Impact of COVID-19 infection on gamete quality and embryo development and in subsequent pregnancy of patients undergoing ART

Coronavirus Disease 2019 (COVID-19 ) was a public health concern from 2019 through to 2022. It was assumed that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)—the virus responsible for COVID-19—could infect human ovaries and cross the blood-testis barrier. Nonetheless, the impact of COVID-19 infection on gamete quality, embryonic development, and pregnancy is yet to be reported, forming the basis of this study.

This case-control study, conducted at Sichuan Jinxin Xi’nan Women’s and Children’s Hospital from December, 2020 to July, 2023, aimed to explore the impact of SARS-CoV-2 on gamete quality, embryo development and subsequent pregnancy in patients undergoing artificial reproductive technology (ART). The participants included ten female (average age 30.7 ± 4.11years ) and eight male (average age 32.13 ± 4.45 years) COVID-19 patients, along with their COVID-19 negative spouses. All female patients underwent ovarian stimulation for In Vitro Fertilization (IVF) and frozen-thawed embryo transfer (FET). The control group comprised 16 healthy couples who underwent ART procedures matched on the criteria: age, body mass index (BMI), infertility etiology, infertility and treatment duration, serum follicle-stimulating hormone (FSH) and anti-Mullerian hormone (AMH) levels, antral follicle count (AFC), initial gonadotropin (Gn) dosage, duration of Gn administration and total Gn dose. Semen and follicular fluid samples were analyzed for SARS-CoV-2 RNA using Real-time Fluorescent Quantitative Polymerase Chain Reaction (RT-qPCR) assay. The sperm parameters, fertilization, cleavage and blastulation rates were compared between the groups, and follow-up data collected during was statistically analyzed.

The COVID-19-positive patients and controls were comparable in average age. Furthermore, no SARS-CoV-2 RNA was detected in semen or follicular fluid samples from affected patients. There were also no statistically significant differences between the control and test groups in sperm parameters, as well as fertilization, cleavage, and blastulation rates (P>0.05). Nonetheless, COVID-19 patients still exhibited a declining trend. Moreover, although the clinical pregnancy rate between male COVID-19 patients and controls was statistically significant (P=0.034), no statistical significance was observed in the difference between female COVID-19 patients and controls (P>0.05), albeit with a declining tendency.

We found that COVID-19 infections could negatively influence gamete quality, embryonic development, and clinical pregnancy. We hope that our findings will greatly inform future studies on the impact of COVID-19 infections on fertility in SARS-CoV-2-infected patients.