Female Reproductive Health in SARS-CoV-2 Pandemic Era.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic struck global health systems with overgrowing demands in many fields of health care; yet, reproductive care, particularly pregnancy care remains a special focus of interest. Pregnancy is a major physiologic change that alters temporarily normal function of many organs, and specifically the immune system. Therefore, pregnant women are more susceptible to respiratory pathogens compared to the others. The current pandemic may have serious consequences on pregnancy whether directly or indirectly. In the present review, direct and indirect possible adverse effects of SARS-CoV-2 infection on female reproductive system by focusing on pregnancy and delivery has been discussed in details. In addition, the pregnancy consequences and whether maternal infection can affect infants were deliberated. The adverse impact of luck down and related psychological complications and obesity on pregnant women were discussed as well. Finally, the effects of SARS-CoV-2 vaccination on maternal health and pregnancy outcome was analyzed.

Mild Androgen Insensitivity Syndrome presenting in male with infertility and sexual difficulties

Androgen insensitivity syndrome has a wide spectrum of presentations. It results from a mutation in androgen receptor (AR) gene. It ranges from mild androgen insensitivity syndrome (MAIS) which is the mildest form to complete androgen insensitivity syndrome (CAIS). In case of MAIS, the abnormality that can be observed appears to be male infertility and sexual difficulties including premature ejaculation and erectile dysfunction. In this case report, we discuss a case of MAIS in a 37-year-old male who presented with infertility, premature ejaculation, and secondary erectile dysfunction.Copyright © 2023, Ibn Sina Trust. All rights reserved.

Angiotensin Converting Enzyme 2 (ACE2)-A macromolecule and its impact on human reproduction during COVID-19 pandemic

Coronavirus disease 2019 (COVID 19) is caused by severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV-2). It has been declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, several researchers have worked/ are working on this virus by a multifactorial approach to finding out the mechanism of entry, transmission route, post-infection replication process, survival, and post-recovery utilities. As we know, SARS, MERS, and Zika viruses have affected human reproductive potentials, consequently, COVID 19 also can affect both men's and women's reproductive potential through ACE2 macromolecule. This study aimed to summarize the role of ACE2-macromolecule in COVID 19 entry and further processes in the reproductive path of both men and women. Research articles were searched in NCBI-NLM, Google Scholar, and Scopus databases. We searched based on the phrase ―COVID 19”, ―ACE2”, ―ACE2 in testes”, ―ACE2 in the female reproductive tract”, ―ACE2 during pregnancy”, ―ACE2 during early embryo”, ―COVID 19 and impact in human reproduction” and selected the articles for summarizing this article. Most recent articles and the mechanism of COVID 19 were selected for our understanding. The results of the study revealed that COVID 19 impacts the reproductive potential of both men and women. Testes are the most vulnerable organ prone to infection in men, and vaginal fluid and the uterus could be the choice of infection in the female. Till now, COVID 19 has not been directly detected in semen samples and vaginal fluid. Results of the study can be concluded that ACE2 plays a major role in COVID 19 infection, ACE2 expression could Angiotensin Converting Enzyme 2 (ACE2) - A macromolecule and its impact on human reproduction. © 2022, Editorial board of Journal of Experimental Biology and Agricultural Sciences. All rights reserved.

The impact of COVID-19 vaccines on fertility-A systematic review and meta-analysis.

BACKGROUND: Despite literature's evidence about COVID-19 vaccines' safety, concerns have arisen regarding adverse events, including the possible impact on fertility, accentuated by misinformation and anti-vaccine campaigns. The present study aims to answer the question: Is there any impact of COVID-19 vaccines on the fertility of men and women of reproductive age? METHODS: PubMed, Scopus, Web of Science, Cochrane and Embase databases were searched for eligible studies until June 8th, 2022. The search was restricted to articles regarding humans, published in any languages, without additional restrictions. Studies' quality was assessed by the Newcastle-Ottawa and the Before and After Quality Assessment scales for cohort and pre-post studies, respectively. Random-effect meta-analyses were performed for parameters considered in ≥ 2 studies, calculating means, p-values and 95 % Confidence Intervals (CIs). RESULTS: Out of 1406 studies screened, 29 were included in the systematic review. These studies, conducted in Israel (34.5 %), USA (24.1 %), Russia (20.7 %) China (10.3 %), Italy (3.5 %), North America (3.5%) and Turkey (3.5 %) were of poor (34.5 %), moderate (58.6 %) and good (6.9 %) quality. Meta-analyses were performed for pre- and post-vaccination sperm progressive motility (44 %, 95 % CI 42 %-62 % vs 43 %, 95 % CI 31 %-59 % p = 0.07) and concentration (50.6 mln/ml, 95 % CI 35.1-72.8 vs 55.4 mln/ml, 95 % CI 37.4-82.2p = 0.12). Biochemical (0.51, 95 % CI 0.40-0.66 vs 0.60, 95 % CI 0.53-0.68p = 0.45) and clinical (0.45, 95 % CI 0.37-0.54 vs 0.47, 95 % CI 0.40-0.55 p = 0.31) pregnancy rate did not differ among vaccinated and not vaccinated groups. Subgroup meta-analyses based on the type of vaccine showed no significant difference: between vaccinated with mRNA vaccines and non-vaccinated regarding biochemical pregnancy rates; pre- and post-vaccination with Gam-COVID-Vac regarding testosterone, FSH and LH levels; pre- and post-vaccination with BNT162b2 vaccines regarding sperm volumes. CONCLUSION: Based on the studies published so far, there is no scientific proof of any association between COVID-19 vaccines and fertility impairment in men or women.

