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Scaravelli G, Levi Setti PE, Gennarelli G, Mencaglia L, Ubaldi FM, De Luca R, Cimadomo D, Spoletini R, Vigiliano V, Sileri PP. The actual impact of SARS-CoV-2/COVID-19 pandemic on IVF activity: a survey across Italian ART centers. J Assist Reprod Genet 2022; 39:2373-2380. [PMID: 35997867 PMCID: PMC9395871 DOI: 10.1007/s10815-022-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose Since the end of February 2020, SARS-CoV-2 dramatically spread in Italy. To ensure that most of National Health System (NHS) resources were employed to control the pandemic, non-urgent medical procedures (including IVF) were suspended in March 2020. Here, we aimed at assessing the impact of the restrictive measures on Italian IVF activity. Methods In May 2020, the Italian ART Register launched an online survey (multiple choices and open answers) across ART centers (89.0% response rate; N = 170/191) to investigate how they were facing the emergency and estimate the reduction in their activity. In February 2022, the official data of the whole 2020 were published and retrospectively analyzed. The ART cycles conducted in Italy in 2020 (67,928 by 57,423 patients) were then compared to those conducted in 2019 (82,476 by 67,633 patients). The estimates formulated through the survey were compared to the actual reduction. Results In 2020, 14,548 less IVF cycles were conducted with respect to 2019 (− 17.6% reduction). This led to 2539 fewer live births (− 19.8%) than 2019. If the reduction unveiled by the survey launched in May 2020 (i.e., − 35%) would have persisted throughout 2020, a significantly larger impact was expected (4200 less newborns). Instead, the activity was gradually recovered, and it compensated the months of greatest emergency, thus fulfilling the most optimistic scenario. Conclusions Italy suffers from the lowest birth rate in Europe, and COVID-19 impact on IVF-derived live births testified how key ART is for Italian demographics. The government should support access to these treatments with dedicated actions. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-022-02600-2.
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Affiliation(s)
- Giulia Scaravelli
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, via Regina Elena, 299, 00161, Rome, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Gianluca Gennarelli
- Obstetrics and Gynecology 1U, Physiopathology of Reproduction and IVF Unit, Department of Surgical Sciences, Sant'Anna Hospital, University of Torino, Turin, Italy.,Livet, GeneraLife IVF, Turin, Italy
| | - Luca Mencaglia
- Physiopathology of Reproduction, Santa Margherita Hospital, Cortona, Italy
| | | | - Roberto De Luca
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, via Regina Elena, 299, 00161, Rome, Italy.
| | | | - Roberta Spoletini
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, via Regina Elena, 299, 00161, Rome, Italy
| | - Vincenzo Vigiliano
- ART Italian National Register, National Centre for Diseases Prevention and Health Promotion, National Health Institute, via Regina Elena, 299, 00161, Rome, Italy
| | - Pier Paolo Sileri
- Undersecretary for Health, Ministry of Health, Rome, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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2
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Carbone L, Conforti A, La Marca A, Cariati F, Vallone R, Raffone A, Buonfantino C, Palese M, Mascia M, DI Girolamo R, Capuzzo M, Esteves SC, Alviggi C. The negative impact of most relevant infections on fertility and assisted reproduction technology. Minerva Obstet Gynecol 2022; 74:83-106. [PMID: 34137567 DOI: 10.23736/s2724-606x.21.04870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Vallone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michela Palese
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marika Mascia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaella DI Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sandro C Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- ANDROFERT - Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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3
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Lugli G, Ottaviani MM, Botta A, Ascione G, Bruschi A, Cagnazzo F, Zammarchi L, Romagnani P, Portaluri T. The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review. Mediterr J Hematol Infect Dis 2022; 14:e2022012. [PMID: 35070219 PMCID: PMC8746940 DOI: 10.4084/mjhid.2022.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy. METHODS A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19. RESULTS Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. CONCLUSIONS Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.
