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Review
. 2024 Sep 3;12(9):201.
doi: 10.3390/diseases12090201.

The Effect of COVID-19 and COVID-19 Vaccination on Assisted Human Reproduction Outcomes: A Systematic Review and Meta-Analysis

Andrea Milostić-Srb  1 , Nika Srb  1 , Jasminka Talapko  1 , Tomislav Meštrović  2   3   4 , Tihomil Žiger  1 , Stana Pačarić  1   5 , Rajko Fureš  1   6 , Vedrana Makarović  1   7 , Ivana Škrlec  1
Affiliations
Review

The Effect of COVID-19 and COVID-19 Vaccination on Assisted Human Reproduction Outcomes: A Systematic Review and Meta-Analysis

Andrea Milostić-Srb et al. Diseases. .

Abstract

The most discussed infectious disease is coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Many research endeavors have focused on the effects of the virus on reproductive organs, as these have also been shown to carry the receptors to which the virus attaches. The results of assisted reproductive technology (ART) have been significantly affected by the pandemic, with some in vitro fertilization (IVF) centers being closed due to the risk of further spread of the disease. According to World Health Organization statistics, 17.5% of adults worldwide suffered from fertility problems in 2023; in other words, one in six people in the world have reproductive health problems. As infertility is a growing problem in the modern world and new developments in assisted reproduction are always a topic of profound interest, it is important to understand the impact of SARS-CoV-2 on reproductive health. This systematic review aimed to examine studies describing patients undergoing ART procedures with a COVID-19-positive history and to shed light on the recent evidence on the safety of COVID-19 vaccination in the ART context. A meta-analysis was conducted to confirm the results of the systematic review. The results showed a significant difference in clinical pregnancy rates between the vaccinated and unvaccinated groups and an increased miscarriage rate in those with a COVID-19-positive history. However, no significant difference in clinical pregnancy and birth rates was found in participants with a previous COVID-19 infection. The results show that further studies and research are needed, even though the spread and impact of the virus have decreased. Evidence-based information for individuals and couples undergoing infertility treatment is vital to enable informed decision-making.

Keywords: ART; ART outcomes; COVID-19; COVID-19 vaccine; IVF; SARS-CoV-2.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the study’s design, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plot of studies of COVID-19 positive vs. COVID-19 negative for clinical pregnancy [38,39,40,42,44,45,47,48].
Figure 3
Figure 3
Forest plot of included studies on clinical pregnancy rate for vaccinated vs. not vaccinated participants [51,52,53,54,55,56,57].
Figure 4
Figure 4
Forest plot of studies of COVID-19 positive vs. COVID-19 negative for birth rates [39,42,45,47,48].
Figure 5
Figure 5
Forest plot of included studies on birth rate for vaccinated vs. not vaccinated participants [55,56,57].
Figure 6
Figure 6
Forest plot of studies of COVID-19 positive vs. COVID-19 negative for miscarriage rates [38,39,42,47,48].
Figure 7
Figure 7
Forest plot of included studies on miscarriage rate for vaccinated vs. not vaccinated participants [54,57].
Figure 8
Figure 8
Funnel plots of clinical pregnancy rate. (A) COVID-19 positive vs. negative participants, (B) vaccinated vs. unvaccinated participants.
Figure 9
Figure 9
Funnel plots of birth rate. (A) COVID-19 positive vs. negative participants, (B) vaccinated vs. unvaccinated participants.
See this image and copyright information in PMC

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