impact of SARS-CoV-2 (COVID-19) on fertility treatment

 

The purpose of this essay is to highlight the effects of the current pandemic in providing fertility treatments (consequences on short and long term, and measures recommended by professional organizations). Like many other industries, the assisted reproductive technology (ART) has been severely affected by this pandemic. Because this virus has a high rate of transmission between humans, and also because it can be very serious in some cases, WHO (World Health Organization) declared COVID-19 as a pandemic in the 11th of March 2020. Afterward, most of the professional associations worldwide strongly recommended the temporary closure of specialized clinics and the postponement of fertility treatments. These measures have been taken especially for the care of patients, but also for the protection of staff.

Unfortunately, studies are limited, we are still in the infancy, and there is not enough data on the potential of this virus and what its long-term consequences are. We can analyze existing data and try to adapt to the current situation as best we can by applying safety measures adopted by Government / National Regulations, together with professional organizations for both patients and staff.

Introduction:

An unprecedented global state of concern and a major change in our social and individual plans occurred because of the new type of coronavirus. This is called COVID-19 or SARS CoV-2 and it was identified for the first time in humans following an unusual outbreak of viral pneumonia in Wuhan, China in December 2019 (*WHO), and then spread rapidly in 210 countries around the world (*Worldometer). This novel coronavirus is responsible for the largest pandemic of the last 100 years and the first pandemic caused by a coronavirus (*WHO). Its characterized by high infectious rates,  high level of severity in some cases, and relatively high mortality with more than 4 million confirmed cases worldwide and more than 280.000 deaths, according to the latest figures on the 9th of May 2020 (*Worldometer).

Immediate worldwide impact of SARS-CoV-2 (COVID-19) on fertility treatment:

In line with the guidance from the ARCS/BFS (Association of Reproductive and Clinical Scientists and British Fertility Society), HFEA (Human Fertilisation and Embryology Authority) issued, in 23rd of March 2020, the General Directions 0014 (Covid-19 Treatment Strategy), which required all clinics to have a COVID-19 treatment strategy and ceased the treatment services by 15th of April 2020 (*HEFA).

Many other European countries that have been severely affected by SARS-CoV-2 (COVID-19) have decided to temporarily postpone fertility treatments (*ESHRE).

Infertility is a serious disease and affects a considerable percentage of the human population (*WHO) and delaying even for a short period of treatment, for some patients this decision can have dramatic consequences. But at the same time, continuing to provide fertility treatments in these difficult times without evidence that is safe to do so can have even more dramatic consequences, and that is why authorities decided to postpone the treatments until new recommendations.

After analyzing the limited literature about SARS-CoV-2 (COVID-19), there are few possible consequences on short and long-term:

· On the very short term, the first and the most significant impact, with immediate consequences, is, obviously, the closure of specialized clinics and the postponement of fertility procedures, affecting the most vulnerable category, with immediate needs for treatment, like oncology patients and those patients at the age limit at which these treatments can be given.

· One possible short-term, but also long-term consequence can be represented by one of the most common symptom of the infection with SARS-CoV-2 (COVID-19), the high fever, and this can produce major changes in sperm parameters. This has been proven that in feverish episodes, healthy men of reproductive age have experienced significant changes associated with decreased sperm concentration, motility, and morphology, but fortunately, this aspect has been observed to be reversible and after a while, they completely recovered (Carlsen et al., 2003).

· The previous potential consequence was attributed only to fever, but not to other potential factors caused by SARS-CoV-2 (COVID-19) infection, which are currently unknown, and which can potentially produce other serious and irreversible effects on fertility. There are many controversies about the association between infection with SARS-CoV-2 (COVID-19) and potential testicular damage and germ cell destruction (Maya et al., 2020) but it is still too early to draw a clear conclusion. Because the virus uses ACE2 protein to infect the human body, and also because this protein is highly expressed into the Leydig cells and cells of the seminiferous tubules in the human testis, many researchers decided to alert th

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