A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

[Pregnant women with COVID-19 ARDS on the intensive care unit]

BACKGROUND

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues.

OBJECTIVE

Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS).

MATERIAL AND METHODS

We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021.

RESULTS

The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a PaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth.

CONCLUSION

High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.

The Multi-faceted Effects of COVID-19 on Female Reproductive Health: An Updated Narrative Review

Concerns about the SARS-CoV-2 pandemic's possible impact on sexual and reproductive health have grown significantly. In this narrative review, the latest research on the effects of SARS-CoV-2 infection on several facets of sexual and reproductive health is reviewed. The review starts initially by going through the possible consequences of SARS-CoV-2 on female menstrual cycles. The virus may interfere with the menstrual cycle, which could affect hormone synthesis and endometrial reactions, according to newly available evidence. Menstrual blood loss may be impacted by COVID-19's potential to influence endothelial cell function and systemic hemostasis. Hypothalamic amenorrhea may be brought on by severe COVID-19 disease. There is little research on this subject, although most women resume their regular menstrual cycles after 1-2 months of recuperation. The review also examines how SARS-CoV-2 infection may affect assisted reproductive technology (ART) treatments. There are few clinical data, although some research points to potential effects on embryo quality. Overall, ART results, however, did not materially change from the time before the epidemic. Obstetric problems are more likely when SARS-CoV-2 infection occurs during pregnancy, especially in the third trimester. Even though the maternal death rate is still low, pregnant women, especially those with comorbidities, are more likely to experience serious sickness. The review emphasizes how the COVID-19 vaccine affects menstrual cycles, showing brief, modest modifications without serious health hazards. Also included are the psychological effects of family planning choices during the pandemic. In conclusion, this narrative review offers a thorough assessment of the complicated and changing effects of SARS-CoV-2 on sexual and reproductive health. The different requirements of people and couples during and after the pandemic are highlighted, underscoring the necessity for ongoing study and specialized healthcare practices.

Effect of COVID-19 infection and vaccination on SARS-CoV-2 antibody titer change following ovarian stimulation: Prospective analysis of IVF outcomes

The coronavirus disease 2019 (COVID-19) outbreak caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) has affected various medical fields worldwide. However, relatively few studies have examined the impact of COVID-19 infection and vaccination on in vitro fertilization (IVF) outcomes and changes in SARS-CoV-2 antibody concentration in follicular fluid (FF). A total of 45 women were prospectively recruited and assigned to 3 groups: uninfected and non-vaccinated control group (Control group), infected group (COVID + group), and vaccinated group (Vaccination group). Serum and follicular fluid (FF) estradiol, progesterone, and SARS-CoV-2 antibody concentrations were measured. There were no statistical differences in the total number of retrieved oocytes (P = .291), mature oocytes (P = .416), and good-quality embryos (P = .694) among the 3 groups. In the vaccination group, BNT162b2 exhibited a significantly lower trigger-day serum estradiol/MII oocyte level (110.6 pg/mL) than other vaccines (289.5 pg/mL) (P = .006). No statistical differences in serum (P = .687) and FF (P = .108) SARS-CoV-2 antibody changes were noted among the 3 groups. Only FF antibody changes exhibited statistically significant differences between the BNT162b2 and other vaccine subgroups (P = .047). COVID-19 infection and vaccination do not affect IVF outcomes. However, the effect of BNT162b2 on steroidogenesis of the mature oocyte and FF SARS-CoV2 antibody titer should be further investigated.

Impacts of the COVID-19 pandemic on early pregnancy outcomes among women undergoing frozen-thawed embryo transfer: a retrospective cohort study

The effect of COVID-19 pandemic on early pregnancy outcomes among women undergoing frozen-thawed embryo transfer (FET) remains unclear. We aimed to evaluate whether early pregnancy outcomes were altered in patients undergoing FET during the pandemic. In this retrospective cohort study, women conceived through FET in 2016-2021 from two hospitals in China were included. The early pregnancy outcomes were compared using Logistic regression model, including biochemical pregnancy rate (BPR), clinical pregnancy rate (CPR), and early pregnancy loss rate (EPLR). A total of 16,669 (67.2%) and 6,113 (26.8%) FET cycles enrolled before and during the pandemic, respectively. Univariate analyses showed that women undergoing FET during the pandemic had significantly increased BPR (72.9% vs. 69.7%) and CPR (59.5% vs. 55.0%), and significantly decreased EPLR (13.7% vs. 16.7%) compared to pre-pandemic (all P < 0.001). Moreover, after adjustment, the results were in accordance with univariate analysis for CPR [adjusted OR (95%CI) = 1.08 (1.01-1.14)] and EPLR [adjusted OR (95%CI) = 0.82 (0.73-0.91)], while the statistical significance between BPR and the pandemic disappeared. In summary, women conceived by FET did not have a reduced possibility of clinical pregnancy and a higher risk of early pregnancy loss during the pandemic compared with the pre-pandemic.

The influence of lifestyle interventions and overweight on infertility: a systematic review, meta-analysis, and meta-regression of randomized controlled trials

This study aimed to investigate the effect of lifestyle intervention (LSI) on diagnosed infertility in overweight and obese women. A systematic review and meta-analysis were conducted. A literature search was performed on the following databases from September 2022 to December 2022: PubMed, Web of Science, and SPORTDiscus. The inclusion criteria were the following: women between 18 and 45 years of age, BMI over 25.0 kg/m2, diagnosed with infertility, a weight loss intervention, and control group part of RCTs. In total, 15 studies were identified and included. The meta-analysis shows a beneficial effect of LSI on reducing weight, waist circumference, and BMI and increasing infertility. A significantly beneficial effect of lifestyle intervention on weight reduction was observed for participants who initially had a higher BMI, while a non-significant effect was observed for individuals with a BMI above 35 kg/m2. The meta-analysis showed a beneficial effect of lifestyle intervention on ovulation incidence and sex hormone-binding globulin. The lifestyle intervention group had 11.23 times more ovulatory incidence than the control group, which in turn increased the ability to conceive. As robust evidence for the effect of lifestyle interventions on infertility in obese and overweight women was found, it is advised to integrate similar interventions into future infertility treatment processes.

COVID-19 pandemic hits differently: examining its consequences for women's livelihoods and healthcare access - a cross-sectional study in Kinshasa DRC

OBJECTIVES

The emergence of the COVID-19 pandemic led to multiple preventive actions as primary interventions to contain the spread of the virus. Globally, countries are facing enormous challenges with consequences for use of social, economic and health services. The Democratic Republic of Congo (DRC) was among the African countries implementing strict lockdown at the start of the pandemic, resulting in shortages and decreased access to services. The adverse effects of the pandemic had unpleasant consequences for the country. This study aimed to examine the association between COVID-19 pandemic-related factors, sociodemographic factors, and the need to visit healthcare facilities, including family planning services, among women aged 15-49 years in the DRC.

METHODS

We conducted a secondary analysis of a performance monitoring for action (PMA) cross-sectional COVID-19 phone survey in Kinshasa, DRC, which had a response rate of 74.7%. In total, 1325 randomly selected women aged 15-49 years from the Kinshasa province who had previously participated in the PMA baseline survey participated in the survey. Bivariate and multivariate logistic regressions were used to assess associations.

RESULTS

The COVID-19 pandemic and related factors affected 92% of women in the Kinshasa province socioeconomically. A majority were highly economically dependent on their partner or some other sources for their basic needs to be met, and even more worried about the future impact of the pandemic on their household finances. Over 50% of women did not attempt visiting a health service, with some of the top reasons being fear of being infected with COVID-19 and not being able to afford services. We found a significant association between age groups and contraceptive use. The need for and use of contraceptives was higher among women aged 25-34 years than those aged 15-24 or 35-49 years.

CONCLUSION

Effective social/economic support to women and girls during pandemics and in crises is essential as it can have lasting beneficial effects on many domains of their lives, including their ability to access health services and the contraceptives of their choice.