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Affiliation(s)
- Gianmarco Lugli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Matteo Maria Ottaviani
- Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Alessandro Bruschi
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
| | - Federico Cagnazzo
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy
| | - Paola Romagnani
- Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children’s University Hospital, Florence, Italy
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
| | - Tommaso Portaluri
- IN Srl, Udine, Italy
- CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy
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4
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Setti PEL, Cirillo F, Immediata V, Morenghi E, Canevisio V, Ronchetti C, Baggiani A, Albani E, Patrizio P. First trimester pregnancy outcomes in a large IVF center from the Lombardy County (Italy) during the peak COVID-19 pandemic. Sci Rep 2021; 11:16529. [PMID: 34400730 PMCID: PMC8368203 DOI: 10.1038/s41598-021-96134-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023] Open
Abstract
At the beginning of 2020, the Italian Lombardy region was hit by an "epidemic tsunami" which was, at that point in time, one of the worst pandemics ever. At that moment the effects of SARS-COV 2 were still unknown. To evaluate whether the pandemic has influenced ART (Assisted Reproduction Techniques) outcomes in an asymptomatic infertile population treated at one of the major COVID-19 epicentres during the weeks immediately preceding lockdown. All ART procedures performed during two time periods were compared: November 1st, 2018 to February 28th, 2019 (non-COVID-19 risk) and November 1st, 2019 to February 29th, 2020 (COVID-19 risk). In total 1749 fresh cycles (883 non-COVID-19 risk and 866 COVID-19 risk) and1166 embryos and 63 oocytes warming cycles (538 and 37 during non-COVID and 628 and 26 during COVID-19 risk, respectively) were analysed. Clinical pregnancies per cycle were not different: 370 (25.38%) in non-COVID versus 415 (27.30%) (p = 0.237) during COVID-19 risk. There were no differences in biochemical pregnancy rates 52 (3.57%) versus 38 (2.50%) (p = 0.089) nor in ectopic pregnancies 4 (1.08%) versus 3 (0.72%) (p = 0.594), spontaneous miscarriages 84 (22.70%) versus 103 (24.82%) p = 0.487, nor in intrauterine ongoing pregnancies 282 (76.22%) versus 309 (74.46%) p = 0.569. A multivariate analysis investigating differences in spontaneous miscarriage rate showed no differences between the two timeframes. Our results support no differences in asymptomatic infertile couples' ART outcomes between the pre COVID and COVID-19 periods in one of the earliest and most severe pandemic areas.
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Affiliation(s)
- P E Levi- Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
| | - F Cirillo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - V Immediata
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - E Morenghi
- Biostatistics Unit, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - V Canevisio
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - C Ronchetti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - A Baggiani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - E Albani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - P Patrizio
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA
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5
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Chandi A, Jain N. State of ART in the COVID-19 era and consequences on human reproductive system. Biol Reprod 2021; 105:808-821. [PMID: 34159367 DOI: 10.1093/biolre/ioab122] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/14/2021] [Accepted: 06/21/2021] [Indexed: 01/22/2023] Open
Abstract
The outbreak of the COVID-19 virus has created havoc on the socio-economic aspect of the world. With billions of lives affected by this wrecking pandemic, global fertility services were also not left untouched by its impact. The possibility of sexual transmission of SARS-CoV-2 virus, its impact on male and female fertility, pregnancy, its potential teratogenic effect, and handling of gametes in the clinical laboratories were major concerns among reproductive medicine specialists which led down all the reproductive health services including IUI, IVF/ICSI in most of the countries. Even the people did not intend to conceive during the pandemic crisis and were hesitant to avail such services. Discrete evidence regarding the pathophysiology of COVID-19 infection and its impact on the human reproductive system is not very clear. In this review article, we intend to incorporate all the evidence related to the COVID-19 infection and its impact on human reproduction available to date. It's our responsibility to provide rightful information and to keep our patients familiar with the existing lack of clear evidence. In this COVID-19 era, it's important that the fertility management be prioritized in sub-fertile couples with diminished fertility reserve, and high-risk conditions like malignancies, that may affect their long-term fertility prospects.
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Affiliation(s)
- Anadeep Chandi
- PGIMER, Chandigarh, H No 957, Sector 25, Panchkula, Haryana, India
| | - Neelam Jain
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Sector 32, Chandigarh, India
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6
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Paoli D, Pallotti F, Nigro G, Aureli A, Perlorca A, Mazzuti L, Di Carlo D, Turriziani O, Lenzi A, Lombardo F. Sperm cryopreservation during the SARS-CoV-2 pandemic. J Endocrinol Invest 2021; 44:1091-1096. [PMID: 33040303 PMCID: PMC7547554 DOI: 10.1007/s40618-020-01438-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/26/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Sperm cryopreservation is fundamental in the management of patients undergoing gonadotoxic treatments. Concerns have risen in relation to SARS-CoV-2 and its potential for testicular involvement, since SARS-CoV-2-positive cryopreserved samples may have unknown effects on fertilization and embryo safety. This study therefore aimed to analyze the safety of sperm cryopreservation for cancer patients after the onset of the pandemic in Italy, through assessment of the risk of SARS-CoV-2 exposure and viral RNA testing of semen samples. METHODS We recruited 10 cancer patients (mean age 30.5 ± 9.6 years) referred to our Sperm Bank during the Italian lockdown (from March 11th to May 4th 2020) who had not undergone a nasopharyngeal swab for SARS-CoV-2 testing. Patients were administered a questionnaire on their exposure to COVID-19, and semen samples were taken. Before cryopreservation, SARS-CoV-2 RNA was extracted from a 150 µl aliquot of seminal fluid in toto using QIAamp viral RNA kit (Qiagen) and amplified by a real time RT PCR system (RealStar SARS-CoV2 RT PCR, Altona Diagnostics) targeting the E and S genes. RESULTS The questionnaire and medical interview revealed that all patients were asymptomatic and had had no previous contact with COVID-19 infected patients. All semen samples were negative for SARS-CoV-2 RNA. CONCLUSION This preliminary assessment suggests that a thorough evaluation (especially in the setting of a multidisciplinary team) and molecular confirmation of the absence of SARS-CoV-2 in seminal fluid from asymptomatic cancer patients may assist in ensuring the safety of sperm cryopreservation.
