ABSTRACT
OBJECTIVES: Among youth in Nairobi, we (1) characterised fertility and contraceptive use dynamics by gender; (2) estimated pregnancy prevalence over the pandemic; and (3) assessed factors associated with unintended pandemic pregnancy for young women. DESIGN: Longitudinal analyses use cohort data collected at three timepoints prior to and during the COVID-19 pandemic: June to August 2019 (pre-pandemic), August to October 2020 (12-month follow-up) and April to May 2021 (18-month follow-up). SETTING: Nairobi, Kenya. PARTICIPANTS: At initial cohort recruitment, eligible youth were aged 15-24 years, unmarried and residing in Nairobi for at least 1 year. Within-timepoint analyses were restricted to participants with survey data per round; trend and prospective analyses were restricted to those with complete data at all three timepoints (n=586 young men, n=589 young women). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes comprised fertility and contraceptive use for both genders, and pregnancy for young women. Unintended pandemic pregnancy (assessed at 18-month follow-up) was defined as a current or past 6-month pregnancy with intent to delay pregnancy for more than 1 year at 2020 survey. RESULTS: While fertility intentions remained stable, contraceptive dynamics varied by gender-young men both adopted and discontinued coital-dependent methods, whereas young women adopted coital-dependent or short-acting methods at 12-month follow-up (2020). Current pregnancy was highest at 2020 (4.8%), and approximately 2% at 2019 and 2021. Unintended pandemic pregnancy prevalence was 6.1%, with increased odds for young women recently married (adjusted OR (aOR)=3.79; 95% confidence interval (CI) 1.83-7.86); recent contraceptive use was protective against unintended pandemic pregnancy (aOR=0.23; 95% CI 0.11-0.47). CONCLUSIONS: Current pregnancy in Nairobi was highest at the height of the COVID-19 pandemic (2020), and subsided to pre-pandemic levels by 2021 data collection; however, requires further monitoring. New marriages posed considerable risk for unintended pandemic pregnancy. Contraceptive use remains a crucial preventive strategy to averting unintended pregnancy, particularly for married young women.
Subject(s)
COVID-19 , Pregnancy, Unplanned , Pregnancy , Female , Adolescent , Young Adult , Humans , Male , Contraceptive Agents , Kenya/epidemiology , Pandemics , Prospective Studies , COVID-19/epidemiology , COVID-19/prevention & control , Fertility , Contraception BehaviorABSTRACT
INTRODUCTION AND OBJECTIVE: Micropollutants (MPs) are defined as persistent and biologically-active substances which occur in the environment in trace amounts, mainly as a result of industrial processes and human domestic activity. The published experimental data prove that, among other things, MPs present in the environment may also affect and disturb hormonal balance in humans, resulting in impairment of the reproductive function. In addition to the many MPs disrupting endocrine function described in literature and which exert an effect on human reproductive function, the study presents a review of current literature concerning the exposure to Bisphenol A, phthalates, organochlorine pesticides, and pyrethroids. REVIEW METHODS: Two independent authors searched in PubMed and Google scholar (any date until September 2022) for studies concerning chosen endocrine-disrupting MPs in water and their effects on human fertility and fecundity. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: The review of the literature showed that EDMs present in the environment may create risk in the prenatal and postnatal development following premature birth, and exert a negative effect on fertility and reproductive functions in humans, especially during the perinatal period. SUMMARY: The presented review of literature indicates a negative effect of exposure to BPA, phthalates, OC and OP pesticides, as well as to pyrethroids, regarding human reproductive health. It also demonstrated considerable differences according to gender. Generally, there is a definitely stronger evidence for the presence of a cause-effect relationship between the discussed EDMs and a decreased fertility and fecundity in males. The negative effect of exposure to Bisphenol A, phthalates, selected organochlorine pesticides and pyrethroids appears to be quite well documented.