IMPACT OF THE COVID-19 PANDEMIC ON THE SEXUAL FUNCTION OF PATIENTS SEEKING FERTILITY CARE

Introduction: The COVID-19 pandemic and subsequent public health response resulted in unprecedented changes to society, including recommendations for social and physical distancing. Sexual dysfunction is best understood within a biopsychosocial framework, and it is reasonable to predict that biological, psychological, and social aspects of the COVID-19 pandemic may impact sexual function, particularly in a patient population actively planning pregnancy. Objective: The aim of this study was to understand the impact of the COVID19 pandemic - including COVID-19 infection, COVID-19 vaccination, and psychosocial conditions of the pandemic - on the sexual function of women receiving fertility care. Methods: Eligible patients aged 18 or older were identified using ICD codes related to female infertility and fertility testing and invited to complete an online survey regarding COVID-19 infection and vaccination status, fertility planning, and the impact of pandemic conditions on sexual function. Participants were recruited from a large academic-based fertility center and received care between April 2020 and April 2021. χ2 was used for between-group comparisons. Results: Of the 738 eligible patients, 197 participants completed the survey. Seventy-four (37.5%) participants had been pregnant within the past year and 168 (85.3%) participants had attempted to conceive in the past year. Forty-four (22.3%) participants reported prior COVID-19 infection, with 29 confirmed diagnoses and 15 suspected diagnoses. Further, 107 (54.2%) participants had been vaccinated against COVID-19, 35 (17.8%) were planning on being vaccinated, and 52 (26.4%) were not planning on being vaccinated. Participants declining vaccination cited concerns with health, fertility, pregnancy, breastfeeding, and a lack of vaccine safety data as common reasons for declining. Most (n = 180;91.4%) participants were sexually active at the time of survey, but only 25 (12.7%) reported their sex life was improved as a result of the pandemic;this did not differ in patients with or without a prior COVID-19 infection (15.9% vs. 11.8%, P=NS). These participants cited having more time with their partner, working from home, fewer outside stressors and social obligations, improved relationship dynamics and emotional bonding, and shared feelings about pandemic-related policies as reasons for improved sexual function. Of the 44 participants who had experienced COVID-19 infection, the majority (52.3%) expressed interest in returning to sexual activity within two weeks of infection. An additional 20.5% reported interest in sexual activity between two and four weeks after infection. Most (81.8%) stated that they were “not at all” or “not really” concerned about infecting their partner through intimacy or intercourse and 70.5% stated that their interest in sex was “not at all” or “not really” affected by their COVID-19 infection. Finally, 68.2% of participants reported that their ability to enjoy sex was “not at all” or “not really” affected by their COVID-19 infection. Conclusions: The majority of participants in this study did not experience improved sexual function during the pandemic, but those who did may offer insight into psychosocial and environmental factors that contribute to sexual function. The majority of participants who experienced COVID-19 infection did not report significant disruption to their sexual function as a result of their infection.

ATTITUDES AND PERCEIVED IMPACT OF THECOVID- 19 PANDEMIC ON FERTILITY TREATMENT AND CONCEPTION PLANNING AMONG HEALTHCARE WORKERS WITH INFERTILITY