The instantly blocking-based fluorescent immunochromatographic assay for the detection of SARS-CoV-2 neutralizing antibody

Introduction

At present, there is an urgent need for the rapid and accurate detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibodies (NAbs) to evaluate the ability of the human body to resist coronavirus disease 2019 (COVID-19) after infection or vaccination. The current gold standard for neutralizing antibody detection is the conventional virus neutralization test (cVNT), which requires live pathogens and biosafety level-3 (BSL-3) laboratories, making it difficult for this method to meet the requirements of large-scale routine detection. Therefore, this study established a time-resolved fluorescence-blocking lateral flow immunochromatographic assay (TRF-BLFIA) that enables accurate, rapid quantification of NAbs in subjects.

Methods

This assay utilizes the characteristic that SARS-CoV-2 neutralizing antibody can specifically block the binding of the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein and angiotensin-converting enzyme 2 (ACE2) to rapidly detect the content of neutralizing antibody in COVID-19-infected patients and vaccine recipients.

Results

When 356 samples of vaccine recipients were measured, the coincidence rate between this method and cVNT was 88.76%, which was higher than the coincidence rate of 76.97% between cVNT and a conventional chemiluminescence immunoassay detecting overall binding anti-Spike-IgG. More importantly, this assay does not need to be carried out in BSL-2 or 3 laboratories.

Discussion

Therefore, this product can detect NAbs in COVID-19 patients and provide a reference for the prognosis and outcome of patients. Simultaneously, it can also be applied to large-scale detection to better meet the needs of neutralizing antibody detection after vaccination, making it an effective tool to evaluate the immunoprotective effect of COVID-19 vaccines.

Identification of Leading Compounds from Euphorbia neriifolia (Dudsor) Extracts as a Potential Inhibitor of SARS-CoV-2 ACE2-RBDS1 Receptor Complex: An Insight from Molecular Docking ADMET Profiling and MD-simulation Studies

Coronavirus disease-19 (COVID-19) are deadly and infectious disease that impacts individuals in a variety of ways. Scientists have stepped up their attempts to find an antiviral drug that targets the spike protein (S) of Angiotensin converting enzyme 2 (ACE2) (receptor protein) as a viable therapeutic target for coronavirus. The most recent study examines the potential antagonistic effects of 17 phytochemicals present in the plant extraction of Euphorbia neriifolia on the anti-SARS-CoV-2 ACE2 protein. Computational techniques like molecular docking, absorption, distribution, metabolism, excretion, and toxicity (ADMET) investigations, and molecular dynamics (MD) simulation analysis were used to investigate the actions of these phytochemicals. The results of molecular docking studies showed that the control ligand (2-acetamido-2-deoxy-β-D-glucopyranose) had a binding potential of -6.2 kcal/mol, but the binding potentials of delphin, β-amyrin, and tulipanin are greater at -10.4, 10.0, and -9.6 kcal/mol. To verify their drug-likeness, the discovered hits were put via Lipinski filters and ADMET analysis. According to MD simulations of the complex run for 100 numbers, delphin binds to the SARS-CoV-2 ACE2 receptor's active region with good stability. In root-mean-square deviation (RMSD) and root mean square fluctuation (RMSF) calculations, delphinan, β-amyrin, and tulipanin showed reduced variance with the receptor binding domain subunit 1(RBD S1) ACE2 protein complex. The solvent accessible surface area (SASA), radius of gyration (Rg), molecular surface area (MolSA), and polar surface area (PSA) validation results for these three compounds were likewise encouraging. The convenient binding energies across the 100 numbers binding period were discovered by using molecular mechanics of generalized born and surface (MM/GBSA) to estimate the ligand-binding free energies to the protein receptor. All things considered, the information points to a greater likelihood of chemicals found in Euphorbia neriifolia binding to the SARS-CoV-2 ACE2 active site. To determine these lead compounds' anti-SARS-CoV-2 potential, in vitro and in vivo studies should be conducted.

How to cite this article

Islam MN, Pramanik MEA, Hossain MA, et al. Identification of Leading Compounds from Euphorbia Neriifolia (Dudsor) Extracts as a Potential Inhibitor of SARS-CoV-2 ACE2-RBDS1 Receptor Complex: An Insight from Molecular Docking ADMET Profiling and MD-simulation Studies. Euroasian J Hepato-Gastroenterol 2023;13(2):89-107.

Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review

Several studies and research papers have been published to elucidate and understand the mechanism of the coronavirus disease 2019 (COVID-19) pandemic and its long-term effects on the human body. COVID-19 affects a number of organs, including the female reproductive system. However, less attention has been given to the effects of COVID-19 on the female reproductive system due to their low morbidity. The results of studies investigating the relationship between COVID-19 infection and ovarian function in women of reproductive age have shown the harmless involvement of COVID-19 infection. Several studies have reported the involvement of COVID-19 infection in oocyte quality, ovarian function, and dysfunctions in the uterine endometrium and the menstrual cycle. The findings of these studies indicate that COVID-19 infection negatively affects the follicular microenvironment and dysregulate ovarian function. Although the COVID-19 pandemic and female reproductive health have been studied in humans and animals, very few studies have examined how COVID-19 affects the female reproductive system. The objective of this review is to summarize the current literature and categorize the effects of COVID-19 on the female reproductive system, including the ovaries, uterus, and hormonal profiles. The effects on oocyte maturation, oxidative stress, which causes chromosomal instability and apoptosis in ovaries, in vitro fertilization cycle, high-quality embryos, premature ovarian insufficiency, ovarian vein thrombosis, hypercoagulable state, women’s menstrual cycle, the hypothalamus-pituitary-ovary axis, and sex hormones, including estrogen, progesterone, and the anti-Müllerian hormone, are discussed in particular.

Clinical and laboratory characteristics of COVID-19 in pregnant women

This article discusses the distinct characteristics of COVID-19 in pregnant women and investigates potential early predictors of disease severity in this specific patient population. The study included 116 pregnant women with a confirmed diagnosis of COVID-19 in different trimesters of pregnancy. In addition to clinical features, we evaluated general clinical research methods, biochemical parameters (procalcitonin, C-reactive protein, D-dimer), and the leukocyte index of endogenous intoxication and lymphocytic index to identify potential early predictors of disease severity. All pregnant women were divided into two study groups: Group I - pregnant women with mild course, and Group II - pregnant women with moderate and severe course of COVID-19. Most pregnant women (72.4%) experienced a non-severe course characterized by catarrhal symptoms and moderate intoxication. However, pulmonary manifestations and pregnancy-related complications were detected in pregnant women from Group 2. The levels of C-reactive protein and procalcitonin in both study groups were significantly increased compared to the control group. In pregnant women with moderate and severe COVID-19, indicators of endogenous intoxication were significantly pronounced. Establishing associations between leukocyte indices and biomarkers, such as procalcitonin and C-reactive protein, enables the utilization of routine complete blood counts as a primary screening tool for predicting the severity of COVID-19 in pregnant women.

Rescuing fertility during COVID-19 infection: exploring potential pharmacological and natural therapeutic approaches for comorbidity, by focusing on NLRP3 inflammasome mechanism

The respiratory system was primarily considered the only organ affected by Coronavirus disease 2019 (COVID-19). As the pandemic continues, there is an increasing concern from the scientific community about the future effects of the virus on male and female reproductive organs, infertility, and, most significantly, its impact on the future generation. The general presumption is that if the primary clinical symptoms of COVID-19 are not controlled, we will face several challenges, including compromised infertility, infection-exposed cryopreserved germ cells or embryos, and health complications in future generations, likely connected to the COVID-19 infections of parents and ancestors. In this review article, we dedicatedly studied severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) virology, its receptors, and the effect of the virus to induce the activation of inflammasome as the main arm of the innate immune response. Among inflammasomes, nucleotide oligomerization domain-like receptor protein, pyrin domain containing 3 (NLRP3) inflammasome pathway activation is partly responsible for the inflicted damages in both COVID-19 infection and some reproductive disorders, so the main focus of the discussion is on NLRP3 inflammasome in the pathogenesis of COVID-19 infection alongside in the reproductive biology. In addition, the potential effects of the virus on male and female gonad functions were discussed, and we further explored the potential natural and pharmacological therapeutic approaches for comorbidity via NLRP3 inflammasome neutralization to develop a hypothesis for averting the long-term repercussions of COVID-19. Since activation of the NLRP3 inflammasome pathway contributes to the damage caused by COVID-19 infection and some reproductive disorders, NLRP3 inflammasome inhibitors have a great potential to be considered candidates for alleviating the pathological effects of the COVID-19 infection on the germ cells and reproductive tissues. This would impede the subsequent massive wave of infertility that may threaten the patients.