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Affiliation(s)
- D. Paoli
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Pallotti
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - G. Nigro
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - A. Aureli
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - A. Perlorca
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - L. Mazzuti
- Laboratory of Virology, Department of Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - D. Di Carlo
- Laboratory of Virology, Department of Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - O. Turriziani
- Laboratory of Virology, Department of Molecular Medicine, “Sapienza” University of Rome, Rome, Italy
| | - A. Lenzi
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - F. Lombardo
- Laboratory of Seminology - Sperm Bank “Loredana Gandini”, Department of Experimental Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
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7
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Ceschin I, Ali T, Carvalho C, Uehara M, Motta P, Riboldi M. COVID-19: A review and considerations for the resumption of activities in an IVF laboratory and clinic in Brazil. JBRA Assist Reprod 2021; 25:293-302. [PMID: 33710841 PMCID: PMC8083870 DOI: 10.5935/1518-0557.20200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
COVID-19 has caused radical effects on the daily lives of millions of people. The causal agent of the current pandemic is SARS-CoV-2, a virus that causes symptoms related to the respiratory system, leading to severe complications. In the in vitro fertilization (IVF) universe, there are several protocols for infection control and laboratory safety. Some professional associations have issued guidelines recommending measures involving patient flow and IVF practices. This study presents a review and considerations for the resumption of activities in IVF laboratories and clinics in Brazil during the COVID-19 pandemic, according to the guidelines and statements from professional organizations and societies in reproductive medicine.
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Affiliation(s)
- Ianaê Ceschin
- Feliccità Instituto de Fertilidade - Curitiba, Paraná, Brasil.,Centro de Estudos sobre o Genoma Humano e Células-Tronco (CEGH-CEL), Departamento de Biologia Evolutiva, Instituto de Biociências - Universidade de São Paulo, São Paulo, Brasil
| | - Taccyanna Ali
- Laboratório Igenomix - Laboratório de Genética e Medicina Reprodutiva - São Paulo, São Paulo, Brasil
| | - Cristina Carvalho
- Laboratório Igenomix - Laboratório de Genética e Medicina Reprodutiva - São Paulo, São Paulo, Brasil
| | - Mariane Uehara
- Laboratório Igenomix - Laboratório de Genética e Medicina Reprodutiva - São Paulo, São Paulo, Brasil
| | - Priscila Motta
- Laboratório Igenomix - Laboratório de Genética e Medicina Reprodutiva - São Paulo, São Paulo, Brasil
| | - Marcia Riboldi
- Laboratório Igenomix - Laboratório de Genética e Medicina Reprodutiva - São Paulo, São Paulo, Brasil
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8
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Gingold JA, Galperin S, Fowler S, Kappy M, Pollack S, Singh M, Lieman H, Jindal S. Early experience with universal SARS-CoV-2 testing in a New York-based reproductive endocrinology practice. Syst Biol Reprod Med 2021; 67:144-150. [PMID: 33726574 DOI: 10.1080/19396368.2021.1884317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The SARS-CoV-2 pandemic peak around March 2020 led to temporary closures of most fertility clinics. Many clinics reopened but required universal SARS-CoV-2 screening. However, the rate of positive results and the necessity for such testing is unknown. We report here on early results from asingle-center academic NewYork fertility practice utilizing universal SARS-CoV-2 screening. This mixed prospective retrospective cohort included 164 patients who underwent at least one SARS-CoV-2 screening test for fertility treatment between May and July2020. Patients completed 1 to 3 nasopharyngeal SARS-CoV-2 tests per cycle and remained symptom-free to continue fertility treatments. SARS-CoV-2 test results, past results, history of Covid-19 infection, and patient/cycle characteristics were recorded and tabulated through October2020. Outcomes included positive SARS-CoV-2 RNA tests, rate of prior Covid-19 infections, and clinical courses of patients testing positive. Patients underwent 263 cycles entailing 460 total SARS-CoV-2 screening tests. Fifteen patients reported astrong prior clinical history of Covid-19. Six patients experienced apositive SARS-CoV-2 test (2.3% of all cycles). Among 77 cycles (n = 58 patients) entailing one SARS-CoV-2 test, 2 cases (2.6%) were noted. Among 173 cycles (n = 121 patients) entailing two SARS-CoV-2 tests, 4 cycles (2.3%) were noted. Zero (0%) of 13 cycles (n = 13 patients) entailing 3 SARS-CoV-2 tests were positive. All patients were cleared to resume treatment within one month. Overall, anew asymptomatic infection was identified in 2 cycles (0.8%), while 4 of the 6 positive SARS-CoV-2 tests were among patients with aprior history of Covid-19. 3 of 4 also had adocumented prior positive RNA test. Our data suggest that universal SARS-CoV-2 screening among fertility patients is feasible, with an approximately 2% positive rate per cycle among the patients of this study. Most positive patients had aprior remote infection, but their infectiousness while being screened remains unclear.Abbreviations: REI: reproductive endocrinology and infertility; IUI: intrauterine insemination; IVF: in vitro fertilization; sono: sonography; cryo: cryopreservation; FET: frozen embryo transfer.