OBJECTIVE: To determine the impact of the COVID-19 pandemic on the attitudes and perceptions towards conception planning and fertility treatment among health care workers with infertility MATERIALS AND METHODS: Eligible female subjects age 18 years or older were identified with ICD codes related to female infertility and fertility testing. Recruited subjects received care from a single provider in an academic- based fertility center between April 2020 and April 2021. Respondents completed an online survey regarding attitudes and perceived impact of the pandemic towards fertility treatment, vaccination, and conception planning. Subjects were compared based on their healthcare worker (HCW) status. RESULTS: Of the 738 eligible subjects, 190 participants completed the survey, 72 (37.9%) of which had conceived in the last year, and 58 (30.7%) were HCWs. In the last year, 82.6% had fertility treatment and 20% underwent IVF. Additionally, 23.2% had confirmed or presumed COVID-19 and 22.7% were pregnant at the time of diagnosis. A total of 34.1% of patients had postponed treatment, most of whom (75%) were due to hospital or clinic delays. Only 25% made the personal decision to delay treatment. 34.1% of HCWs compared to 32.2% of non-HCWs delayed treatment during the pandemic (NS). The power analysis for this comparison provided 98.5% power with an alpha 0.05 to detect a difference of 30% given our sample size. HCWs were more likely to delay treatment due to concerns of becoming ill from COVID-19 while pregnant than non-HCW (p<0.0001). However, HCWs had a tendency to delay care due to distress surrounding prenatal care, labor, and delivery (2.7 ± 1.5 vs 2.4 ± 1.4 on a Likert scale). HCWs who had COVID had a more negative pregnancy and birth experience (2.0 ±2.3 vs 1.3 ± 0.8). Overall, 54.2% of patients have been vaccinated, 62.1% of whom were HCWs. Of those unvaccinated, 40.5% plan on getting vaccinated. Reasons not to get vaccinated was due to fertility concerns (45.9%), health concerns (25.7%) (i.e. allergies to vaccines), or breastfeeding status (28.4%). A small number of patients stated that they would like to not be breastfeeding (6.3%) or pregnant (14.7%) when vaccinated. Among non-vaccinated individuals, fewer HCWs (23.8%) planned on becoming vaccinated compared to non- HCW (46.0%). Non-HCWs trended towards not being vaccinated due to fertility concerns (20.5% vs 12.1%), while HCW trended towards other reasons (i.e. breastfeeding) (13.8% vs 9.9%). CONCLUSIONS: In the infertility population, the pandemic affected HCW and non-HCW discordantly. Although HCW workers were less worried about having COVID-19 while pregnant and more non-HCWs did not get vaccinated due to fertility concerns. HCWs also had a tendency towards more stress and negative experiences with prenatal care and L&D. IMPACT STATEMENT: HCWs with infertility are discordantly affected by the pandemic and by understanding these differences providers can provider better support and care for these patients.

Potential effects of COVID-19 on reproductive health: A mini review

Coronavirus disease 2019 (COVID-19) is now a major public health problem worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity is extremely strong. One major target of the virus is the lung, which can lead to death due to the development of respiratory distress syndrome and even multiple system organ failure. The possible pathophysiology by which SARS-CoV-2 affects the object is by way of the receptor, angiotensin-converting enzyme 2 (ACE2). From the study of the viral structure and infection mechanisms, researchers have discovered that the ACE2 acts as a receptor for SARS-CoV-2. According to previous studies, ACE2 is one of the key enzymes in the RAS system. Physiological functions can be found in angiosarcomas and in the kidney, liver, intestine and so on. Whether SARS-CoV-2 infection leads to male fertility impairment has recently received attention. Nevertheless, the association between SARS-CoV-2 infection and reproductive health is currently poorly understood. Using key words including “SARS-CoV-2”, “reproductive health”, “ACE2” and “2019-nCoV”, we retrieved original articles and reviews from the PubMed and WEB OF SCI databases published before December 16, 2020 and performed a thorough review of them. Compared with females, we discovered that infected person with SARSCoV-2 was higher in males. Men who were infected with SARS-CoV-2 may be easy to suffer from impaired reproductive health. These investigations would help for a comprehensive grasp of the relationship between SARS-CoV-2 infection and reproductive health.

Impact of the COVID-19 Pandemic on the Lifestyles and Quality of Life of Women With Fertility Problems: A Cross-Sectional Study.

Background: The COVID-19 pandemic has implied worldwide the imposition of confinement measures and mobility restrictions, to a greater or lesser extent. It has also meant the closure of some public medical services such as reproductive care. This situation may have impacted the health-related behaviour and quality of life of women with fertility problems. Objective: The objective of this study was to analyse the effects of confinement and the suspension of reproductive medical care on the lifestyle (diet, physical exercise, and smoking habits), anxiety and depression, and quality of life of infertile women by comparing their pre- and post-confinement situations. Methods: We carried out a cross-sectional, internet-based study. Information was collected on these women's adherence to the Mediterranean diet (MEDAS questionnaire), physical exercise (IPAQ-SF), anxiety and depression (HADS), and quality of life related to fertility (FertiQol) before, during, and after confinement. The survey was conducted between 1 September and 28 October 2020. Results: A total of 85 women participated. There had been a significant increase in anxiety and depression levels (P < 0.001) and an increase in tobacco consumption among female smokers during confinement vs. pre-confinement (62.5% had increased their consumption). The participants had also increased the mean number of hours they spent sitting (P < 0.001). There had also been an increase in vigorous and moderate exercise levels by 40 and 30%, respectively (P = 0.004). However, no differences were observed in these patients' eating habits as a result of confinement (P = 0.416). When the reproduction service was resumed, the participants showed higher anxiety level scores (P = 0.001) with respect to the pre-confinement situation as well as lower mean FertiQol scale score (P = 0.008). Conclusions: Confinement had increased anxiety and depression levels among these infertile women as well as tobacco use among the participants who were smokers. The prolonged closure of reproductive care units decreased the quality of life of the participants of this study. These results suggest the need to implement online programs to improve healthy habits and quality of life of this population group.