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Voros C, Mavrogianni D, Minaoglou A, Papahliou AM, Topalis V, Varthaliti A, Mathiopoulos D, Kondili P, Darlas M, Pantou A, Sina S, Athanasiou A, Athanasiou D, Loutradis D, Daskalakis G. Unveiling the Impact of COVID-19 on Ovarian Function and Premature Ovarian Insufficiency: A Systematic Review. Biomedicines 2025; 13:407. [PMID: 40002820 PMCID: PMC11853103 DOI: 10.3390/biomedicines13020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Revised: 01/30/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Premature ovarian insufficiency (POI) is a disorder that affects women under the age of 40. It is characterized by decreased ovarian function, elevated gonadotropin levels, and decreased estradiol. SARS-CoV-2 disrupts ovarian function largely through oxidative stress, inflammation, and immunological dysregulation, which are enhanced by its entrance into ovarian tissues via ACE2 receptors. The purpose of this comprehensive review was to investigate the molecular pathways that link SARS-CoV-2 infection to POI and analyze their consequences for ovarian reserve and fertility. Methods: We searched databases such as PubMed, Scopus, EMBASE, and Google Scholar for papers published between 2020 and 2024. Eligible studies investigated the effects of SARS-CoV-2 on ovarian function, including the hormonal indicators anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), oocyte quality, and ovarian reserve. The data were compiled into a complete examination of molecules and clinical findings. Increased inflammatory indicators, such as interleukin-6 and NLRP3 inflammasome activation, impaired ovarian homeostasis. Anti-SARS-CoV-2 antibodies in follicular fluid could have impaired oocyte quality. Observational studies showed transitory decreases in AMH and changed FSH levels following infection, with variable effects on antral follicle count and IVF results. Changes in lipid profiles and VEGF expression emphasized the virus's influence on ovarian angiogenesis and the ovarian microenvironment. Conclusions: SARS-CoV-2 infection impairs ovarian function by causing oxidative stress, inflammation, and hormonal disruption, thereby increasing the incidence of POI. While most alterations are temporary, the long-term reproductive consequences remain unknown. Continuous monitoring and specific treatments are required to reduce the reproductive risks associated with COVID-19.
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Affiliation(s)
- Charalampos Voros
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Despoina Mavrogianni
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Aspasia Minaoglou
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Anthi-Maria Papahliou
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Vasileios Topalis
- Department of Internal Medicine, Hospital of Thun, 3600 Thun, Switzerland;
| | - Antonia Varthaliti
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Dimitris Mathiopoulos
- Rea Maternity Hospital S.A., Avenue Siggrou 383 & Pentelis 17, P. Faliro, 17564 Athens, Greece;
| | - Panagiota Kondili
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Menelaos Darlas
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Agni Pantou
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Sophia Sina
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
| | - Antonia Athanasiou
- IVF Athens Reproduction Center V. Athanasiou, 15123 Maroussi, Greece; (A.A.); (D.A.)
| | - Diamantis Athanasiou
- IVF Athens Reproduction Center V. Athanasiou, 15123 Maroussi, Greece; (A.A.); (D.A.)
| | - Dimitrios Loutradis
- Fertility Institute-Assisted Reproduction Unit, Paster 15, 11528 Athens, Greece;
- Athens Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Georgios Daskalakis
- 1st Department of Obstetrics and Gynecology, ‘Alexandra’ General Hospital, National and Kapodistrian University of Athens, 80 VasilissisSofias Avenue, 11528 Athens, Greece; (D.M.); (A.M.); (A.-M.P.); (A.V.); (P.K.); (M.D.); (A.P.); (S.S.); (G.D.)
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Polese D, Costanzi F, Bianchi P, Frega A, Bellati F, De Marco MP, Parisi P, Bruni O, Caserta D, Cozza G. The impact of COVID-19 on menstrual cycle's alterations, in relation to depression and sleep disturbances: a prospective observational study in a population of medical students. BMC Womens Health 2024; 24:130. [PMID: 38373995 PMCID: PMC10877769 DOI: 10.1186/s12905-024-02971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/12/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND The sars-Cov-2 pandemic has determined psychological stress, particularly in the young population of medical students. We studied the impact of the pandemic on menstrual cycle alteration in relation to psychological stress, presence of depression, sleep disturbances and post-traumatic stress, on a population of medical students. METHODS 293 female students at the Faculty of Medicine and Psychology of the Sapienza University of Rome (23.08 years old ± 3.8) were enrolled. In March 2021, one year after quarantine, a personal data sheet on menstrual cycle, examining the quality of the menstrual cycle during the pandemic, compared to the previous period. Concomitantly, the Beck Depression Inventory and the Impact of Event Scale have been administered. A Pearson chi-square test was assessed to evaluate the difference between the characteristics of the menstrual cycle and the scores obtained with the questionnaires. RESULTS A statistically significant association between menstrual alterations and stress during pandemic had been found. The onset of depressive symptoms and sleep disturbances was observed in 57.1% and in 58.1% of young women with cycle's alterations, respectively. Amenorrhea was three times more common in female students with depressive symptoms, premenstrual syndrome had a significant correlation with both depression and sleep disturbances. The pandemic has been related to menstrual alterations, with depressive symptoms and sleep disorders. Amenorrhea is connected to depression, as observed on the functional hypothalamic amenorrhea. CONCLUSIONS The pandemic affected the menstrual cycle as well as the depressive symptoms and sleep. Practical implications of the study lead to the development of strategies for psychological intervention during the pandemic experience, in order to help medical trainees, with specific attention to women's needs. Future studies should analyze the impact of other types of social stress events, on sleep, depression and the menstrual cycle beside the pandemic.
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Affiliation(s)
- Daniela Polese
- PhD Program on Sensorineural Plasticity, Department of Neuroscience, Mental Health and Sensory Organs NESMOS, Sapienza University of Rome, Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, Rome, 00189, Italy.
| | - Flavia Costanzi
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Paola Bianchi
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Antonio Frega
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Filippo Bellati
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Maria Paola De Marco
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University c/o Sant'Andrea University Hospital, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Via dei Marsi 78, Rome, 00185, Italy
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
| | - Giuliana Cozza
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035-1039, Rome, 00189, Italy
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