P-298 Women undergoing IVF-ICSI cycles after mild Covid-19 infection do not show a poor ovarian response: A prospective randomized controlled study
Authors: Jindal A 
Published: June 2023

Abstract

Study question
Does mild COVID-19 infection in women undergoing IVF-ICSI cycles affect their ovarian reserve ?

Summary answer
A recent past mild COVID-19 infection does not seem to alter the ovarian reserve testing and ovarian response to stimulation in women undergoing IVF-ICSI cycles.

What is known already
Since December 2019, the world has been facing a COVID-19 pandemic. Besides its effect on mortality, COVID-19 infection raises questions about short and longterm effects on general health. Clinical manifestations are highly heterogeneous and involve many different organs. The SARS-CoV-2 virus penetrates human cells by directly binding with angiotensin-converting enzyme 2 (ACE2) receptors present on the cell surface.The ACE2 receptors are present in testes and in ovarian tissue. In the ovary, ACE2 plays a role in the response to gonadotrophins, steroidogenesis regulation, and in follicle development, angiogenesis and degeneration and therefore, SARS-CoV-2 could be responsible for adversely affecting ovarian reserve.

Study design, size, duration
A prospective randomized controlled study was conducted between June 2020 and December 2021. Women with primary or secondary infertility undergoing IVF-ICSI between the age of 25-40 years were included. All the women underwent a COVID testing by RT-PCR and were subsequently tested for ovrian reserve by assessing their AMH and AFC (USG).

Participants/materials, setting, methods
The study population consisted of 128 women, 22% of whom were COVID RT-PCR positive. None of the tested women presented with a history of severe COVID-19 infection. They were randomized into two groups depending on whether they were positive for past COVID-19 infection or negative. These women were then subjected to AMH testing and estimation of AFC by transvaginal ultrasonography.

Main results and the role of chance
The difference between the initial AMH concentration and AMH concentration tested during ART treatment was not significantly different between the COVID RDT positive group and COVID RDT negative group (–1.24 ng/ml [–0.35 to –1.61) versus –0.56ng/ml [–0.15 to –1.11], P = 0.22). Similarly the AFC (Antral Follicle Count) was also not significantly different between the two groups of patients.
The results of this prospective study showed that, based on AMH concentrations, mild COVID-19 infection did not affect ovarian reserve in our population of asymptomatic women who underwent an ART protocol susequently.

Limitations, reasons for caution
First, it has been shown that the AMH concentration is modified during ART treatment as this hormone is secreted by granulosa cells of small growing follicles thus reflecting the granulosa cell activity. Second, a relatively small number of women were included in the analysis and larger study groups are required.

Wider implications of the findings
The wider implication of our study is that AMH concentrations were tested in the same women at different time points and could, therefore, analyse any potential modification of the ovarian reserve after COVID-19 infection. This information can be used to reassure the population who have been afflicted by COVID-19 infection.

Trial registration number
not applicable