Addressing Chronic Gynecological Diseases in the SARS-CoV-2 Pandemic

Introduction: the COVID-19 pandemic has had a considerable impact on healthcare systems worldwide. Since the actual influence of the pandemic on gynecological care is still unclear, we aim to evaluate the effect of the SARS-CoV-2 pandemic on gynecological procedures compared to the pre-pandemic period in Romania. Materials and Methods: this is a single-center retrospective observational study, involving patients hospitalized in the year before the SARS-CoV-2 pandemic (PP), in the first year of the pandemic (P1), and in the second year of the pandemic until February 2022 (P2). The percentages of interventions were analyzed globally but also according to the type of surgery applied on the female genital organs. Results: during pandemic, the number of gynecological surgeries dropped considerably, by more than 50% in some cases, or even decreased by up to 100%, having a major impact on women's health, especially in the first year of the pandemic (P1), before slightly increasing in the post-vaccination period (PV). Surgically treated cancer cases dropped by over 80% during the pandemic, and the consequences of this will be seen in the future. Conclusions: the COVID-19 pandemic played an important part in gynecological care management in the Romanian public health care system, and the effect will have to be investigated in the future.

The need to reorganize health research systems in pandemic crisis: A prospective study

Background and Aims

A pandemic has posed a major challenge to health systems all over the world. All countries have realized that the only way to get real growth and development and solve their problems is to use what they have learned from research.

Methods

A descriptive and analytic type of study was conducted with the help of experts in the field of health research. The components affecting the research system were obtained via process approach and content analysis methods, and then the position of each component was identified by the Mic Mac technique.

Results

Seventeen influential structural components in the health research system were identified. The leadership and management components had the most direct and indirect influence among other components. The health promotion component had a greater dependency than the other components.

Conclusion

All health systems need to provide adequate financial resources and manpower to provide a useful research system. Human resources are the most important inputs to such a system. Components such as the research process, research sustainability, quality, or innovation in research can play a balancing role. Having the right infrastructures for creating, transferring, developing, and getting access to knowledge makes it possible to do systematic science. It is hoped that this science will be used in other results of the health research system, like improving the effectiveness or promoting health.

Fertility Does not Quarantine: Coronavirus Disease 2019 Pandemic Impacts on in Vitro Fertilization Clinical Pregnancy Rates

OBJECTIVE

 To understand the impact of the coronavirus disease 2019 pandemic on in vitro fertilization (IVF) clinical pregnancy rates and analyze factors that may have influenced their outcome.

METHODS

 This was a retrospective observational study conducted at a tertiary-care Brazilian fertility center. All fresh IVF and embryo warming cycles performed from March 11 to December 31, 2018-2021 were analyzed, and their data were used to calculate fertilization, embryo cleavage, cycle cancellation, embryo transfer (ET), and clinical pregnancy rates. Statistical tests were used to evaluate the alterations found. Logistic regression models were used to explore the association of the categorical variables with the observed clinical pregnancy rates. Data from 2018 and 2019 (prepandemic) and 2020 and 2021 (pandemic) were grouped.

RESULTS

 A total of 756 cycles were analyzed (n = 360 prepandemic and n = 396 pandemic). The age group of the patients, fertilization rates, and cleavage rates did not have significant differences (p > 0.05). There was a reduction in the percentage of fresh IVF and an increase in embryo warming cycles (p = 0.005) during the pandemic. There was also an increase in fresh cycle cancellations (p < 0.001) and a reduction in ET rates (p < 0.001). The pandemic had a negative impact on clinical pregnancy rates (p < 0.001) especially due to the increase in fresh cycle cancellations (p < 0.001).

CONCLUSION

 Embryo warming cycles with subsequent frozen-thawed ET were presented as a viable alternative to continue assisted reproductive treatments against pandemic restrictions on fresh cycles, ensuring clinical pregnancy, albeit at a lower rate than that of the prepandemic period.

SARS-CoV-2 Infection and the Male Reproductive System: A Brief Review

Many studies have suggested that SARS-CoV-2, directly or indirectly, can affect the male reproductive system, although the underlined mechanisms have not been completely elucidated yet. The purpose of this review is to provide a summary of the current data concerning the impact of SARS-CoV-2 infection on the male urogenital tract, with a particular emphasis on the testes and male fertility. The main data regarding the morphological alterations in the testes emerged from autoptic studies that revealed interstitial congestion, micro thrombosis, reduction of Sertoli, Leydig, and germinal cells, infiltrated immune cells, and atrophic seminiferous tubules consistent with orchitis. Furthermore, men with severe infection exhibit sperm parameter alterations, together with abnormalities of the hypothalamic-pituitary-testis axis, strongly suggesting that SARS-CoV-2 could increase the risk of male infertility. However, despite the inadequate number of longitudinal studies, spermatogenesis and sex hormone imbalance seem to improve after infection resolution. The yet unresolved question is whether the virus acts in a direct or/and indirect manner, as discordant data related to its presence in the testis and semen have been reported. Regardless of the direct effect, it has been postulated that the cytokine storm and the related local and systemic inflammation could strongly contribute to the onset of testis dysfunction, leading to male infertility. Therefore, multicentric and longitudinal studies involving a large number of patients are needed to understand the real impact of SARS-CoV-2 infection on male reproduction.

PEGylation Prolongs the Half-Life of Equine Anti-SARS-CoV-2 Specific F(ab')2

Therapeutic antibodies-F(ab')₂ obtained from hyperimmune equine plasma could treat emerging infectious diseases rapidly because of their high neutralization activity and high output. However, the small-sized F(ab')₂ is rapidly eliminated by blood circulation. This study explored PEGylation strategies to maximize the half-life of equine anti-SARS-CoV-2 specific F(ab')₂. Equine anti-SARS-CoV-2 specific F(ab')₂ were combined with 10 KDa MAL-PEG-MAL in optimum conditions. Specifically, there were two strategies: Fab-PEG and Fab-PEG-Fab, F(ab')₂ bind to a PEG or two PEG, respectively. A single ion exchange chromatography step accomplished the purification of the products. Finally, the affinity and neutralizing activity was evaluated by ELISA and pseudovirus neutralization assay, and ELISA detected the pharmacokinetic parameters. The results displayed that equine anti-SARS-CoV-2 specific F(ab')₂ has high specificity. Furthermore, PEGylation F(ab')₂-Fab-PEG-Fab had a longer half-life than specific F(ab')₂. The serum half-life of Fab-PEG-Fab, Fab-PEG, and specific F(ab')₂ were 71.41 h, 26.73 h, and 38.32 h, respectively. The half-life of Fab-PEG-Fab was approximately two times as long as the specific F(ab')₂. Thus far, PEGylated F(ab')₂ has been prepared with high safety, high specificity, and a longer half-life, which could be used as a potential treatment for COVID-19.

The effects of preconception and early gestation SARS-CoV-2 infection on pregnancy outcomes and placental pathology

OBJECTIVE

To evaluate if peri-pregnancy timing of a PCR+ test for SARS-CoV-2 RNA affects pregnancy outcomes and placental pathology.

METHODS

This is a retrospective cohort study conducted in a tertiary center. Pregnancy outcomes and placental pathology were compiled for women who tested positive for SARS-CoV-2 RNA from a nasopharyngeal swab assessed by RT-PCR. The population comprised four groups that were PCR+ preconception (T₀) or in the 1st (T₁), 2nd (T₂), or 3rd (T₃) trimester of pregnancy. A fifth, control group (T_C) tested PCR- for SARS-CoV-2 before delivery.

