ABSTRACT
ImportanceThis is the first study to examine the impact of SARS-Cov-2 infection and COVID-19 vaccination on ovarian function. ObjectiveTo characterize anti-COVID-19 antibodies in follicular fluid and compare ovarian follicle function in women following confirmed SARS-CoV-2 infection, COVID-19 vaccination, and non-infected, unvaccinated controls. DesignThis is a cohort study conducted between February 1 and March 10, 2021. SettingA single university hospital-based IVF clinic. ParticipantsConsecutive sample of female patients undergoing oocyte retrieval. InterventionsConsenting patients were recruited and assigned to one of three study groups: recovering from confirmed COVID 19 (n=9); vaccinated (n=9); and uninfected, non-vaccinated controls (n=14). Serum and follicular fluid samples were taken and analyzed for anti-COVID IgG as well as estrogen, progesterone and HSPG2 concentration, as well as the number and maturity of aspirated oocytes and previous estrogen and progesterone measurements. Main outcome measuresFollicular function, including steroidogenesis, follicular response to the LH/hCG trigger, and oocyte quality biomarkers. ResultsBoth natural and vaccine elicited anti-COVID IgG antibodies were detected in the follicular fluid in levels proportional to the IgG serum concentration. No differences were detected in any of the surrogate ovarian follicle quality reporting parameters. Conclusions and relevanceBoth SARS-COV-2 infection and vaccination with the BNT162b2 mRNA vaccine mediate IgG immunity that crosses into the follicular fluid. No detrimental effect on follicular function was detected. Trial RegistrationCinicalTrials.gov registry number NCT04822012 Key PointCOVID 19 disease and BNT162b2 mRNA vaccine induce anti-COVID IgG in follicular fluid; neither recent infection nor vaccination appear to negatively effect follicular function.
ABSTRACT
OBJECTIVE: To compare the treatment outcomes in in vitro maturation (IVM) cycles primed with human menopausal gonadotropin with those for pure IVM cycles in patients with polycystic ovary syndrome. DESIGN: Prospective observational. SETTING: University-based tertiary medical center. PATIENT(S): Patients undergoing IVM cycles (primed IVM, 47; pure IVM, 118). INTERVENTION(S): IVM treatment with and without human menopausal gonadotropin stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): The clinical pregnancy rate demonstrated a tendency toward improvement in the primed IVM group (53.1% vs. 43.6%, 20.1% vs. 14.0% and 40.4% vs. 30.8%, [corrected] respectively) with better implantation and delivery rates (20.1% versus 14.4%; 95% confidence intervals 1.0-3.06 and 40.4% versus 24.6%; 95% confidence intervals 0.1-0.8, respectively). We found no significant difference in pure IVM compared with primed IVM in the number of eggs collected, size of leading follicle, fertility rate, cleavage rate, and the number of embryos transferred. Total mature eggs and maturation rate were significantly higher in the group of pure IVM (11 ± 2.1 versus 8.7 ± 0.5 and 68.5% ± 17.5% versus 60.9% ± 0.4%, respectively). Importantly, the endometrial thickness was significantly improved in primed IVM cycles (7.9 ± 1.9 mm versus 7.1 ± 0.8 mm), possibly leading to better implantation and pregnancy rates. CONCLUSION(S): Patients who fail to demonstrate endometrial or follicular growth during IVM cycles may benefit from gonadotropin priming during the same cycle.
