Assessing the impact of SARS-CoV-2 infection and vaccination on fertility and assisted reproductive techniques outcomes: an umbrella review.

OBJECTIVE

To assess the impact of SARS-CoV-2 infection and vaccination on fertility and assisted reproductive technology (ART) outcomes.

STUDY

DESIGN

This is an Umbrella Review of Meta-analyses. We searched major databases until December 30, 2023. The quality of evidence was assessed by a Measurement Tool to Assess Systematic Reviews and the Grading of Recommendations, Assessment, Development and Evaluation.

RESULTS

Of 647 studies identified, 14 studies with 40 outcomes were included. COVID-19 infection may decrease semen quality in men, including semen volume (WMD, -0.48 ml; 95% CI, -0.59 to -0.36 ml), total sperm count (WMD, -34.84 × 10^6; 95% CI, -43.51 to -26.17 × 10^6), sperm concentration (WMD, -16.23 × 10^6/ml; 95% CI, -25.56 × 10^6 to -6.89 × 10^6), viability (SMD, -0.66; 95% CI, -1.27 to -0.06), and total sperm motility (SMD, -0.61; 95% CI, -0.96 to -0.25), and elevated levels of estradiol (SMD 0.652; 95% CI, 0.254 to 1.049; p = 0.001) and prolactin (SMD 0.305; 95% CI, 0.045 to 0.566; p = 0.022). However, it did not significantly affect testosterone levels. Notably, even after recovery (over 90 days), sperm concentration and motility remained lower compared to uninfected individuals. Conversely, COVID-19 showed minimal impact on female ovarian reserve (including antral follicle count, AMH) or ART outcomes (including oocyte number and quality, embryo quality, implantation rates, clinical pregnancy rates and miscarriage rates). Vaccination also had minimal effects on both sexes. Evidence quality was generally very low, highlighting the need for high-quality, long-term studies.

CONCLUSION

SARS-CoV-2 infection primarily affects male fertility, leading to reductions in sperm quality, count, and motility. However, female fertility and ART outcomes show little to no impact. COVID-19 vaccination shows minimal impact on fertility and ART outcomes. The quality of evidence is rated as very low to low. High-quality prospective studies with longer follow-up periods are needed.