Subject(s)
Environmental Pollutants , Pesticides , Pyrethrins , Male , Pregnancy , Female , Humans , Water , Fertility , Pesticides/toxicity , Pyrethrins/toxicityABSTRACT
The coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has precipitated a global health crisis of unprecedented proportions. Because of its severe impact, multiple COVID-19 vaccines are being rapidly developed, approved and manufactured. Among them, mRNA vaccines are considered as ideal candidates with special advantages to meet this challenge. However, some serious adverse events have been reported after their application, significantly increasing concerns about the safety and efficacy of the vaccines and doubts about the necessity of vaccination. Although several fertility societies have announced that COVID-19 mRNA vaccines are unlikely to affect fertility, there is no denying that the current evidence is very limited, which is one of the reasons for vaccine hesitancy in the population, especially in pregnant women. Herein, we provide an in-depth discussion on the involvement of the male and female reproductive systems during SARS-CoV-2 infection or after vaccination. On one hand, despite the low risk of infection in the male reproductive system or fetus, COVID-19 could pose an enormous threat to human reproductive health. On the other hand, our review indicates that both men and women, especially pregnant women, have no fertility problems or increased adverse pregnancy outcomes after vaccination, and, in particular, the benefits of maternal antibodies transferred through the placenta outweigh any known or potential risks. Thus, in the case of the rapid spread of COVID-19, although further research is still required, especially a larger population-based longitudinal study, it is obviously a wise option to be vaccinated instead of suffering from serious adverse symptoms of virus infection.
Subject(s)
COVID-19 , COVID-19 Vaccines , Female , Fertility , Humans , Longitudinal Studies , Male , Pregnancy , SARS-CoV-2 , Vaccination Hesitancy , Vaccines, Synthetic , mRNA VaccinesABSTRACT
Bacterial or viral infections, such as Brucella, mumps virus, herpes simplex virus, and Zika virus, destroy immune homeostasis of the testes, leading to spermatogenesis disorder and infertility. Of note, recent research shows that SARS-CoV-2 can infect male gonads and destroy Sertoli and Leydig cells, leading to male reproductive dysfunction. Due to the many side effects associated with antibiotic therapy, finding alternative treatments for inflammatory injury remains critical. Here, we found that Dmrt1 plays an important role in regulating testicular immune homeostasis. Knockdown of Dmrt1 in male mice inhibited spermatogenesis with a broad inflammatory response in seminiferous tubules and led to the loss of spermatogenic epithelial cells. Chromatin immunoprecipitation sequencing (ChIP-seq) and RNA sequencing (RNA-seq) revealed that Dmrt1 positively regulated the expression of Spry1, an inhibitory protein of the receptor tyrosine kinase (RTK) signaling pathway. Furthermore, immunoprecipitation-mass spectrometry (IP-MS) and co-immunoprecipitation (Co-IP) analysis indicated that SPRY1 binds to nuclear factor kappa B1 (NF-κB1) to prevent nuclear translocation of p65, inhibit activation of NF-κB signaling, prevent excessive inflammatory reaction in the testis, and protect the integrity of the blood-testis barrier. In view of this newly identified Dmrt1- Spry1-NF-κB axis mechanism in the regulation of testicular immune homeostasis, our study opens new avenues for the prevention and treatment of male reproductive diseases in humans and livestock.