RESULTS

Seventy-one pregnancies were studied. The T₀ group exhibited lower gestational ages at delivery, had infants with the lowest birth weights, the highest rate of pregnancy loss before 20 weeks. Features of maternal vascular malperfusion and accelerated villous maturation were prominent findings in the histopathology of placentas from women PCR+ for SARS-CoV-2 RNA, especially in the T₀ and the T₁ groups.

CONCLUSION

Women at highest risk for pregnancy complications are those who test PCR+ for viral RNA preconception or during first trimester of pregnancy.

Early coronavirus disease 2019 restrictive measures and changes in maternal characteristics, use of assisted reproductive technology, and stillbirth

BACKGROUND

The initial COVID-19 pandemic response-related effects on conceptions following the use of assisted reproductive technologies (ART), and on changes in the maternal characteristics of women who conceived during the early vs. pre-pandemic period, have been understudied.

OBJECTIVES

To examine the effects of ART clinic closures in the United States (US) in March 2020 on the frequency of ART-conceived live births, multiple births and stillbirths; and to describe changes in the characteristics of women who conceived in the early pandemic period.

METHODS

Population-based cohort study including all births in the US from January 2015 to December 2020 (22,907,688 live births; 134,537 stillbirths). Interrupted time series (ITS) methodology was used to estimate rate ratios (RR) of expected versus observed rates in December 2020 (i.e., among births conceived mainly in March 2020). Demographic and clinical characteristics were compared between mothers who conceived in March 2020 versus March 2015-2019.

RESULTS

Overall, 1.1% of live births and 1.7% of stillbirths were conceived by ART. ART-conceived live births decreased by 57.0% in December 2020 (observed vs. expected RR 0.43, 95% confidence interval [CI] 0.40, 0.45), and these declines occurred in all subgroups of women. Multiple births also declined in December 2020. Stillbirth rates increased in December 2020 in ART-conceived births (RR 2.55, 95% CI 1.63, 3.92) but remained unchanged in the non-ART group. Maternal characteristics of women who conceived in the early pandemic versus pre-pandemic period differed and included an increased prevalence of pre-pregnancy obesity class 3 and chronic hypertension.

CONCLUSIONS

The early pandemic closure of ART clinics resulted in a substantial decline in ART-conceived live births and multiple births in December 2020 and an increase in the proportion of stillbirths among ART-conceived births. Women who conceived in the early pandemic period also had an increased prevalence of obesity and chronic hypertension.

SARS-CoV-2 Infection in Pregnancy: Clues and Proof of Adverse Outcomes

BACKGROUND

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) represents one of the most threatening viral infections in the last decade. Amongst susceptible individuals, infected pregnant women might be predisposed to severe complications. Despite the extensive interest in SARS-CoV-2 research, the clinical course of maternal infection, the vertical transmission and the neonatal outcomes have not been completely understood yet. The aim of our study was to investigate the association between SARS-CoV-2 infection, obstetric outcomes and vertical transmission.

METHODS

A prospective observational study was performed, enrolling unvaccinated pregnant patients positive for SARS-CoV-2 (cases) and matched with uninfected pregnant women (controls). Maternal and neonatal nasopharyngeal swabs, maternal and cord blood, amniotic fluid and placenta tissue samples were collected; blood samples were tested for anti-S and anti-N antibodies, and histologic examination of placental tissues was performed.

RESULTS

The cases showed a significant association with the development of some obstetric complications, such as intrauterine growth restriction and pregnancy-associated hypothyroidism and diabetes, as compared to controls; their newborns were more likely to have a low birth weight and an arterial umbilical pH less than 7. The viral genome was detected in maternal and cord blood and placental samples in six cases.

CONCLUSIONS

Pregnant women positive for SARS-CoV-2 infection are more likely to develop severe obstetric outcomes; their newborns could have a low birth weight and arterial pH. Vertical transmission seems a rare event, and further investigation is strongly needed.

Pregnancy in the time of COVID-19: towards Fetal monitoring 4.0

On the outbreak of the global COVID-19 pandemic, high-risk and vulnerable groups in the population were at particular risk of severe disease progression. Pregnant women were one of these groups. The infectious disease endangered not only the physical health of pregnant women, but also their mental well-being. Improving the mental health of pregnant women and reducing their risk of an infectious disease could be achieved by using remote home monitoring solutions. These would allow the health of the mother and fetus to be monitored from the comfort of their home, a reduction in the number of physical visits to the doctor and thereby eliminate the need for the mother to venture into high-risk public places. The most commonly used technique in clinical practice, cardiotocography, suffers from low specificity and requires skilled personnel for the examination. For that and due to the intermittent and active nature of its measurements, it is inappropriate for continuous home monitoring. The pandemic has demonstrated that the future lies in accurate remote monitoring and it is therefore vital to search for an option for fetal monitoring based on state-of-the-art technology that would provide a safe, accurate, and reliable information regarding fetal and maternal health state. In this paper, we thus provide a technical and critical review of the latest literature and on this topic to provide the readers the insights to the applications and future directions in fetal monitoring. We extensively discuss the remaining challenges and obstacles in future research and in developing the fetal monitoring in the new era of Fetal monitoring 4.0, based on the pillars of Healthcare 4.0.

First Croatian Case of Double Aneuploidy: A Child With Klinefelter and Edwards Syndrome (48,XXY,+18) - Possible Causes and Contributing Factors

We report a case of double aneuploidy in a preterm male newborn with karyotype 48,XXY,+18 whose mother was of advanced age and infected with the SARS-CoV-2 virus during the early stages of her pregnancy. The clinical features observed in the newborn included intrauterine growth retardation, dysmorphic facial features, overlapping fingers on both hands, respiratory distress syndrome, ventricular septal defect, patent ductus arteriosus, persistent pulmonary hypertension, and bilateral clubfoot, a phenotype that mainly correlates with Edwards syndrome (trisomy 18). To our knowledge, this is the first reported case of double aneuploidy in Croatia. This paper provides a detailed description of the clinical presentation and treatment strategies used, with the aim of providing valuable data for future recognition and management of similar cases. Furthermore, we discuss the mechanisms of nondisjunction that might account for this rare form of aneuploidy.

The Impact of Coronavirus Disease 2019 Pandemic on Female Patients Seeking or Undergoing Fertility Treatment in a Single In vitro Fertilisation Clinic in Greece: An International, Cross-sectional Study

Background

The temporary delay in fertility treatments due to the coronavirus disease 2019 (COVID-19) pandemic, in combination with the imposed lockdowns, has created psychological distress and anxiety amongst infertile patients.

Aims

The aim of this study was to evaluate how the pandemic has influenced assisted reproduction technology (ART) patients in Greece, during the second wave of the pandemic. An additional aim was to examine the effects of the pandemic on cross-border patients in particular, compared to national ones.

Settings and Design

This study was a cross-sectional, questionnaire-based study, distributed to 409 patients of a single in vitro fertilisation (IVF) clinic in Greece, during the period between January until the end of April 2021.

Materials and Methods

The survey was conducted online via E-mail and was distributed to national and international female patients of a single IVF clinic in Greece, who were undergoing ART treatment during the second wave of the COVID-19 pandemic. Patient participation was anonymous, and participants provided informed consent for collection and publication of data.

Statistical Analysis Used

The mean values of baseline characteristics, along with answer percentages per questionnaire item, were calculated. Collected data were cross-tabulated, and the Chi-square test was used as a measurement of the differences between national and cross-border patients. A P value lower than 0.05 was considered statistically significant. All analyses were conducted using the SPSS Statistics software.

Results

From 409 initial candidates, 106 women, with a mean age of 41.2 years, completed the questionnaire (26% response rate). The majority of national patients did not experience any delays in their fertility plans (62%), while cross-border patients experienced over 6 months of delays (54.7%). The main reason for fertility postponement was travel restrictions due to COVID-19 for cross-border patients (62.5%), while national patients cited additional reasons. The majority of patients experienced a degree of stress (65.2%) due to the delays, however were not fearful of COVID-19 infection (54.7%). Most patients were aware of the protective measures taken by IVF clinics (80.2%), and this was a determinant factor (71.7%) for their decision to restart their fertility treatment.