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Affiliation(s)
- Julian A Gingold
- Montefiore Medical Center,Institute for Reproductive Medicine and Health, Hartsdale, NY, USA.,Division of Reproductive Endocrinology and Infertility, Montefiore Medical Center, Bronx, NY, USA
| | - Sharon Galperin
- School of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Sabrina Fowler
- School of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Michelle Kappy
- Department of OB/GYN and Women's Health, Montefiore Medical Center, Bronx, NY, USA
| | - Staci Pollack
- Montefiore Medical Center,Institute for Reproductive Medicine and Health, Hartsdale, NY, USA.,Division of Reproductive Endocrinology and Infertility, Montefiore Medical Center, Bronx, NY, USA.,Department of OB/GYN and Women's Health, Montefiore Medical Center, Bronx, NY, USA
| | - Manvinder Singh
- Montefiore Medical Center,Institute for Reproductive Medicine and Health, Hartsdale, NY, USA.,Division of Reproductive Endocrinology and Infertility, Montefiore Medical Center, Bronx, NY, USA.,Department of OB/GYN and Women's Health, Montefiore Medical Center, Bronx, NY, USA
| | - Harry Lieman
- Montefiore Medical Center,Institute for Reproductive Medicine and Health, Hartsdale, NY, USA.,Division of Reproductive Endocrinology and Infertility, Montefiore Medical Center, Bronx, NY, USA.,Department of OB/GYN and Women's Health, Montefiore Medical Center, Bronx, NY, USA
| | - Sangita Jindal
- Montefiore Medical Center,Institute for Reproductive Medicine and Health, Hartsdale, NY, USA.,Division of Reproductive Endocrinology and Infertility, Montefiore Medical Center, Bronx, NY, USA.,Department of OB/GYN and Women's Health, Montefiore Medical Center, Bronx, NY, USA
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9
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Absence of SARS-CoV-2 (COVID-19 virus) within the IVF laboratory using strict patient screening and safety criteria. Reprod Biomed Online 2021; 42:1067-1074. [PMID: 33814309 PMCID: PMC7937039 DOI: 10.1016/j.rbmo.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/27/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Research question Is there a risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral exposure and potential cross-contamination from follicular fluid, culture media and vitrification solution within the IVF laboratory using strict patient screening and safety measures? Design This was a prospective clinical study. All women undergoing transvaginal oocyte retrieval were required to have a negative SARS-CoV-2 RNA test 3–5 days prior to the procedure. Male partners were not tested. All cases used intracytoplasmic sperm injection (ICSI). The first tube of follicular fluid aspirated during oocyte retrieval, drops of media following removal of the embryos on day 5, and vitrification solution after blastocyst cryopreservation were analysed for SARS-CoV-2 RNA. Results In total, medium from 61 patients, vitrification solution from 200 patients and follicular fluid from 300 patients was analysed. All samples were negative for SARS-CoV-2 viral RNA. Conclusions With stringent safety protocols in place, including testing of women and symptom-based screening of men, the presence of SARS-CoV-2 RNA was not detected in follicular fluid, medium or vitrification solution. This work demonstrates the possibility of implementing a rapid laboratory screening assay for SARS-CoV-2 and has implications for safe laboratory operations, including cryostorage recommendations.
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10
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Sansone A, Mollaioli D, Ciocca G, Limoncin E, Colonnello E, Vena W, Jannini EA. Addressing male sexual and reproductive health in the wake of COVID-19 outbreak. J Endocrinol Invest 2021; 44:223-231. [PMID: 32661947 PMCID: PMC7355084 DOI: 10.1007/s40618-020-01350-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a "cytokine storm", which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients. METHODS A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed. RESULTS Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED. CONCLUSION COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.