Subject(s)
COVID-19 , Rodent Diseases , Zika Virus Infection , Zika Virus , Humans , Male , Mice , Animals , Testis , NF-kappa B/metabolism , COVID-19/veterinary , SARS-CoV-2/metabolism , Homeostasis , Fertility , Zika Virus/metabolism , Zika Virus Infection/metabolism , Zika Virus Infection/veterinary , Membrane Proteins/metabolism , Phosphoproteins/metabolism , Phosphoproteins/pharmacology , Adaptor Proteins, Signal Transducing/metabolism , Adaptor Proteins, Signal Transducing/pharmacology , Rodent Diseases/metabolismABSTRACT
PURPOSE OF REVIEW: The emergence of the novel coronavirus infection that arose in Wuhan, China in December 2019 has resulted in an epidemic that has quickly expanded to become one of the most significant public health threats in recent times. The objective of this review is to summarize how this pandemic has affected the activity of a Reproductive Medicine Center, which established a series of measures in parallel with governments decisions and scientific societies. RECENT FINDINGS: The control measures adopted for restarting the healthcare activity should be equitable and inclusive. Moreover, this pandemic has implied changes in treatments and strategies to be alert regarding the daily changing information. Finally, for ensuring a safe practice both for patients and staff, it is important to detect asymptomatic patients, so Reproductive Medicine centers must take special care with screening and testing procedures. SUMMARY: The pandemic has pushed up toward a new reality in terms of Assisted Reproductive treatments, where social distance and responsibility are protagonists. We face a new challenge of balancing between responding to the committed efforts of infertile couples to achieve pregnancy and safeguarding the health of the future parents and their children during this time of pandemic.
Subject(s)
COVID-19/epidemiology , Infertility/therapy , Reproductive Medicine/methods , Reproductive Techniques, Assisted , Disease Outbreaks , Female , Fertility , Humans , Pandemics , Pregnancy , Reproductive Medicine/trends , Risk Assessment , Spain/epidemiologyABSTRACT
The previous academic research on work-family conflict mainly focused on the relevant elements in the work field. This study concludes that elements of the family domain have a significant impact on the relationship between work-family conflict and employee wellbeing. Female employees' perceptions of wellbeing largely depend on their willingness to have children when they take on family roles. During COVID-19, employees had more time to fulfill both work and family roles in the family sphere due to the epidemic blockade, the contribution of the female employee's significant other (husband) in family matters had a significant impact on Fertility intention. This study using SPSS 24.0 AMOS 20.0 and M plus 7.4 statistical analysis tools to test the proposed hypotheses. In the paired data of 412 working female employees and husbands of Chinese dual-earner families with different occupational backgrounds, hypothesis testing results support that female employees' work â family conflict is negatively related to female employees' fertility intentions, and female employees' fertility intentions are positively related to wellbeing; female employees' family â work conflict is negatively related to female employees' wellbeing; husband's flexible work stress is negatively related to husband's share of housework; husband's share of housework moderated the front, rear and overall mediating effects by the fertility intention. When formulating policies, the managers should consider not only the direct effects of policies, but also the indirect effects that policies may have on other family members of employees. Managers should develop management policies during an epidemic that are more responsive to the actual needs of employees during an epidemic. The management of female employees should give due consideration to the family status of female employees and the enterprises should recognize the importance of childcare for female employees.
Subject(s)
COVID-19 , Family Conflict , Child , Humans , Female , Intention , Pandemics , COVID-19/epidemiology , FertilityABSTRACT
KEY MESSAGE: Menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, however, the ovarian reserve estimated by AMH is not compromised. BACKGROUND: Recent studies have suggested that the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine causes menstrual abnormalities which led to concerns regarding its influence on the reproductive system. This study aims to investigate the influence of the SARS-CoV-2 mRNA vaccine on gynecologic well-being and future fertility of adolescent girls. METHODS: This is a prospective cohort study conducted at a university affiliated medical center between June and July 2021. Adolescent girls aged 12-16 years who were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart) were included in the study. All participants completed a computerized questionnaire regarding their general medical and gynecological background at recruitment and 3 months later. Blood samples were collected for AMH levels before and 3 months following the first mRNA vaccine RESULTS: The study group consisted of 35 girls, and of them, follow-up was completed by questionnaire and AMH sampling in 35 (90%) and 22 (56%) girls, respectively. Among the 22/35 girls who reported regular menstruation before vaccination, seven (31.8%) experienced irregularities post-vaccination. Four of the eight pre-menarche girls included in the study reported on menarche on follow-up. Median AMH levels were 3.09 (IQR 1.96-4.82) µg/L and 2.96 (2.21-4.73) µg/L at baseline and after 3 months, respectively (p = 0.07). After controlling for age, BMI and presentation of side effects, no association was demonstrated to the change in AMH levels (AMH2-AMH1). CONCLUSIONS: Although menstruation of adolescent girls might be influenced by Covid-19 mRNA vaccine, it seems that the ovarian reserve estimated by AMH is not compromised. CLINICAL TRIAL REGISTRATION: National Institutes of Health (NCT04748172).