Conclusion

The COVID-19 pandemic lockdowns had a significant emotional impact on patient receiving or undergoing ART treatment in Greece. This impact was more pronounced on cross-border patients. This highlights the need for continuation of ART care, with the appropriate protective measures, during the pandemic, as well as during similar times of crisis in the future.

SARS-CoV-2 infection induces testicular injury in Rhesus macaque

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The infection of SARS-CoV-2 lead to varying degrees of testicular pathological damage.

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The NP antigen of SARS-CoV-2 was not found in male reproductive system of rhesus macaque.

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Infection-associated inflammatory insult and sex hormone fluctuations may account for the testicular pathophysiology.

Co-infection associated with SARS-CoV-2 and their management

SARS-CoV-2 was discovered in Wuhan, China and quickly spread throughout the world. This deadly virus moved from person to person, resulting in severe pneumonia, fever, chills and hypoxia. Patients are still experiencing problems after recovering from COVID-19. This review covers COVID-19 and associated issues following recovery from COVID-19, as well as multiorgan damage risk factors and treatment techniques. Several unusual illnesses, including mucormycosis, white fungus infection, happy hypoxia and other systemic abnormalities, have been reported in recovered individuals. In children, multisystem inflammatory syndrome with COVID-19 (MIS-C) is identified. The reasons for this might include uncontrollable steroid usage, reduced immunity, uncontrollable diabetes mellitus and inadequate care following COVID-19 recovery.

COVID-19, Vaccination, and Female Fertility in the Czech Republic

The fast-track process to approve vaccines against COVID-19 has raised questions about their safety, especially in relation to fertility. Over the last 2 years, studies have appeared monitoring female fertility, especially from assisted reproduction centers or in animal experiments. However, studies monitoring healthy populations are still limited. The aim of our study was to monitor the relevant parameters of female fertility (sex and other steroids, LH, FSH, SHBG, Antimüllerian hormone and antral follicle count) before and then 2-4 months after the third dose of vaccination against COVID-19 in a group of 25 healthy fertile woman. In addition, anti-SARS-CoV-2 and anti-SARS-CoV-2S antibodies were determined. We did not observe significant changes in the measured parameters before and after the third dose of vaccination. By comparing levels of the analytes with antibodies indicating a prior COVID-19 infection, we found that women who had experienced the disease had statistically lower levels of estrone, estradiol, SHBG and 5α-dihydroprogesterone, and conversely, higher levels of androgen active dehydroepiandrosterone and dihydrotestosterone. Our results confirm that vaccination does not affect female fertility, and that what fertile women should be worried about is not vaccination, but rather COVID-19 infection itself.

SARS-CoV-2 can infect human embryos

The spread of SARS-CoV-2 has led to a devastating pandemic, with infections resulting in a range of symptoms collectively known as COVID-19. The full repertoire of human tissues and organs susceptible to infection is an area of active investigation, and some studies have implicated the reproductive system. The effects of COVID-19 on human reproduction remain poorly understood, and particularly the impact on early embryogenesis and establishment of a pregnancy are not known. In this work, we explore the susceptibility of early human embryos to SARS-CoV-2 infection. By using RNA-seq and immunofluorescence, we note that ACE2 and TMPRSS2, two canonical cell entry factors for SARS-CoV-2, are co-expressed in cells of the trophectoderm in blastocyst-stage preimplantation embryos. For the purpose of viral entry studies, we used fluorescent reporter virions pseudotyped with Spike (S) glycoprotein from SARS-CoV-2, and we observe robust infection of trophectoderm cells. This permissiveness could be attenuated with blocking antibodies targeting S or ACE2. When exposing human blastocysts to the live, fully infectious SARS-CoV-2, we detected cases of infection that compromised embryo health. Therefore, we identify a new human target tissue for SARS-CoV-2 with potential medical implications for reproductive health during the COVID-19 pandemic and its aftermath.

The relationship between perceived stress, uncertainty emotions and hopelessness regarding pandemics in pregnant women

The objective of this study was to determine the emotional reactions of pregnant women towards the pandemic and to increase awareness of healthcare professionals on this subject. In this descriptive, cross-sectional, and correlational study, an online questionnaire was applied to 375 pregnant women (n = 375). Data were collected with pregnant information form, Intolerance of Uncertainty Scale and Beck Hopelessness Scale. The mean age of the pregnant women was 29.495 ± 4.301, and the mean gestational week was 27.469 ± 7.971. Pregnant women's levels of perceived stress and intolerance to uncertainty were high. There was a moderate positive correlation between stress and uncertainty levels of the women who stated that they experienced mild hopelessness. It is recommended to identify risky groups and provide the necessary psychological support by health professionals during the pandemic.

Intrauterine Instillation of Human Chorionic Gonadotropin with Intrauterine Insemination Catheter Around the Golden Time of Embryo Transfer Does Not Improve In Vitro Fertilization /Intracytoplasmic Sperm Injection Outcomes in Infertile Women: A Randomized Controlled Trial

BACKGROUND

We set out to explore the effect of intrauterine human chorionic gonadotropin (hCG) instillation by intrauterine insemination (IUI) catheter before embryo transfer (ET) on assisted reproductive technologies (ART) outcomes of infertile women.

METHODS

One hundred women with infertility who were scheduled for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles were included in the study. They were randomly devoted to two groups: experimental (n= 50) and control (n= 50). In the experimental group, 500 IU hCG passed into the internal cervical orifice via IUI catheter within 15 minutes before the transfer of fresh or vitrified cleavage-stage embryos. The control group underwent the same ET procedure without prior injection of hCG.

RESULTS

None of the outcomes showed a statistically significant difference between the two groups. In the intervention and control groups, respectively, biochemical pregnancies rates were 26% and 18%, implantation rates were 13.5% and 8.6%, clinical pregnancies rates were 22% and 14%, ongoing pregnancies rates were 18% and 14%, and live birth rates were 14% and 12%.

CONCLUSION

Intrauterine injection of hCG via IUI catheter is not recommended in a clinical routine setting at this stage. Future efforts are warranted to further refine the applicability of this modality.

Blockchain Assisted Disease Identification of COVID-19 Patients with the Help of IDA-DNN Classifier

Globally, millions of people were affected by the Corona-virus disease-2019 (COVID-19) causing loads of deaths. Most COVID-19 affected people recover in a few spans of weeks. However, certain people even those with a milder variant of the disease persist in experiencing symptoms subsequent to their initial recuperation. Here, a novel Block-Chain (BC)-assisted optimized deep learning algorithm, explicitly improved dragonfly algorithm based Deep Neural Network (IDA-DNN), is proposed for detecting the different diseases of the COVID-19 patients. Initially, the input data of the COVID-19 recovered patients are gathered centered on their post symptoms and their data is amassed as a BC for rendering security to the patient's data. After that, the disease identification of the patient's data is performed with the aid of system training. The training includes '4' disparate datasets for data collection, and then, performs preprocessing, Feature Extraction (FE), Feature Reduction (FR), along with classification utilizing ID-DNN on the gathered inputted data. The IDA-DNN classifies '2' classes (presence of disease and absence of disease) for every type of data. The proposed method's outcomes are examined as well as contrasted with the other prevailing techniques to corroborate that the proposed IDA-DNN detects the COVID-19 more efficiently.

Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study

With the arrival of the highly transmissible Omicron variants (BA.4 and BA.5), dentistry faces another seasonal challenge to preserve the biosafety of dental care and education. With the aim of protecting patients, students, teachers and healthcare professionals, this paper introduces a prospective sustainable biosafety setting for everyday dental care and education. The setting developed by dental clinicians, epidemiologists, and teachers of dentistry consists of a combination of modern technologies focused on the air-borne part of the viral pathway. The introduced biosafety setting has been clinically evaluated after 18 months of application in the real clinical environment. The protocol has three fundamental pillars: (1) UVC air disinfection; (2) air saturation with certified virucidal essences with nebulizing diffusers; (3) complementary solutions including telehealth and 3D printing. A pseudonymous online smart form was used as the evaluation method. The protocol operates on the premise that everybody is a hypothetical asymptomatic carrier. The results of a clinical evaluation of 115 patient feedbacks imply that no virus transmission from patient to patient or from doctor to nurse was observed or reported using this protocol, and vice versa, although nine patients retrospectively admitted that the clinic visit is likely to be infectious. Despite these promising results, a larger clinical sample and exposition to the current mutated strains are needed for reliable conclusions about protocol virucidal efficiency in current dental environments.