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Affiliation(s)
- A Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - D Mollaioli
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - G Ciocca
- Department of Dynamic and Clinical Psychology, "Sapienza" University of Rome, Rome, Italy
| | - E Limoncin
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - E Colonnello
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy
| | - W Vena
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - E A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, via Montpellier 1, 00133, Rome, Italy.
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11
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Alteri A, Pisaturo V, Somigliana E, Viganò P. Cryopreservation in reproductive medicine during the COVID-19 pandemic: rethinking policies and European safety regulations. Hum Reprod 2021; 35:2650-2657. [PMID: 32744638 PMCID: PMC7454562 DOI: 10.1093/humrep/deaa210] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/14/2020] [Indexed: 12/29/2022] Open
Abstract
Cryopreservation of reproductive cells and tissues represents an essential aspect of ART practices that might be particularly strategic and helpful during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emergency. However, recommendations on how and when to preserve reproductive tissues and cells during a novel severe pandemic are scanty. This article uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to identify favourable and unfavourable factors and to recognize challenges and obstacles related to the use of cryopreservation procedures during the spreading of a new virus. One of the strengths associated with the cryopreservation is represented by the availability of robust European guidelines on storage safety to prevent sample contamination or cross-contamination by pathogens. These recommendations should be deep-rooted in all ART laboratories. Weaknesses include uncertainties regarding the management of COVID-19 affected asymptomatic patients, the suboptimal accuracy of diagnostic tests for the disease, the nebulous prospective regarding the duration of the pandemic and the additional costs. The application of the strategy represents an opportunity to postpone pregnancy in order to avoid a severe infectious disease during gestation while concomitantly counteracting the possible detrimental effect of time. Critical threats, at present still undefined, are represented by potential adverse events for the mother and offspring due to infected gametes or embryos after thawing and, subsequently, the re-spreading of the virus.
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Affiliation(s)
- Alessandra Alteri
- Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valerio Pisaturo
- Reproductive Medicine Department, International Evangelical Hospital, Genoa, Italy
| | - Edgardo Somigliana
- Obstetrics and Gynaecology Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Obstetrics and Gynaecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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12
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Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A, Siristatidis C, Bakas P, Vlahos N, Pantos K. Navigating assisted reproduction treatment in the time of COVID-19: concerns and considerations. J Assist Reprod Genet 2020; 37:2663-2668. [PMID: 32939662 PMCID: PMC7494248 DOI: 10.1007/s10815-020-01942-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/07/2020] [Indexed: 01/28/2023] Open
Abstract
The COVID-19 pandemic has fueled numerous debates in the field of assisted reproductive technology (ART) as the effect of SARS-CoV-2 on pregnancy and infancy is still considered uncharted territory. Various theses and recommendations on what optimal practice is have emerged, as evidenced by surveys, webinars, and recent publications. ART specialists are faced with dilemmas in light of the lack of concrete scientific evidence required to pave the way towards future safe practice. Meanwhile, infertile couples were similarly left in limbo unable to exercise their reproductive autonomy unlike fertile couples-where achieving a pregnancy via natural conception is a matter of decision. ART treatment being classified as non-essential has only recently re-started, facing new challenges while enabling pregnancy at a time of uncertainty. This article highlights matters of bioethical nature to be considered in the ART world at the time of COVID-19 while presenting an all-inclusive critique of the current status. When pursuing pregnancy through IVF treatment during the pandemic, distancing and caution have the lead role in an effort to defend the health of the intended parents and future children. To promote patient autonomy along with our ethical, moral, and legal duty towards our patients, emphasis should be given on ascertaining shared decision-making, and ensuring that an appropriate all-inclusive informed consent is signed prior to initiating any IVF treatment.
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Affiliation(s)
- Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Mikras Asias, 11527, Athens, Greece.
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias, 11528, Athens, Greece.