Subject(s)
COVID-19 Vaccines , COVID-19 , United States , Adolescent , Humans , Female , Male , COVID-19 Vaccines/adverse effects , Prospective Studies , COVID-19/prevention & control , SARS-CoV-2 , FertilitySubject(s)
COVID-19 Vaccines , COVID-19 , Humans , Male , SARS-CoV-2 , Retrospective Studies , Fertility , Vaccination , Vaccines, Inactivated , Antibodies, ViralABSTRACT
Fertility intentions-intentions regarding whether and when to have children-predict reproductive health outcomes. Measuring fertility intentions is difficult, particularly during macrostructural shocks, for at least two reasons: (1) fertility intentions may be especially volatile during periods of uncertainty and (2) macrostructural shocks may constrain data collection. We propose a set of indicators that capture how a macrostructural shock directly alters fertility intentions, with a particular focus on the Coronavirus disease 2019 (Covid-19) pandemic. We advance the conceptualization and construct of fertility intentions measures in three ways. First, we demonstrate the value of direct questions about whether women attributed changes in fertility intentions to the pandemic. Second, we highlight the importance of a typology that delineates fertility postponement, advancement, foregoing, and indecision. Third, we demonstrate the importance of incorporating a granular time window within a two-year period to capture short-term changes to fertility intentions. We exemplify the value of our proposed measures using survey data from a probabilistic sample of women aged 18-34 in Pernambuco, Brazil. We discuss the self-reported change in intentions due to Covid in wave 1 as well as panel change across waves. We further ground our contributions by uncovering important variations by social origin and parity.
Subject(s)
COVID-19 , Intention , Pregnancy , Child , Humans , Female , Pandemics , COVID-19/epidemiology , Fertility , Surveys and QuestionnairesABSTRACT
Uptake of COVID-19 vaccine first doses in UK care homes has been higher among residents compared to staff. We aimed to identify causes of lower COVID-19 vaccine uptake amongst care home staff within Liverpool. An anonymised online survey was distributed to all care home managers, between the 21st and the 29th January 2021. 53 % of 87 care homes responded. The overall COVID-19 vaccination rate was 52.6 % (n = 1119). Reasons, identified by care home managers for staff being unvaccinated included: concerns about lack of vaccine research (37.0 %), staff being off-site during vaccination sessions (36.5 %), pregnancy and fertility concerns (5.6 %), and allergic reactions concerns (3.2 %). Care home managers wanted to tackle vaccine hesitancy through conversations with health professionals, and provision of evidence dispelling vaccine misinformation. Vaccine hesitancy and logistical issues were the main causes for reduced vaccine uptake among care home staff. The former could be addressed by targeted training, and public health communication campaigns to build confidence and acceptance of COVID-19 vaccines.