Determinants of Place of Delivery during the COVID-19 Pandemic-Internet Survey in Polish Pregnant Women

Background and Objectives: COVID-19 is a pandemic disease, and its unpredictable outcome makes it particularly dangerous, especially for pregnant women. One of the decisions they have to make is where they will give birth. This study aimed to determine the factors influencing the choice of place of delivery and the impact of the COVID 19 pandemic on these factors. Materials and Methods: The study was conducted on 517 respondents from Poland. The research methods comprised the authors’ own survey questionnaire distributed via the Internet from 8 to 23 June 2021. The survey was fully anonymous, voluntary, and addressed to women who gave birth during the pandemic or will give birth shortly. Results: A total of 440 (85.1%) respondents were afraid of SARS-CoV-2 infection. The most frequently indicated factors were fear of complications in the newborn, fear of intrauterine fetal death, and congenital disabilities in a newborn. A total of 74 (14.3%) women considered home delivery. The main factors that discouraged the choice of home birth were the lack of professional medical care 73.1% (N = 378), the lack of anesthesia 23.6% (N = 122), and the presence of indications for caesarean section 23.4% (N = 121). The possibility of mother–child isolation caused the greatest fear about hospital delivery. During the COVID-19 pandemic, pregnant women concerned about SARS-CoV-2 infection were more likely to consider home delivery than those without such fears. The most important factors affecting the choice of the place of delivery included the possibility of a partner’s presence, excellent sanitary conditions and optimal distance from the hospital, and the availability of epidural analgesia for delivery. Conclusions: Our study identifies the determinants of place of delivery during the COVID-19 pandemic. The data we obtained can result in the healthcare system considering patients’ needs in case of similar crisis in the future.

Pharmacotherapy Based on ACE2 Targeting and COVID-19 Infection

The new SARS-CoV-2 coronavirus is responsible for the COVID-19 pandemic. A massive vaccination campaign, which is still ongoing, has averted most serious consequences worldwide; however, lines of research are continuing to identify the best drug therapies to treat COVID-19 infection. SARS-CoV-2 penetrates the cells of the host organism through ACE2. The ACE2 protein plays a key role in the renin–angiotensin system (RAS) and undergoes changes in expression during different stages of COVID-19 infection. It appears that an unregulated RAS is responsible for the severe lung damage that occurs in some cases of COVID-19. Pharmacologically modifying the expression of ACE2 could be an interesting line of research to follow in order to avoid the severe complications of COVID-19.

Metabolic, Oxidative and Psychological Stress as Mediators of the Effect of COVID-19 on Male Infertility: A Literature Review

Over 300 million patients with coronavirus disease 2019 (COVID-19) have been reported worldwide since the outbreak of the pandemic in Wuhan, Hubei Province, China. COVID-19 is induced by the acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effect of SARS-CoV-2 infection on the male reproductive system is unclear. The aim of this review is to assess the effect of SARS-CoV-2 infection on male fertility and the impact of possible mediators, such as metabolic, oxidative and psychological stress. SARS-CoV-2 infection aggravates metabolic stress and directly or indirectly affects male fertility by reducing seminal health. In addition, SARS-CoV-2 infection leads to excessive production of reactive oxygen species (ROS) and increased psychological distress. These data suggest that SARS-CoV-2 infection reduces male fertility, possibly by means of metabolic, oxidative and psychological stress. Therefore, among other consequences, the possibility of COVID-19-induced male infertility should not be neglected.

Serum 25(OH) Vitamin D Levels in Pregnant Women with Coronavirus Disease 2019 (COVID-19): A Case-Control Study

The physiological changes during pregnancy may increase the risk of complications in pregnant women with coronavirus disease 2019 (COVID-19). Vitamin D is a fat-soluble secosteroid hormone and its role in immunity is appears to be of particular importance in this recent pandemic. Nevertheless, there is little research about the role of vitamin D levels regarding COVID-19 in pregnant women to date. This study aimed to establish a relationship between serum 25-hydroxyvitamin D (25(OH)D) levels in pregnant women and COVID-19. A comparative case-control study was performed with a study population of 256 pregnant women (82 pregnant women with infection and 174 women in control group). Serum 25(OH)D levels were significantly lower in pregnant women with COVID-19 infection than in those without infection. In addition, 89% of COVID-19-positive pregnant women had 25(OH)D deficiency, while in the control group the percentage was 75.30%, finding statistically significant differences (ORa = 2.68; 95% CI 1.19–6.06; p = 0.01). Our results find a relationship between vitamin D deficiency in pregnant women and COVID-19 infection. This finding could be relevant for actual clinical practice. Thus, more research is needed in this field.

Are the Follicular Fluid Characteristics of Recovered Coronavirus Disease 2019 Patients Different From Those of Vaccinated Women Approaching in vitro Fertilization?

The aim of this pilot study is to evaluate if SARS-CoV-2 infection or vaccination against SARS-CoV-2 infection induce observable metabolic effects in follicular fluid of women who are following in vitro fertilization (IVF) treatments. The possible impact of coronavirus disease 2019 (COVID-19) on fertility and IVF outcome is considered. We have selected for this study: six women vaccinated against SARS-CoV-2 infection, five recovered COVID-19 patients, and we used nine healthy women as the control group. At the time of oocytes retrieval from participants in the study, follicular fluids were collected and metabolomic analysis was performed by ¹H NMR spectroscopy in combination with multivariate analysis to interpret the spectral data. The search for antibody positivity in the follicular fluid aspirates was also carried out, together with the western blotting analysis of some inflammatory proteins, interleukin-6, tumor necrosis factor α (TNFα), and the free radical scavenger superoxide dismutase 2. Higher levels of Ala and Pro together with lower levels of lipids and trimethylamine N-oxide (TMAO) were found in follicular fluids (FFs) of vaccinated women while lower levels of many metabolites were detected in FFs of recovered COVID patients. Expression level of TNF-α was significantly lower both in recovered COVID-19 patients and vaccinated women in comparison to healthy controls.

Choosing Wisely Canada: Canadian fertility and andrology society’s list of top items physicians and patients should question in fertility medicine

Purpose

To create a Choosing Wisely Canada list of the top 5 diagnostic and therapeutic interventions that should be questioned in Reproductive Endocrinology and Infertility in Canada.

Methods

The Canadian Fertility and Andrology Society (CFAS) National Working Group developed an initial list of recommendations of diagnostic and therapeutic interventions that are commonly used, but are not supported by evidence, and could expose patients to unnecessary harm. These were chosen based on their prevalence, cost, potential for harm, and quality of supporting evidence. A modified Delphi consensus was used over 5 rounds to generate ideas, review supporting evidence, assess clinical relevance, estimate recommendation impact and narrow the recommendations list to 5 items.

Results

Fifty unique ideas were first proposed by the working group, and after 5 rounds including a survey of Canadian Fertility and Andrology Society (CFAS) members, the final list of recommendations was created, including topics related to unnecessary investigations and interventions for patients with infertility and recurrent pregnancy loss, and those undergoing IVF. In this article, we describe not only the Delphi process used to determine the list, but also provide a summary of the evidence behind each of the final recommendations.

Conclusions

The list of five recommendations highlights opportunities to initiate conversations between clinicians and patients about the risks, benefits, harms and costs of unnecessary fertility treatments and procedures in a Canadian context.

Practical COVID-19 Prevention Training for Obstetrics and Gynecology Residents Based on the Conceive–Design–Implement–Operate Framework

Background

The spread of COVID-19 poses a challenge for obstetrics and gynecology (O&G) residents. In order to improve the theoretical knowledge and practical skills of residents in epidemic prevention and control, reduce work pressure and improve professional skills, effective and sound training models are required to improve the protection of O&G residents from COVID-19.

