Prior and novel coronaviruses, Coronavirus Disease 2019 (COVID-19), and human reproduction: what is known?

A review of prior and the novel coronaviruses and their impact on human reproduction, specifically male and female gametes, pregnancy, and postpartum suggests that much remains unknown.

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Volume 113, Issue 6, Pages 1140–1149

Authors:

James Segars, M.D., Quinton Katler, M.D., M.S., Dana B. McQueen, M.D., Alexander Kotlyar, M.D., Tanya Glenn, M.D., Zac Knight, Ph.D., Eve C. Feinberg, M.D., Hugh S. Taylor, M.D., James P.Toner, M.D., Ph.D., Jennifer F. Kawwass, M.D., for the ASRM Coronavirus/COVID-19 Task Force

Abstract:

Objective: 

To summarize current understanding of the effects of novel and prior coronaviruses
on human reproduction, specifically male and female gametes, and in pregnancy.

Design: 

Review of English publications in PubMed and Embase to April 6, 2020.

Methods: 

Manuscripts were screened for reports including coronavirus, reproduction, including
pathophysiology and pregnancy.

Intervention(s): 

None.

Main Outcome Measure(s): 

Reproductive outcomes; effects on gametes; pregnancy outcomes; neonatal complications.

Results: 

Seventy-nine reports formed the basis of the review. Coronavirus binding to cells involves the S1 domain of the spike protein to receptors present in reproductive tissues, including angiotensin converting enzyme-2 (ACE2), CD26, Ezrin, and cyclophilins. SARS-CoV1 may cause severe orchitis leading to germ cell destruction in males. Reports indicate decreased sperm concentration and motility for 72-90 days following COVID-19 infection. Gonadotropindependent expression of ACE2 was found in human ovaries, but it is unclear whether SARSCoV-2 adversely affects female gametogenesis. Evidence suggests that COVID-19 infection has a lower maternal case fatality rate than SARS or MERS, but anecdotal reports suggest that infected, asymptomatic women may develop respiratory symptoms postpartum. COVID-19 infections in pregnancy are associated with preterm delivery. Postpartum neonatal transmission from mother to child has been reported.

Conclusion: 

COVID-19 infection may adversely affect some pregnant women and their
offspring. Additional studies are needed to assess effects of SARS-CoV-2 infection on male and female fertility. 

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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