Subject(s)
Biomedical Research , COVID-19 , Female , Pregnancy , Humans , COVID-19 Vaccines , COVID-19/prevention & control , Communication , Fertility , VaccinationABSTRACT
National health departments across the globe have utilized persuasive strategies to promote COVID-19 vaccines through Twitter. However, the effectiveness of those strategies is unclear. This study thereby examined how national health departments deployed persuasive strategies to promote citizen engagement in COVID-19 vaccine-related tweets in six countries, including the UK, the US, Germany, Japan, South Korea, and India. Guided by the heuristic-systematic model and the health belief model, we found that national health departments differed significantly in the use of systematic-heuristic cues and health belief constructs in COVID-19 vaccine-related tweets. Generally, the provision of scientific information and appeals to anecdotes and fear positively, while appeals to bandwagon negatively, predicted citizen engagement. Messages about overcoming barriers and promoting vaccine benefits and self-efficacy positively affected engagement. Emphases of COVID-19 threats and cues to vaccinate demonstrated negative impacts. Importantly, health departments across countries often used futile or detrimental strategies in tweets. A locally adapted evidence-based approach for COVID-19 vaccination persuasion was discussed.
Subject(s)
COVID-19 , Social Media , Humans , COVID-19 Vaccines/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , Persuasive Communication , Fertility , Cues , VaccinationABSTRACT
Lockdown edicts during the COVID-19 pandemic have led to concerns about consequences for childbirth plans and decisions. Robust empirical research to either refute or confirm these concerns, however, is lacking. To evaluate the causal impact of lockdowns on fertility, we exploited a large sample of Australians (aged 18-45) from a nationally representative household panel survey and leveraged variation from a unique natural experiment that occurred in Australia in 2020: a lockdown imposed in the state of Victoria, but not elsewhere in Australia. Difference-in-differences models were estimated comparing changes in fertility intentions of persons who resided in Victoria during lockdown, or within four weeks of the lockdown being lifted, and those living elsewhere in Australia. Results revealed a significantly larger decline in reported intentions of having another child among women who lived through the protracted lockdown. The average effect was small, with fertility intentions estimated to fall by between 2.8% and 4.3% of the pre-pandemic mean. This negative effect was, however, more pronounced among those aged over 35 years, the less educated, and those employed on fixed-term contracts. Impacts on men's fertility intentions were generally negligible, but with a notable exception being Indigenous Australians.
Subject(s)
COVID-19 , Male , Child , Humans , Female , COVID-19/epidemiology , Pandemics , Intention , Australia/epidemiology , Communicable Disease Control , FertilityABSTRACT
OBJECTIVES: Studies in several sub-Saharan geographies conducted early in the COVID-19 pandemic suggested little impact on contraceptive behaviours. Initial results may mask widening disparities with rising poverty, and changes to women's pregnancy desires and contraceptive use amid prolonged health service disruptions. This study examined trends in contraceptive behaviours in four sub-Saharan African settings 1 year into the pandemic. DESIGN: Nationally and regionally representative longitudinal surveys. SETTING: Burkina Faso, Kenya, Democratic Republic of Congo (Kinshasa) and Nigeria (Lagos). PARTICIPANTS: Women aged 15-49 years with sample size ranging from 1469 in Nigeria to 9477 in Kenya. OUTCOME MEASURES: Fertility preferences, contraceptive use and unintended pregnancies measured before COVID-19 (November 2019 to January 2020) and during COVID-19 (November 2020 to January 2021). ANALYSIS: We described population-level and individual-level changes by socioeconomic characteristics using generalised equation modelling. We used logistic regression models to identify factors related to contraceptive adoption and discontinuation and to experiencing an unintended pregnancy. RESULTS: At the population level, we found no change in women's exposure to unintended pregnancy risk, alongside 5-9 percentage point increases in contraceptive prevalence in Burkina Faso, Kenya and Lagos. Reliance on provider-dependent methods dropped by 2 and 4 percentage points in Kenya and Burkina Faso, respectively, although these declines were not statistically significant. Between 1.0% and 2.8% of women across sites experienced an unintended pregnancy during COVID-19, with no significant change over time. Individual-level trajectories showed contraceptive adoption was more common than discontinuation in Burkina Faso, Kenya and Lagos, with little difference by sociodemographic characteristics. Women's COVID-19-related economic vulnerability was unrelated to unintended pregnancy across sites. CONCLUSIONS: This study highlights the resilience of African women across diverse settings in sustaining contraceptive practices amid the COVID-19 pandemic. However, with reports of rising poverty in sub-Saharan Africa, there is continued need to monitor access to essential sexual and reproductive health services.