| | | | - Polina Giannelou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Mikras Asias, 11527, Athens, Greece
- Centre for Human Reproduction, Genesis Athens Clinic, Papanikoli, 15232, Athens, Greece
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Mikras Asias, 11527, Athens, Greece
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias, 11528, Athens, Greece
| | - Charalampos Siristatidis
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias, 11528, Athens, Greece
| | - Panagiotis Bakas
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias, 11528, Athens, Greece
| | - Nikolaos Vlahos
- Assisted Conception Unit, 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Vasilissis Sofias, 11528, Athens, Greece
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic, Papanikoli, 15232, Athens, Greece
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13
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Jirge PR, Patwardhan S, Jirge SN, Bhomkar DA, Chougule SM, Salpekar A, Modi D. Resuming Assisted Reproduction Services during COVID-19 Pandemic: An Initial Indian Experience. J Hum Reprod Sci 2020; 13:323-332. [PMID: 33627983 PMCID: PMC7879848 DOI: 10.4103/jhrs.jhrs_211_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The pandemic of COVID-19 has affected many countries and medical services including assisted reproductive treatment (ART) have been hampered. AIM The study was conducted to assess the preparedness of ART clinics and staff to resume services; patients' reasons to initiate treatment; and key performance indicators (KPIs) of ART laboratories during the pandemic. SETTING AND DESIGN This was a semidescriptive, prospective study in two private in vitro fertilization (IVF) clinics in Maharashtra, India, when COVID-19 testing for asymptomatic people was unavailable. MATERIALS AND METHODS Time required for replenishing consumables and clinic preparedness to function under "new norms" of pandemic was documented. Infection mitigation measures and triaging strategy were evaluated. KPIs following resumption were analyzed. The Student's t-test was performed for comparing parameters. RESULTS Thirty percent of the patients consulted through telemedicine accepted or were eligible to initiate treatment on clinic resumption. Lack of safe transport and financial constraints prevented majority from undergoing IVF, and 9% delayed treatment due to fear of pandemic. With adequate training, staff compliance to meet new demands was achieved within a week, but procuring consumables and injections was time-consuming. Fifty-two cycles of IVF were performed including fresh and frozen embryo transfers with satisfactory KPIs even during pandemic. Conscious sedation and analgesia during oocyte retrieval were associated with reduced procedure time and no intervention for airway maintenance compared to general anesthesia. Self-reported pain scores by patients ranged from nil to mild on a graphic rating scale. CONCLUSIONS This study provides practical insight for the resumption of IVF services during the COVID-19 pandemic.
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Affiliation(s)
- Padma Rekha Jirge
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic & Shreyas Hospital, Kolhapur, India
| | - Sadhana Patwardhan
- Department of Reproductive Medicine, Nagpur Test Tube Baby Centre, Nagpur, India
| | - Shishir Narendra Jirge
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic & Shreyas Hospital, Kolhapur, India
| | - Deepali A. Bhomkar
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic & Shreyas Hospital, Kolhapur, India
| | - Shruti M. Chougule
- Department of Reproductive Medicine, Sushrut Assisted Conception Clinic & Shreyas Hospital, Kolhapur, India
| | - Anita Salpekar
- Department of Reproductive Medicine, Nagpur Test Tube Baby Centre, Nagpur, India
| | - Deepak Modi
- Molecular and Cellular Biology Laboratory, ICMR-National Institute for Research in Rproductive Health, Mumbai, Maharashtra, India
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14
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La Marca A, Nelson SM. SARS-CoV-2 testing in infertile patients: different recommendations in Europe and America. J Assist Reprod Genet 2020; 37:1823-1828. [PMID: 32681280 PMCID: PMC7366442 DOI: 10.1007/s10815-020-01887-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
The incorporation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing into patient care algorithms has been proposed to mitigate risk. However, the two main professional societies for human reproduction (ESHRE and ASRM) appear divergent on their clinical utility and whether they should be adopted. In this opinion paper, we review the currently available tests and discuss the strengths and weaknesses of the proposed clinical care pathways. Nucleic acid amplification tests are the cornerstone of SARS-CoV-2 testing but test results are largely influenced by viral load, sample site, specimen collection method, and specimen shipment technique, such that a negative result in a symptomatic patient cannot be relied upon. Serological assays for SARS-CoV-2 antibodies exhibit a temporal increase in sensitivity and specificity after symptom onset irrespective of the assay used, with sensitivity estimates ranging from 0 to 50% with the first 3 days of symptoms, to 83 to 88% at 10 days, increasing to almost 100% at ≥ 14 days. These inherent constraints in diagnostics would suggest that at present there is inadequate evidence to utilize SARS-CoV-2 testing to stratify fertility patients and reliably inform clinical decision-making. The failure to appreciate the characteristics and limitations of the diagnostic tests may lead to disastrous consequences for the patient and the multidisciplinary team looking after them.
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Affiliation(s)
- Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
- Clinica Eugin, Modena, Italy.
- Obstetrics & Gynecology, University Hospital Modena, Modena, Italy.
