COVID-19 disease does not cause ovarian injury in women of reproductive age: an observational before-and-after COVID-19 study.

RESEARCH QUESTION: Can the SARS-CoV-2 virus injure the ovaries? DESIGN: An observational before-and-after COVID-19 study at an academic medical centre. A total of 132 young women aged 18-40 were enrolled; they were tested for reproductive function in the early follicular phase, and their information was obtained from hospital data between January 2019 and June 2021. Serum FSH, LH, oestradiol, the ratio of FSH to LH and anti-Müllerian hormone (AMH) concentrations were measured for each patient both before and after COVID-19 disease. RESULTS: In women with unexplained infertility, the median serum AMH concentrations (and ranges) were 2.01 ng/ml (1.09-3.78) and 1.74 ng/ml (0.88-3.41) in the pre-COVID-19 disease and post-COVID-19 disease groups, respectively. There was no statistically significant difference in terms of serum concentrations of AMH between pre- and post-illness (P = 0.097). Serum FSH, LH, FSH/LH ratio and oestradiol concentrations of the patients before COVID-19 illness were similar to the serum concentrations of the same patients after COVID-19 illness. CONCLUSION: According to these study results and recent studies investigating the effect of COVID-19 on ovarian reserve, it is suggested that the SARS-CoV-2 virus does not impact ovarian reserve; however, menstrual status changes may be related to extreme immune response and inflammation, or psychological stress and anxiety caused by the COVID-19 disease. These menstrual status changes are also not permanent and resolve within a few months following COVID-19 illness.

Analysis of Ovarian Injury Associated With COVID-19 Disease in Reproductive-Aged Women in Wuhan, China: An Observational Study.

Objective: This study was intended to investigate the relationship between COVID-19 disease and ovarian function in reproductive-aged women. Methods: Female COVID-19 patients of reproductive age were recruited between January 28 and March 8, 2020 from Tongji Hospital in Wuhan. Their baseline and clinical characteristics, as well as menstrual conditions, were recorded. Differentials in ovarian reserve markers and sex hormones (including anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], the ratio of FSH to luteinizing hormone [LH], estradiol [E2], progesterone [P], testosterone [T], and prolactin [PRL] were compared to those of healthy women who were randomly selected and individually matched for age, region, and menstrual status. Uni- and multi-variable hierarchical linear regression analyses were performed to identify risk factors associated with ovarian function in COVID-19 women. Results: Seventy eight patients agreed to be tested for serum hormone, of whom 17 (21.79%) were diagnosed as the severe group and 39 (50%) were in the basal level group. Menstrual status (P = 0.55), menstrual volumes (P = 0.066), phase of menstrual cycle (P = 0.58), and dysmenorrhea history (P = 0.12) were similar without significant differences between non-severe and severe COVID-19 women. Significant lower serum AMH level/proportion (0.19/0.28 vs. 1.12 ng/ml, P = 0.003/0.027; AMH ≤ 1.1 ng/ml: 75/70.4 vs. 49.7%, P = 0.009/0.004), higher serum T (0.38/0.39 vs. 0.22 ng/ml, P < 0.001/0.001) and PRL (25.43/24.10 vs. 12.12 ng/ml, P < 0.001/0.001) levels were observed in basal level and the all-COVID-19 group compared with healthy age-matched control. When adjusted for age, menstrual status and parity variations in multivariate hierarchical linear regression analysis, COVID-19 disease was significantly associated with serum AMH (ß = -0.191; 95% CI: -1.177-0.327; P = 0.001), T (ß = 0.411; 95% CI: 11.154-22.709; P < 0.001), and PRL (ß = 0.497; 95% CI: 10.787-20.266; P < 0.001), suggesting an independent risk factor for ovarian function, which accounted for 3.2% of the decline in AMH, 14.3% of the increase in T, and 20.7% of the increase in PRL. Conclusion: Ovarian injury, including declined ovarian reserve and reproductive endocrine disorder, can be observed in women with COVID-19. More attention should be paid to their ovarian function under this pandemic, especially regarding reproductive-aged women. Clinical Trial Number: ChiCTR2000030015.