Method

A total of 38 standardized training O&G residents working in Shengjing Hospital of China Medical University in March 2020 was selected. They were randomly divided into intervention and control groups. The control group underwent a protection theory exposition according to the traditional training method, while the intervention group adopted a conceive–design–implement–operate (CDIO) mode, arranged training courses in combination with the O&G specialty, and completed four modules of CDIO. After the training, the theoretical knowledge and practical operation were assessed, and the work stress and occupational identity scales were assessed. The assessment results and scores of the two groups of residents were analyzed.

Results

Compared with the scores of the residents in the control group, the theoretical and technical scores of the residents in the intervention group significantly improved (P < 0.05). In the evaluation of organizational management, workload, interpersonal relationship, and doctor–patient relationship pressure, the scores of the intervention group were lower than those of the control group, with a statistical difference (P < 0.05). For the intervention group, the job stress and professional identity evaluation scores were significantly higher than those of the control group (P < 0.05).

Conclusion

The CDIO model can effectively enhance the theoretical knowledge and practical skills of O&G residents in COVID-19 epidemic prevention protocols to reduce work pressure and improve professional identity. In addition, it provides new ideas, methods, and approaches for future clinical practice training.

Effects of the COVID-19 Pandemic on Gynecological Health: An Integrative Review

OBJECTIVE

 To analyze the existing scientific literature to find out if the coronavirus disease 2019 (COVID-19) pandemic has an effect on gynecological health.

SEARCH STRATEGY

 We performed an integrative review of articles published between April 2020 and April 2021 on the PubMed, SciELO, and LILACS databases, using COVID-19 and the following relevant terms: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; and Urogynecology.

SELECTION CRITERIA

 Among the eligible studies found, editorials and primary research articles, which describe the dynamics between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (the cause of the COVID-19 pandemic) and gynecological health, were included.

DATA COLLECTION AND ANALYSIS

 Through qualitative synthesis, data were extracted from the included publications and from guidelines of national and international societies of gynecology.

MAIN RESULTS

 The 34 publications included in the present study showed that some factors of the SARS-CoV-2 infection, and, consequently, the COVID-19 pandemic, might be associated with menstrual abnormalities, effects on contraception, alterations in steroid hormones, changes in urogynecological care, effects on women's mental health, and negative impact on violence against women.

CONCLUSION

 The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.

Oncofertility and COVID-19: At the Crossroads between Two Time-Sensitive Fields

Background: COVID-19 infection has dominated our lives and left its mark on it. The impact on fertility is major, and the long-term consequences may be disastrous. When we talk about oncofertility, we are talking about those patients worried about the delay in receiving medical services (possible cancelation of surgery, decreased availability of medical services, reorientation of medical resources) due to COVID-19. Finally, patients’ worsening biological and reproductive statuses, associated with high levels of anxiety and depression, are closely related to social restrictions, economic impact, reorientation of medical resources, health policies, and fears of SARS-CoV-2 infection. Aim: We reviewed the current literature on fertility during the COVID-19 pandemic and its effect on cancer patients. Specifically, how cancer treatment can affect fertility, the options to maintain fertility potential, and the recovery options available after treatment are increasingly common concerns among cancer patients. Methods: A systematic literature search was conducted using two main central databases (PubMed^®/MEDLINE, and Web of Science) to identify relevant studies using keywords SARS-CoV-2, COVID-19, oncofertility, young cancer patient, cryopreservation, assisted reproductive techniques (ART), psychosocial, telemedicine. Results: In the present study, 45 papers were included, centered on the six main topics related to COVID-19. Conclusions: Fertility preservation (FP) should not be discontinued, but instead practiced with adjustments to prevent SARS-CoV-2 transmission. The increased risk of SARS-CoV-2 infection in cancer patients requires screening for COVID-19 before FP procedures, among both patients and medical staff in FP clinics, to prevent infection that would rapidly worsen the condition and lead to severe complications.

Association of Covid-19 with blood type A in relation to blood sugar, urea, and blood test (D-dimer and ferritin) in patients from Al-Najaf

COVID-19 is an emerging infectious disease caused by the novel enveloped single-stranded RNA virus quickly declared a pandemic. This study aimed to investigate the severity of COVID-19 infection in patients with blood group type A. A cross-sectional study was conducted at Al-Amal specialized hospital, Al-Najaf (March 8 to March 20/2021). The study included 123 hospitalized patients (63 females and 60 males), aged between 15-95 years, diagnosed with COVID-19, tested for blood group, blood sugar, blood urea, D-dimer, and serum ferritin. Results indicated significant differences in blood sugar and D-dimer in patients with type A blood group at P>0.05. At the same time, no significant difference was found in blood urea and ferritin at P>0.05. The majority of patients showed elevated levels of blood sugar, blood urea, serum D-dimer and ferritin. COVID-19 can infect people of all ages and causes severe infection in all blood groups.

Extra-Pulmonary Complications in SARS-CoV-2 Infection: A Comprehensive Multi Organ-System Review

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is typically presented with acute symptoms affecting upper and lower respiratory systems. As the current pandemic progresses, COVID-19 patients are experiencing a series of nonspecific or atypical extra-pulmonary complications such as systemic inflammation, hypercoagulability state, and dysregulation of the renin-angiotensin-aldosterone system (RAAS). These manifestations often delay testing, diagnosis, and the urge to seek effective treatment. Although the pathophysiology of these complications is not clearly understood, the incidence of COVID-19 increases with age and the presence of pre-existing conditions. This review article outlines the pathophysiology and clinical impact of SARS-CoV-2 infection on extra-pulmonary systems. Understanding the broad spectrum of atypical extra-pulmonary manifestations of COVID-19 should increase disease surveillance, restrict transmission, and most importantly prevent multiple organ-system complications.

Is there impact of the SARS-CoV-2 pandemic on steroidogenesis and fertility?

In December of 2019, several cases of unknown atypical respiratory diseases emerged in Wuhan, Hubei Province in China. After preliminary research, it was stated that the disease is transmittable between humans and was named COVID-19. Over the course of next months, it spread all over the world by air and sea transport and caused a global pandemic which affects life of everyone now-a-days. A large number of countries, have since been forced to take precautions such as curfews, lockdowns, wearing facemasks etc. Even with vaccines being produced in mass numbers, lack of targeted therapy continues to be a major problem. According to studies so far it seems that elderly people are more vulnerable to severe symptoms while children tend to by asymptomatic or have milder form the disease. In our review, we focused on gathering data about the virus itself, its characteristics, paths of transmission, and its effect on hormone production and secretion. In such, there is insufficient information in the literature worldwide, especially the ones that focus on the effect of COVID-19 on individual organs systems within the human body. Hence, the present evidence-based study focused on the possible effects of COVID-19 on adrenal gland and gonads i.e. on the process of steroidogenesis and fertility.

Potential effects of COVID-19 on reproductive health: a mini review

Coronavirus disease 2019 (COVID-19) is now a major public health problem worldwide. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity is extremely strong. One major target of the virus is the lung, which can lead to death due to the development of respiratory distress syndrome and even multiple system organ failure. The possible pathophysiology by which SARS-CoV-2 affects the object is by way of the receptor, angiotensin-converting enzyme 2 (ACE2). From the study of the viral structure and infection mechanisms, researchers have discovered that the ACE2 acts as a receptor for SARS-CoV-2. According to previous studies, ACE2 is one of the key enzymes in the RAS system. Physiological functions can be found in angiosarcomas and in the kidney, liver, intestine and so on. Whether SARS-CoV-2 infection leads to male fertility impairment has recently received attention. Nevertheless, the association between SARS-CoV-2 infection and reproductive health is currently poorly understood. Using key words including "SARS-CoV-2", "reproductive health", "ACE2" and "2019-nCoV", we retrieved original articles and reviews from the PubMed and WEB OF SCI databases published before December 16, 2020 and performed a thorough review of them. Compared with females, we discovered that infected person with SARS-CoV-2 was higher in males. Men who were infected with SARS-CoV-2 may be easy to suffer from impaired reproductive health. These investigations would help for a comprehensive grasp of the relationship between SARS-CoV-2 infection and reproductive health.