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- The Fertility Partnership, Oxford, UK
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15
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Corona G, Baldi E, Isidori AM, Paoli D, Pallotti F, De Santis L, Francavilla F, La Vignera S, Selice R, Caponecchia L, Pivonello R, Ferlin A, Foresta C, Jannini EA, Lenzi A, Maggi M, Lombardo F. SARS-CoV-2 infection, male fertility and sperm cryopreservation: a position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) (Società Italiana di Andrologia e Medicina della Sessualità). J Endocrinol Invest 2020; 43:1153-1157. [PMID: 32462316 PMCID: PMC7252417 DOI: 10.1007/s40618-020-01290-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/02/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The recent pandemic of severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has raised several concerns in reproductive medicine. The aim of this review is to summarize available evidence providing an official position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) METHODS: A comprehensive Pubmed, Web of Science, Embase, Medline and Cochrane library search was performed. Due to the limited evidence and the lack of studies, it was not possible to formulate recommendations according to the Oxford 2011 Levels of Evidence criteria. RESULTS Several molecular characteristics of the SARS-CoV-2 can justify the presence of virus within the testis and possible alterations of spermatogenesis and endocrine function. Orchitis has been reported as a possible complication of SARS-CoV infection, but similar findings have not been reported for SARS-CoV-2. Alternatively, the orchitis could be the result of a vasculitis as COVID-19 has been associated with abnormalities in coagulation and the segmental vascularization of the testis could account for an orchitis-like syndrome. Finally, available data do not support the presence of SARS-CoV-2 in plasma seminal fluid of infected subjects. CONCLUSION Data derived from other SARS-CoV infections suggest that in patients recovered from COVID-19, especially for those in reproductive age, andrological consultation and evaluation of gonadal function including semen analysis should be suggested. Studies in larger cohorts of currently infected subjects are warranted to confirm (or exclude) the presence of risks for male gametes that are destined either for cryopreservation in liquid nitrogen or for assisted reproduction techniques.
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Affiliation(s)
- G. Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - E. Baldi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - A. M. Isidori
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - D. Paoli
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - F. Pallotti
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - L. De Santis
- IVF Unit, Gynaecological-Obstetric Department, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - F. Francavilla
- Andrology Unit, Department of Clinical Medicine, Public Health, Life and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - S. La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R. Selice
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - L. Caponecchia
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - R. Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Unità di Andrologia e Medicina della Riproduzione e della Sessualità Maschile e Femminile (FERTISEXCARES), Università Federico II di Napoli; Staff of Unesco Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - A. Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia, Brescia, Italy
| | - C. Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - E. A. Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
| | - A. Lenzi
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
| | - M. Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences ``Mario Serio’’, University of Florence, Florence, Italy
| | - F. Lombardo
- Department of Experimental Medicine, ʺSapienzaʺ University of Rome, Rome, Italy
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16
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Assessment and management of the risk of SARS-CoV-2 infection in an IVF laboratory. Reprod Biomed Online 2020; 41:385-394. [PMID: 32693991 PMCID: PMC7320666 DOI: 10.1016/j.rbmo.2020.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022]
Abstract
Research question The study set out to identify corrective measures aimed at reducing the risk of aerosol-mediated viral infection within an IVF laboratory. Design A failure modes and effect analysis (FMEA) was conducted by a multidisciplinary IVF team. A schematic representation of new protocols and procedures adopted during COVID-19 emergency has been defined, including directives about the behaviour to adopt when entering the clinic and the laboratory, in case of face-to-face contact with patients and between staff members. In addition, the risk of cross-contamination between samples belonging to different patients during cell handling and manipulation has been evaluated. Potential failure modes for each phase of the emergency have been analysed, focusing on possible sources of error. Risk priority numbers have been calculated as products of Occurrence × Severity × Detection scores. Results Except for cell–cell contamination, which was considered highly unlikely, failure modes during patient–staff, staff–staff and staff–cell interactions were estimated as carrrying a moderate to high risk of infection. The main corrective measures entailed precautionary logistic measures, the implementation of additional personal protective equipment and changes in the IVF laboratory procedures and scheduling of the daily routine. Some procedures were also revised, aiming to increase staff's awareness and caution. Conclusions Standard laboratory protocols are insufficient to face a virus whose transmission is aerosol mediated. The measures outlined in this FMEA should thus be considered not only for facing this pandemic, but also for the future to promptly manage any aerosol-mediated virus infection, whose impact on the management of an IVF laboratory might be less severe than COVID-19 although not completely negligible.
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17
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Paoli D, Pallotti F, Turriziani O, Mazzuti L, Antonelli G, Lenzi A, Lombardo F. SARS-CoV-2 presence in seminal fluid: Myth or reality. Andrology 2020; 9:23-26. [PMID: 32453494 PMCID: PMC7283802 DOI: 10.1111/andr.12825] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 12/24/2022]
Abstract
Great concerns have been raised on SARS‐CoV‐2 impact on men's andrological well‐being, and one of the critically unanswered questions is whether it is present or not in the seminal fluid of infected subjects. The expression of ACE2 and TMPRSS2 in the testis and in the male genital tract allows speculations about a possible testicular involvement during the infection, possibly mediated by local and/or systemic inflammation that might allow a high viral load to overcome the hemato‐testicular barrier. To date, few investigations have been carried out to ascertain the presence of SARS‐CoV‐2 in the seminal fluid with contrasting results. Furthermore, the cumulative number of subjects is far too low to answer the question unambiguously. Therefore, great caution is still needed when evaluating this data; otherwise, we risk unleashing unmotivated concerns in the scientific world with troublesome consequences in reproductive medicine.
