Impact of COVID-19 on female fertility: a systematic review and meta-analysis protocol.

ABSTRACT

INTRODUCTION: The increased social and economic burden caused by the novel COVID-19 outbreak is gradually becoming a worrisome issue for the health sector. The novel coronavirus invades the target cell by binding to ACE2, which is widely expressed in the ovaries, uterus, vagina and placenta. Significantly, the SARS-CoV-2 is said to interrupt female fertility through regulating ACE2. Thus, it is essential to investigate if the novel COVID-19 hampers female fertility, given that there is no systematic and comprehensive evidence on the association of COVID-19 with female fertility. METHODS AND ANALYSIS: We will systematically search cohort studies, cross-sectional studies, case-control studies and self-controlled case series designs in the following databases Web of Science, PubMed, EMBASE, Cochrane Library, Ovid, EBSCO, WHO COVID-19 Database, Chinese Biomedical Databases, China National Knowledge Internet, VIP and WanFang Database. Medical Subject Headings and free-text terms for "COVID-19" AND "female" AND "fertility" will be performed. Eligibility criteria are as follows population (female patients aged 13-49 years); exposure (infection with SARS-CoV-2); comparison (population without SARS-CoV-2 infections or latent SARS-CoV-2 infections); and outcome (female fertility, such as ovarian reserve function, uterine receptivity, oviducts status and menstruation status). Article screening and data extraction will be undertaken independently by two reviewers, and discrepancies will be resolved through discussion. We will use the I2 statistics to assess the heterogeneity and perform a meta-analysis when sufficiently homogeneous studies are provided. Otherwise, a narrative synthesis will be performed. We will explore the potential sources of heterogeneity using subgroup analyses and meta-regression. ETHICS AND DISSEMINATION Formal ethical approval is not required, and findings will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020189856.