SARS-CoV-2 infection is detrimental to pregnancy outcomes after embryo transfer in IVF

1. This prospective cohort study found that confirmed or suspected SARS-CoV-2 infection was associated with decreased rates of clinical pregnancy in those undergoing  in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), or frozen-thawed embryo transfer (FET).

Evidence Rating Level:1 (Excellent)

Some research suggests SARS-CoV-2 infection has potential influences on embryo development during controlled ovarian stimulation and increased risks during pregnancy. However, the impact of SARS-CoV-2 infection shortly after embryo transfer in IVF, ICSI or FET is unexplored. This prospective cohort study aims to investigate its effect on the clinical pregnancy rate in women receiving assisted reproductive technology (ART). 1330 patients undergoing embryo transfer in IVF/ICSI/FET were analyzed. Patients were divided into three groups: the diagnosed group, with 51.6% (n = 687) testing positive for SARS-CoV-2 RNA or antigen; the suspected infection group, comprising 16.4% (n = 219) displaying symptoms but unable to get tested; and the uninfected group, consisting of 32% (n = 424) patients with negative test results and no symptoms. Clinical pregnancy rates were 68%, 63%, and 51% in the SARS-CoV-2 diagnosed, suspected infection, and uninfected groups, respectively (P < 0.001). Ongoing pregnancy rates were 58%, 53%, and 45% in the same respective groups (P < 0.001). No significant differences were found in biochemical pregnancy rate, early miscarriage rate, or ectopic pregnancy rate. Logistic regression analysis demonstrated that vaccination (OR 1.513, 95% CI 1.134–2.019, P = 0.005), especially with three doses (OR 1.804, 95% CI 1.332–2.444, P < 0.001) increased the clinical pregnancy rate. Suspected infection status (odds ratio [OR] 0.618, 95% CI 0.444–0.862, P = 0.005), SARS-CoV-2 symptoms with the occurrence of fever and dizziness/headache (OR 0.715, 95% CI 0.526–0.972, P = 0.032) and short interval (≤ 22 days) between embryo transfer and SarS-CoV-2 infection  (OR 3.76, 95% CI 1.92–8.24, P < 0.001) decreased the clinical pregnancy rate. Overall, these findings suggest symptomatic SARS-CoV-2 infection shortly after embryo transfer is not conducive to clinical pregnancy.

Click to read the study in BMC Medicine

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