The global COVID-19 pandemic introduced a new layer of complexity for those navigating in vitro fertilization (IVF). Patients and providers faced an urgent need to understand how the virus, its vaccines, and public health measures would intersect with fertility treatments. This situation led to evolving clinic protocols and required careful consideration of risks and benefits at every stage of the IVF process.
COVID-19 Vaccination and IVF Treatment
Major health organizations, including the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG), recommend vaccination for individuals planning to conceive or undergoing IVF. Their consensus is based on evidence that mRNA vaccines do not contain live virus and pose no known mechanism for impacting fertility, egg quality, or sperm function. Scientific studies have consistently found no negative impact of COVID-19 vaccination on these reproductive parameters.
Concerns about vaccine timing in relation to an IVF cycle have been specifically addressed. There is no evidence that the vaccine interferes with the outcomes of ovarian stimulation, egg retrieval, or embryo transfer. However, the ASRM advises that patients may consider timing their vaccination to avoid the three days immediately before and after a procedure. This recommendation is to avoid confusing potential side effects of the vaccine, like fever, with post-procedural symptoms.
The antibodies generated in response to the vaccine do not cause infertility or harm gametes. Furthermore, some patients in the initial vaccine trials became pregnant shortly after vaccination, providing real-world data supporting its safety. For these reasons, fertility specialists encourage patients to receive the vaccine without any need to delay pregnancy attempts or postpone treatment cycles.
Impact of COVID-19 Infection on Fertility
A SARS-CoV-2 infection can have a measurable, though often temporary, effect on male fertility. The testes contain ACE2 receptors, which the virus uses to enter cells, making them a target. Research shows that an infection can lead to a decrease in total sperm count, reduced sperm motility, and an increase in the DNA fragmentation index (DFI), which indicates genetic damage.
For instance, one analysis showed nearly 70% of infected patients had a 17% reduction in total motility, while 75% experienced a 21% increase in their sperm DFI. While these changes are notable, the evidence suggests that for most men, these parameters tend to recover in the months following the illness, indicating the impact is not permanent.
For female fertility, the data has been more nuanced. While the virus is not believed to directly infect eggs, the systemic inflammation caused by the illness can affect the reproductive system. Some studies suggest a temporary impact on ovarian reserve, noting lower levels of Anti-Müllerian Hormone (AMH) in some women after recovering from COVID-19.
There have also been reports of a lower number of top-quality embryos developed during IVF cycles for patients who had recently recovered from the virus. However, fertilization and clinical pregnancy rates did not appear to be significantly affected in most analyses, suggesting the impact may be limited.
Changes to Fertility Clinic Procedures
Fertility clinics worldwide implemented procedural changes to protect both patients and staff. One of the most widespread changes was the mandatory use of masks for everyone within the clinic and the implementation of social distancing in waiting areas. Many facilities also spaced out appointments to minimize the number of people present at any given time.
Pre-procedure screening became a standard component of care. Clinics began requiring COVID-19 testing for patients, and often their partners, one to two days before scheduled procedures like egg retrievals or embryo transfers. These measures were put in place to prevent transmission and to avoid proceeding with a treatment cycle if a patient was actively infected.
The pandemic also accelerated the adoption of telemedicine in fertility care, with many initial consultations and follow-up appointments moved to a virtual format. While this reduced foot traffic in clinics, it also created challenges. Many clinics restricted visitors, meaning partners could often not attend appointments, including early pregnancy scans or the embryo transfer itself.
Risks Associated with COVID-19 During Pregnancy
Understanding the risks of COVID-19 during pregnancy is important for expectant parents. Pregnant individuals are at an increased risk of developing severe illness from a COVID-19 infection compared to their non-pregnant peers. This risk is further compounded by pre-existing conditions such as obesity or diabetes, and severe illness can lead to hospitalization or respiratory support.
The virus also impacts the pregnancy itself. A significant body of evidence has linked COVID-19 infection during pregnancy to a higher rate of preterm birth (delivery before 37 weeks). One large study found the risk of a very preterm birth (before 32 weeks) was 60% higher for those infected, while a meta-analysis showed the overall risk of preterm birth more than doubled.
The timing of the infection influences the level of risk, with studies indicating that an infection during the third trimester carries the highest probability of leading to a preterm delivery. This is due to factors like medically indicated deliveries prompted by worsening maternal health or the infection itself triggering spontaneous labor. These risks underscore the recommendations for vaccination and continued precautions.