Subject(s)
COVID-19 , Contraceptive Agents , Pregnancy , Humans , Female , Family Planning Services , Intention , Pandemics , COVID-19/epidemiology , Nigeria/epidemiology , Democratic Republic of the Congo , Fertility , Health Services , Contraception BehaviorABSTRACT
STUDY QUESTION: What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened? SUMMARY ANSWER: Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients. WHAT IS KNOWN ALREADY: COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine. STUDY DESIGN, SIZE, DURATION: A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa. PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent. LIMITATIONS, REASONS FOR CAUTION: Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty. WIDER IMPLICATIONS OF THE FINDINGS: To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty. STUDY FUNDING/COMPETING INTERESTS: Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work. TRIAL REGISTRATION NUMBER: N/A.
Subject(s)
COVID-19 , Adolescent , Adult , Female , Humans , Male , Pregnancy , Cross-Sectional Studies , Fertility , UncertaintyABSTRACT
The appearance of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major obstacle for the performing of current medical activities throughout the world. COVID-19 has affected humanity in many ways, thus causing a great medical, social, economic, and political instability. The aim of this study was to make an analysis of the scientific data obtained by so far to highlight the impact that COVID-19 has had on fertility and assisted reproductive technology (ART). Infection with SARS-CoV-2 alters the normal immune response by local and systemic damage to tissues and organs. After the virus enters the body, the first lesions are produced in the respiratory tract. Extrapulmonary lesions specific to COVID-19 include acute renal lesions/acute kidney damage, hepatocellular lesions, neurological diseases, myocardial dysfunction and arrhythmia, gastrointestinal diseases but also genital impairment. The possible impairment of the male reproductive system is because angiotensin-converting enzyme 2 (ACE2) receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. Many published studies to date have pointed out that COVID-19 could also affect female fertility and disrupt the functions of the female reproductive system. The theory that this virus can also be transmitted sexually and can cause infertility or testicular damage is supported by the fact that the virus can be isolated in the semen of COVID-19 patients but only during the disease. Choosing the best method of treating infertility during the COVID-19 pandemic is multifactorial, but the risk of infection and compliance with specific ART hygiene protocols must always be considered. Currently, there is no scientific basis regarding the fact that the COVID-19 vaccination would influence fertility.
Subject(s)
COVID-19 , Infertility , Humans , Male , Female , COVID-19/complications , SARS-CoV-2 , Pandemics , COVID-19 Vaccines , Peptidyl-Dipeptidase A , FertilityABSTRACT
This study investigates the association between objective and subjective indicators of economic uncertainty, generated by the COVID-19 health and economic crisis, and young Italians' fertility plans during the 2020. We use unique repeated cross-sectional data, collected at different time points during the pandemic (March and October/November 2020) together with pre-COVID data (2016). The data offer a standard fertility intention question pre- and during-COVID, and also a direct question on whether pre-COVID fertility plans have been confirmed, postponed or abandoned. In March 2020, individuals with more vulnerable occupations show a lower probability of intending to have a(nother) child in the short-term and a higher probability of abandoning their pre-COVID fertility plan; in October 2020 changes in fertility plans do not vary by employment condition. Instead, both in March and October, those who suffered from a negative income shock and those with negative expectations on their future income and occupation are more likely to abandon their pre-pandemic fertility plan compared to their better off counterparts. Overall, economic uncertainty seems to have similarly affected men and women's fertility intentions. Our findings point to the fact that the unequal economic consequences of the pandemic also produced and will produce heterogeneous effects on fertility intentions.