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Affiliation(s)
- Donatella Paoli
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Pallotti
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Ombretta Turriziani
- Laboratory of Virology, Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Laura Mazzuti
- Laboratory of Virology, Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Guido Antonelli
- Laboratory of Virology, Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Lenzi
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Lombardo
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
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Managing the IVF laboratory during a pandemic: international perspectives from laboratory managers. Reprod Biomed Online 2020; 41:141-150. [PMID: 32622702 PMCID: PMC7239787 DOI: 10.1016/j.rbmo.2020.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/22/2022]
Abstract
Fertility societies worldwide responded to the COVID-19 pandemic by recommending that fertility clinics close, or sharply reduce, the clinical operation, leading to a shift in the management of IVF laboratories in three phases: shutdown preparation; maintenance during shutdown; and restart. Each of these phases carries distinct risks that need identification and mitigation, forcing laboratory managers to rethink and adapt their procedures in response to the pandemic. The sudden and unprecedented nature of the pandemic forced laboratory managers from around the world to base decisions on opinion and experience when evidence-based response options were unavailable. These perspectives on pandemic response were presented during a virtual international symposium on COVID-19, held on 3 April 2020, and organized by the London Laboratory Managers’ Group. Laboratory managers from seven different countries at different stages of the pandemic (China, Italy, Spain, France, UK, Brazil and Australia) presented their personal experiences to a select audience of experienced laboratory managers from 19 different countries. The intention of this paper is to collect the learnings and considerations from this group of laboratory managers who collaborated to share personal experiences to contribute to the debate surrounding what constitutes good IVF laboratory practice in extraordinary circumstances, such as the COVID-19 pandemic.
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19
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Sirohi B, Rohatgi TB, Lambertini M. Oncofertility and COVID-19-cancer does not wait. Ecancermedicalscience 2020; 14:ed101. [PMID: 32565906 PMCID: PMC7289605 DOI: 10.3332/ecancer.2020.ed101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 02/05/2023] Open
Abstract
The current pandemic due to the coronavirus disease 2019 (COVID-19) outbreak has forced physicians to review their current clinical practice and guidelines. Although elective procedures using assisted reproductive technologies (ART) should be preferably canceled or postponed at this time, this does not always apply to urgent procedures such as those in patients with cancer. A complete oncofertility counseling balancing the benefits and risks of undergoing fertility preservation before commencing gonadotoxic therapies (chemotherapy and/or radiotherapy) should also be provided during the COVID-19 outbreak. This article briefly highlights what patients, oncologists and fertility specialists need to keep in mind during oncofertility counseling at the time of the COVID-19 outbreak.
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Affiliation(s)
| | | | - Matteo Lambertini
- IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
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20
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Lambalk CB, van Wely M, Kirkegaard K, Williams AC, de Geyter C. Safety first - assisted human reproduction second. Hum Reprod 2020; 35:741-742. [PMID: 32268356 DOI: 10.1093/humrep/deaa075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Vaiarelli A, Bulletti C, Cimadomo D, Borini A, Alviggi C, Ajossa S, Anserini P, Gennarelli G, Guido M, Levi-Setti PE, Palagiano A, Palermo R, Savasi V, Pellicer A, Rienzi L, Ubaldi FM. COVID-19 and ART: the view of the Italian Society of Fertility and Sterility and Reproductive Medicine. Reprod Biomed Online 2020; 40:755-759. [PMID: 32354663 PMCID: PMC7141636 DOI: 10.1016/j.rbmo.2020.04.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/17/2023]
Abstract
The COVID-19 pandemic is an unprecedented global situation. As assisted reproductive technology (ART) specialists, we should be cautious, carefully monitoring the situation while contributing by sharing novel evidence to counsel our patients, both pregnant women and would-be mothers. Time to egg collection and drop-out rates are critical parameters for scheduling treatments once the curve of infections has peaked and plateaued in each country. In order to reduce the values for these two parameters, infertile patients now require even more support from their IVF team: urgent oocyte collection for oncology patients must be guaranteed, and oocyte retrievals for women of advanced maternal age and/or reduced ovarian reserve cannot be postponed indefinitely. This document represents the position of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR) in outlining ART priorities during and after this emergency.
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Affiliation(s)
- Alberto Vaiarelli
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Carlo Bulletti
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Danilo Cimadomo
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Andrea Borini
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Carlo Alviggi
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Silvia Ajossa
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Paola Anserini
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Gianluca Gennarelli
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Maurizio Guido
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Paolo E Levi-Setti
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Antonio Palagiano
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Roberto Palermo
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Valeria Savasi
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Antonio Pellicer
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Laura Rienzi
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR)
| | - Filippo M Ubaldi
- On behalf of the Italian Society of Fertility and Sterility and Reproductive Medicine (SIFES-MR).
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