virus had entered our countries and so little was known and resources (think NY, think Italy) were inadequate. The majority of clinics pivoted to more virtual visits and stopped transfers and retrievals. The duration of these changes varied across states and countries, with most clinics now functioning at full capacity for procedures but still utilizing virtual visits for many patients. We will discuss what we learned from this process, including impact on clinics and patients, as well as the greater community in which we all live.
Pregnancy – The physiology of pregnancy, including increased heart rate and oxygen consumption, decreased lung capacity and a shift away from cell-mediated immunity, all increased the risk for severe illness. Studies have now shown this increased risk for severe disease, mechanical ventilation and even death in pregnant women compared with their non-pregnant counterparts. Additionally, there is increased risk for pre-term labor and fetal death. Studies suggest infection earlier in pregnancy increases risk for complications. What about our patients? The first trimester is a highly critical period for fetal development. As a result, infectious and non-infectious exposures, occurring during the first trimester, are most likely to lead to severe effects on fetal development. Preliminary results no increased risk for pregnancy loss and no effect on nuchal translucency. However, some studies have shown the possibility of vertical transmission and increase in fetal inflammation. We will review the literature and update on current understanding of first trimester exposure and consequences for both mother and child.
Infertility – SARS-CoV-2 utilizes the angiotensin-converting enzyme 2 (ACE2) receptor for viral entry. The ACE2 receptor is present in both the male and female reproductive systems. Early case studies of severe cases of COVID-19 identified orchitis, while the presence in non-fatal disease remains controversial. Lowered sperm counts have been identified and some studies have found SARS-CoV-2 viral particles in the semen. ACE2 receptor is present in both the ovary and the endometrium, while infection is possible, there have been few studies specifically looking at these endpoints and no clear risk identified for women.
Vaccination – The rapid development and deployment of effective vaccination has brought hope to end the pandemic, even as new variants are arising. While vaccine hesitancy is common in many places, the mis-information regarding association between vaccines and infertility has hit our field particularly hard. Updating information to share with our patients, colleagues and friends will be critical to move forward and combat the pandemic.
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