The impact of the coronavirus on the human reproductive system in connection with the ongoing Covid-19 pandemic is being actively studied. According to scientific research, it is now reliably known that the SARS-CoV-2 virus, which causes the infectious disease, penetrates virtually all tissues of the body. The genital sphere turned out to be sensitive to the pathogen: female uterus and gonads of both sexes. Testicles, ovaries and uterus have receptors that perceive pathological agents.
There is more scientific data on the effect of dangerous microflora on the ability to reproduce so far in relation to men. Cases of testicular inflammation of viral origin have been reported. SARS-CoV-2 has also been detected in male seminal fluid. ACE 2 protein, which promotes penetration of the virus into the human cell, is found in large quantities in the testes.
Among women, the age group 37 plus (according to preliminary information) is most susceptible to the negative effects of the microorganisms. Factors contributing to reproductive organ damage are the severity of the disease and excess body weight. Patients who are overweight after a severe form of Covida have a 5-fold increased risk of decreased egg supply, compared to young girls who have had the disease easily or asymptomatically.
No increase in gynecological diseases during the pandemic has been observed so far. Their structure remains stable. The leading position is occupied by inflammatory illnesses of the small pelvis (per 100,000 - 3,000 cases). Menstrual disorders come second (per 100,000 - 1,300). There are 225 women with infertility per 100,000. These are approximate figures because many girls are taking OCs, others are not sexually active, and others are not planning to become mothers in the near future. These categories are (for the most part) unaware of their own fertility status. Many of them probably have a reproductive dysfunction.
Viral orchitis in men and decreased ovarian reserve in women after infection increases the risk of infertility. Scientists have not ruled out the possibility that SARS-CoV-2 may cause infertility, but there is no evidence yet for this assumption.
IVF and the coronavirus
During the pandemic period, infertile patients were much less likely to seek medical care due to sanitary and epidemiological restrictions and self-isolation. Outpatient services were not fully available in 2020. Assisted reproductive programs were suspended from February 2020 through July. Statistically, about 50,000 infertile couples did not benefit from ART during this six-month period. At the moment there are no restrictions, the procedures are performed routinely and the rates have leveled off.
The decision to limit the use of ART techniques was made at the beginning of the pandemic by international professional associations.
During this time, medical recommendations have been made regarding the use of assistive technology:
- IVF can be performed no earlier than three months after an infection. This is to reduce the risk of possible thromboembolic complications, as well as the negative effects on the fetus of the medications used to treat COVID-19.
- Before planning IVF, rule out the presence of coronavirus.
- Vaccinate 2 months before the planned treatment.
- Wait up to 3 months after vaccination.
- The time for ovarian hyperstimulation should be agreed upon with the reproductologist.
- Discuss the risks of possible complications with your doctor.
- The embryo is not transferred until 3 months after recovery from Covid or vaccination.
A vaccination is recommended to minimize all risks of infection during infertility control and the gestational period.
The effect of vaccination on fertility
According to scientific studies, the use of the vaccine does not impair reproduction in men and women, nor does it affect the reproductive organs. "Sputnik V" was experimentally vaccinated with 200 of each sex of reproductive age. They received two doses 90 days apart.
Before and after the procedure the participants were fully examined: pelvic sonography, blood antibodies, hormonal panel, female ovarian resource, spermogram (in men). No abnormalities in male or female fertility were found. Pre-vaccination and post-vaccination diagnostic values were identical in each study subject. This means the safety of vaccination, which cannot cause infertility.
If the men had a fever against the background of vaccine administration, it could have negatively affected spermatogenesis. But spermatozoa are renewed every 2,5-3 months. Therefore, examinations were performed after 90 days and temporary disorders were of no importance.
Vaccination during pregnancy
The Ministry of Health of the Russian Federation plans to vaccinate pregnant women. In the United States, 14,000 women have been vaccinated during gestation. Information on 827 vaccinated pregnant women has been published. The following conclusions are drawn: the complications are the same and occur with the same frequency as in the unvaccinated. The number of spontaneous abortions, premature births, fetal abnormalities and other complications did not increase and did not differ with the general population incidence of pathological changes.
In animals, preclinical studies were conducted and the safety of Sputnik V in gestation was proved. Based on these results, the experts decided to remove restrictions for vaccination of pregnant women.