Molecular diagnosis of SARS-CoV-2 in seminal fluid

PURPOSE

Due to relevant repercussions on reproductive medicine, we aimed to evaluate feasibility of RT-PCR as a detection method of SARS-CoV-2 RNA in seminal fluid.

METHODS

A qualitative determination of the RT-PCR assays in semen was performed through different approaches: (1) efficiency of RNA extraction from sperm and seminal plasma was determined using PRM1 and PRM2 mRNA and a heterologous system as control; (2) samples obtained by diluting viral preparation from a SARS-CoV-2 panel (virus cultured in Vero E6 cell lines) were tested; (3) viral presence in different fractions of seminal fluid (whole sample, seminal plasma and post-centrifugation pellet) was evaluated. Semen samples from mild and recovered COVID-19 subjects were collected by patients referring to the Infectious Disease Department of the Policlinico Umberto I Hospital - "Sapienza" University of Rome. Control subjects were recruited at the Laboratory of Seminology-Sperm Bank "Loredana Gandini'' of the same hospital.

RESULTS

The control panel using viral preparations diluted in saline and seminal fluid showed the capability to detect viral RNA presence with C_t values depending on the initial viral concentration. All tested semen samples were negative for SARS-CoV-2, regardless of the nasopharyngeal swab result or seminal fluid fraction.

CONCLUSION

These preliminary data show that RT-PCR for SARS-CoV-2 RNA testing appears to be a feasible method for the molecular diagnosis of SARS-CoV-2 in seminal fluid, supported by results of the control panel. The ability to detect SARS-CoV-2 in semen is extremely important for reproductive medicine, especially in assisted reproductive technology and sperm cryopreservation.

Fertility-Related Quality of Life in Men Undergoing Medically Assisted Reproduction During the Pandemic: Perfectionism and Thought Control Beliefs Moderate the Effects of the Type of Treatment

OBJECTIVE

After a diagnosis of infertility, an increasing number of couples turns to the Medically Assisted Reproduction (MAR) to achieve a pregnancy. A diagnosis of infertility has a negative impact on the individual's well-being and it can increase the risk of anxious-depressive symptoms, stress, and low self-esteem. Data associated with infertility-related Quality of Life (QoL) are lacking in men. Little is known about men's experience of infertility and its treatments during the pandemic. Among the variables potentially associated with infertility-related QoL, the role of obsessive beliefs is neglected, although preliminary studies considered perfectionistic traits.

METHOD

One hundred and fifty-one participants were included. Eighty men (mean age: 40.83 years) were attending a MAR pathway. Of these, 50 men (67.5%) were undergoing homologous MAR and 30 men (37.5%) were undergoing heterologous MAR. A control group consisting of 71 subjects (mean age: 36.69 years), paired by age, marital status, and number of children, was drawn from the general population. The Obsessive Beliefs Questionnaire-46, the Depression Anxiety Stress Scales-20, and the Fertility Quality of Life Questionnaire were administered.

RESULTS

High levels of anxiety, depression and stress were moderately associated with lower infertility-related Quality of Life. For men undergoing homologous MAR, perfectionism beliefs represented a vulnerability factor for a lower fertility-related QoL, while for men undergoing heterologous MAR, high thought control beliefs represented a risk factor for a lower fertility-related QoL.

CONCLUSIONS

A focus on the obsessive beliefs should be included in the psychological treatment of infertile men, specifically perfectionism in homologous MAR and control of thoughts in heterologous MAR. Therefore, psychological assessment and support interventions should be personalized according to the MAR pathway and be focused on men's cognitive features in order to improve their QoL during the MAR pathway.

The Impact of the Coronavirus Disease 19 Pandemic on Early Pregnancy Outcomes Among Patients Undergoing In Vitro Fertilization Treatment

Objective: To determine if pregnancy rates (PRs) or pregnancy loss rates (PLRs) were altered in patients undergoing single, euploid frozen-thawed embryo transfer (FET) during the initial peak of the Coronavirus Disease 19 (COVID-19) pandemic.

Materials and Methods: This was a retrospective cohort study performed in a single academic center. Patients undergoing single, euploid FET cycles from January to May 2017–2020 were included. Cycles with FET performed in January–May of 2020 (“COVID-surge cohort”) were compared to cycles with FET performed in January–May of 2017–2019 (“pre-COVID cohort”). Pregnancy rate (PR), clinical pregnancy rate (CPR), pregnancy loss rate (PLR), and clinical pregnancy loss rate (CLR) were compared between the cohorts.

Results: A total of 2629 single, euploid FET cycles were included: 2070 from January to May, 2017–2019 and 559 from January to May 2020. PR was similar when comparing FET performed from January to May 2020 (COVID-surge) to those performed from January to May, 2017–2019 (pre-COVID) (77.6% vs. 73.7%, p = 0.06), while CPR was higher among the COVID-surge compared to the pre-COVID cohort (65.5% vs. 60.0%, p = 0.02). No differences were seen in PLR and CLR among the COVID-surge and pre-COVID cohorts (28.3% vs. 32.0%, p = 0.08; 15.0% vs. 16.5%, p = 0.50). PR, CPR, PLR, and CLR were similar when comparing individual months between the cohorts. Adjusted analysis showed no differences in PR, CPR, PLR, or CLR when comparing the cohorts overall or when comparing corresponding individual months in the two time periods.

Conclusion: PRs and PLRs were not decreased when SARS-CoV-2 transmission was widespread in our geographic area, suggesting that high COVID-19 transmission does not compromise early pregnancy outcomes.

Perinatal outcomes of pregnant women having SARS-CoV-2 infection

OBJECTIVES

Aim of this study is to evaluate the prognosis of pregnant women having SARS-CoV-2 infection and investigate whether there was a difference in perinatal outcomes between pregnant women who had SARS-CoV-2 infection and those who did not.

MATERIALS AND METHODS

This prospective observational study was conducted with 116 singleton pregnancies. Cases enrolling in the study were divided into two groups. While those in the first group had a history of SARS-CoV-2 infection (n = 46) the second group consisted of healthy pregnant women (n = 70).

RESULTS

Emergency Cesarean section was performed on three SARS-CoV-2 infected pregnancies (30, 33 and 34 gestational weeks). Intensive care unit admission was required for all three cases after delivery and two of them died. Among the pregnancies that had an infection in the third trimester, 71.4% (n = 20) of them had delivery in 14 days after diagnosis and 17.4% (n = 8) of their newborns were followed up at newborn intensive care unit. Overall, only one newborn had a positive swab test result for SARS-CoV-2. There was no statistically significant difference between groups regarding their delivery week (37.02 ± 5.85 vs 38.5 ± 2.33). Similarly, there was no significant difference between groups, concerning mean age, parity, and birth weight (P = 0.707, P = 0.092, P = 0.334; P < 0.05). Furthermore, the difference between SARS-CoV-2 infected pregnancies that were followed up as inpatient or outpatient with respect to the delivery week and birth weight was not significant (p > 0.05). Also, APGAR 5 scores of hospitalized women (9.3 ± 1.1) were found to be lower than the outpatient group (9.8 ± 0.8) (P = 0.043; p < 0.05).

CONCLUSION

No significant difference was detected between groups in terms of the delivery week, birth weight, and APGAR scores. The inpatient group was found to have lower APGAR 5 scores.

COVID-19 and novel mRNA vaccines in pregnancy: an updated literature review

The novel coronavirus, SARS‐CoV‐2, or COVID‐19, has affected the world on a pandemic scale resulting in catastrophic outcomes and deaths. Currently, there is limited safety data specific to mRNA vaccine use in pregnant or lactating individuals and the potential risks to a pregnant individual and the fetus are unknown. We report an updated literature review of current information and evidence available to aid in the decision whether to vaccinate against COVID‐19 currently being made by pregnant individuals and their healthcare providers so that they are able to make a well‐informed recommendation and decision.