COVID-19 negatively associated with embryo and blastocyst quality


In a recent study, infection with COVID-19 during controlled ovarian stimulation was negatively associated with embryo and blastocyst quality.

COVID-19 negatively associated with embryo and blastocyst quality | Image Credit: © Kirsten D/ - © Kirsten D/ -

COVID-19 negatively associated with embryo and blastocyst quality | Image Credit: © Kirsten D/ - © Kirsten D/ -

According to a recent study published in JAMA Network Open, there is a negative association between COVID-19 infection during controlled ovarian stimulation (COS) and embryo and blastocyst quality.

Significant health effects from COVID-19 have been observed worldwide in the past 3 years, but COVID-19 control has been relaxed in countries such as China. At the same time, a rise in COVID-19 cases among couples during the use of assisted reproductive technology (ART) has occurred.

As angiotensin-converting enzyme 2 and transmembrane protease serine subtype 2 both present in male and female reproductive symptoms, making reproductive function potentially vulnerable to COVID-19 infection. However, there is little data on the association between COVID-19 infection and ART treatment outcomes.

To determine the association between COVID-19 infection during COS and oocyte- and embryo-related outcomes of ART, investigators conducted a multicenter, retrospective cohort study. Participants included couples where the woman was receiving in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.

Eligibility criteria included receiving COS and IVF or ICSI from October 1, 2022, to December 31, 2022, and testing for COVID-19 during COS. Exclusion criteria included undergoing oocyte or sperm donation cycles or oocyte freezing cycles, being unable to obtain oocytes, and being lost during follow-up.

Participants were divided into COVID-19-positive and COVID-19-negative groups. The COVID-19-positive group was further divided into 3 subgroups: female COVID-19-positive, male COVID-19 positive, and both-positive.

Categories of COS protocols included gonadotropin-releasing hormone (GnRH) agonist, GnRH antagonist, and other protocols. Transvaginal ultrasonography was used to evaluate follicular development, with 3 or more follicles with diameters of 17 mm or more indicating a need to perform oocyte retrieval.

Top-quality embryo and blastocyst rates and available embryo and blastocyst rates were measured as the primary outcome of the study. Secondary outcomes included mature oocyte rate, normal fertilization (2PN), number of oocytes collected, blastocyst formation rates, 2PN cleavage, and oocyte degeneration.

There were 585 couples with infertility included in the final analysis, with female partners aged a median 33 years. Of couples, 135 were in the COVID-19 positive group and 450 were in the COVID-19 negative group. Female partners had a median body mass index (BMI) of 22.1.

A median 2 years of infertility was observed among couples, with 53.7% having secondary infertility. A female factor primarily contributing to infertility was seen in 58.3% of couples.

The most common protocol was the GnRH antagonist, used in 50.6% of couples. Significant differences in infertility type and factors, BMI, and COS protocols were not observed between the COVID-19 positive group compared to the COVID-19 negative group. There were also no significant differences in ovarian reserve and ovarian response characteristics.

The 2 groups also did not significantly differin oocyte- and oocyte-related outcomes related to fertilization methods selection, oocyte degeneration rate, mature oocyte rate, 2PN rate, 2PN cleavage rate, and available embryo rate. However, a significantly lower top-quality embryo rate, blastocyst formation rate, available blastocyst rate, and top-quality blastocyst rate was seen in the COVID-19 positive group vs the COVID-19 negative group.

When comparing patient and cycle characteristics between female partners, male partners, and both partners infected during COS, no significant differences were found. However, the female COVID-19 positive group had a significantly lower mature oocyte rate, 2PN cleavage rate, top-quality embryo rate, available blastocyst rate, blastocyst formation rate, and top-quality blastocyst rate.

In the male COVID-19 positive group, the blastocyst formation rate, blastocyst-related rates, top-quality blastocyst rate, and available blastocyst rate were significantly lower. The blastocyst formation rate was significantly decreased in the female and male positive groups.

These results indicated a negative association between COVID-19 infection during COS and embryo-related outcomes. Investigators recommended reproductive physicians provide these couples with proper counseling.


Tian F, Li S, Li N, et al. Association of SARS-CoV-2 infection during controlled ovarian stimulation with oocyte- and embryo-related outcomes. JAMA Netw Open. 2023;6(7):e2323219. doi:10.1001/jamanetworkopen.2023.23219

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