Vaccination is planned in the first instance:
Those not vaccinated before conception and who do not have the appropriate antibodies.
Patients who have had a severe course of Covid-19.
Are on the medical record for a chronic disease that is potentially dangerous to the pregnancy.
Having diagnosed obesity.
Group G antibodies formed after the disease or vaccination are transmitted to the fetus through the placenta. The baby in the womb is thus fully protected from possible infection. Vaccination is not recommended for breastfeeding mothers only, since it is not yet known how the vaccine will affect the newborn through the mother's milk.
Coronavirus in pregnancy
During a successful conception, the expectant mother's immune defense decreases. This physiological reaction is necessary so that the fetus is not perceived by the mother's body as a foreign body and rejection does not occur. Therefore, during pregnancy, women are more susceptible to infections. Because of decreased immunity, COVID increases the risk of serious consequences. Respiratory failure occurs more often, and the patient must be put on a ventilator. There is an increased risk of pre-eclampsia.
Self-isolation is recommended for pregnant women to minimize the possibility of infection. If the woman does become infected, it has been established that she carries the pathology in much the same way as in the normal position. As a rule, the disease has a mild to moderate severity. The main symptoms are fever, weakness, headache, shortness of breath, loss of taste and smell. Recovery occurs within a few days. If you feel unwell, you should immediately call an ambulance or see your family doctor.
If you suspect infection, you need to tell the doctor right away. It can be a common cold. But, if a specialist suspects Covid-19, pregnant women can have a single CT scan or X-ray to rule it out. Doses of radiation from a single examination are safe for the baby and the mother.
Covid is more difficult for at-risk patients with bronchial asthma or chronic bronchitis:
Bronchial asthma or chronic bronchitis.
Dysfunction of the liver, kidneys.
It is especially dangerous if the pregnant woman falls ill in the II-III trimester. During this period, the fetus is already large, supporting the diaphragm of the mother. And in conditions of lack of oxygen it will be even harder for her to breathe. If there is significant difficulty in breathing and premature contractions, a cesarean section is usually resorted to. With a mild form of pathology, patients in the position are treated at home. With a severe form requires hospitalization in a separate room. Therapy is symptomatic.
To avoid becoming infected, you need to:
- Leave home as little as possible.
- Avoid crowded places.
- In public places, wear a mask that covers your mouth and nose.
- Wash your hands (preferably with plain water if you can), especially if you are outside the home.
- Do not touch your face, nose, mouth or eyes with unprotected hands. Use a tissue for this purpose.
- Eat a balanced diet and get enough rest to support your immune system.
- Limit as much as possible any contact, even with relatives who may be carriers of infection.
- In consultation with your doctor, you can postpone for a while scheduled visits to the clinic and reduce the number of visits.
- Vaccinate both partners when planning to conceive.
From an infected mother, the virus can be transmitted to the fetus. But vertical transmission is unlikely and very rare. If this happens, children usually recover quickly, do not lag behind in development and there are no known cases of death for this reason. In this case, the baby develops antibodies to the virus.
Rather, the child may become infected after birth from a sick adult who provides care. The most frequent complications are respiratory disorders (distress syndrome), reduced body weight in newborns, asphyxia. With timely professional assistance, all pathological conditions are eliminated and the infant makes a full recovery.
The role of telemedicine.
SARS-CoV-2 does not increase the risk of miscarriage. There is evidence that women who have contracted the severe form of Covid have given birth to premature babies. However, the exact reasons for this have not yet been identified.
Russian scientists name a figure of 15-20% relating to premature births that occurred in patients who contracted the new strain of coronavirus infection. This is due to the emergence of medical indications for induction of labor, when carrying a fetus becomes too risky for the health of the mother. Usually such indications arise when the course of the disease is severe.
In order to protect pregnant women from unnecessary contact and minimize the chances of infection, telemedicine platforms are used. In the U.S., the Health Cloud service, offered by a charitable NGO, has been launched. The National Health League Foundation organized the project in order to provide free medical consultations with the help of telemedicine technologies.
Not only women in pregnancy, but any patients left without medical attention in the pandemic can get professional advice online. As part of the online consultation, the doctor can make a decision about hospitalization, if necessary. Remote communication with a professional solves many problems and relieves the enormous workload of medical workers engaged in treating patients with coronavirus.