Subject(s)
COVID-19 , Child , Female , Humans , COVID-19/epidemiology , Pandemics , Cross-Sectional Studies , Italy/epidemiology , FertilityABSTRACT
The main issues in the problem of fertility in countries with low and middle incomes of the population are the high prevalence of complications and maternal deaths during childbirth, as well as the high incidence of such indicators of the birth of an infant with low growth and weight indicators for their gestational age, malnutrition of pregnant women and mothers, frequent abortions, short intervals between births due to the educational status of the mother and the financial wealth of households, high prevalence of teenage motherhood, low availability of cesarean section, high cost of educating children as a factor in fertility. The impact of the COVID-19 pandemic on fertility in low- and middle-income countries has been most pronounced due to disruptions in the health care system, a surge in domestic violence, teenage pregnancy and female genital mutilation.
Subject(s)
COVID-19 , Developing Countries , Infant , Adolescent , Child , Female , Pregnancy , Humans , COVID-19/epidemiology , Cesarean Section , Pandemics , FertilityABSTRACT
BACKGROUND AND AIM: SARS-CoV-2 has infected over 614 million people worldwide, killing more than 6.5 million. COVID-19 impact on fertility may have far-reaching ramifications, considering that only in Italy, over 20 million people have been infected, many more considering unconfirmed cases. METHODS: The authors aimed to outline the repercussions of COVID-19 on female reproductive capabilities, through an analysis of underlying mechanisms and dynamics liable to cause long-term COVID-19 complications and sequelae, including direct virus-induced tissue damage. RESULTS: The entry receptor for SARS-CoV-2, Angiotensin-converting enzyme 2 (ACE2) can be found in several tissues and organs within the human body, including ovaries, oocytes and placenta. In order to assess the fertility-damaging potential of the disease, it is necessary to clarify highly complex mechanisms such as the ovarian renin-angiotensin system (OVRAS) affecting ovarian physiology and dysfunction. COVID-19 and its potential to undermine the fertility prospects of millions cannot be underestimated. It is therefore essential for lawmakers to solve inconsistencies such as those in Italy's Law 40/2004, which has been all but dismantled by Constitutional Court and European Court of Human Rights rulings, and cannot therefore offer a sufficient degree of certainty and reliability. CONCLUSIONS: When crafting novel, updated standards, norms and regulations to govern access to medically-assisted procreation, national leaders need to take into account the grave threat to fertility in a country such as Italy, which already has one of the world's lowest birth rates, posed by COVID-19 in light of currently available research findings outlining its impact on reproductive capacity.
Subject(s)
COVID-19 , Pandemics , Female , Humans , Angiotensin-Converting Enzyme 2 , SARS-CoV-2 , Reproducibility of Results , FertilityABSTRACT
The novel coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been a major public health emergency worldwide with over 118.27-million confirmed COVID-19 cases and 2.62-million deaths recorded, as of March 12, 2021. Although this disease primarily targets lungs, damages in other organs, such as heart, kidney, liver, and testis, may occur. Testis is the cornerstone of male reproduction, while reproductive health is the most valuable resource for continuity of the human race. Given the unique nature of SARS-CoV-2, the mechanisms of its impact on the testes have yet to be fully explored. Notably, coronaviruses have been found to invade target cells through the angiotensin-converting enzyme 2 receptor, which can be found in the respiratory, gastrointestinal, cardiovascular, urinary tract, and reproductive organs, such as testes. Coronavirus studies have suggested that testes might be a potential target for SARS-CoV-2 infection. The first etiopathogenic concept proposed by current hypotheses indicates that the virus can invade testes through the angiotensin-converting enzyme 2 receptor. Next, the activated inflammatory response in the testes, disease-associated fever, and COVID-19 medications might be implicated in testicular alterations. Although evidence regarding the presence of SARS-CoV-2 mRNA in semen remains controversial, this emphasizes the need for researchers to pay closer attention to sexually transmitted diseases and male fertility after recovering from COVID-19. In this review the latest updates regarding COVID-19-associated testicular dysfunction are summarized and possible pathogenic mechanisms are discussed.