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      Impact of COVID-19 convalescence on pregnancy outcomes in patients undergoing IVF/ICSI during fresh ART cycles: a retrospective cohort study

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          Abstract

          Objective

          The aim was to study the impact of coronavirus disease 2019 (COVID-19) convalescence on female fertility and laboratory and clinical outcomes in fresh assisted reproductive technology (ART) cycles.

          Methods

          In this retrospective cohort study, we analyzed data from 294 patients who had recovered from COVID-19 and who underwent fresh ART cycles between January and March 2023 (COVID-19 group). This group was compared with 631 patients who underwent similar ART cycles in the same period in 2022 but without having been infected with COVID-19 (non-COVID-19 group). The analysis focused on comparison of basic demographic characteristics and laboratory parameters of patients in each group. The primary outcome measure was the clinical pregnancy rate, which was examined to assess the impact of COVID-19 infection on the efficacy of ART treatment.

          Results

          Basal follicle-stimulating hormone (FSH) levels were significantly lower and antral follicle count (AFC) was markedly higher in the COVID-19 group compared to the non-COVID-19 group (P<0.001 and P=0.004, respectively). The predominant ovarian stimulation protocol in the COVID-19 group was GnRH antagonists (64.85%, P<0.001), with a reduced gonadotropin (Gn) dosage and duration in comparison to the non-COVID-19 group (P<0.05). Although the number of blastocysts formed was lower in the COVID-19 group (P=0.017), this group also exhibited a higher blastocyst freezing rate and a higher rate of high-quality embryos per retrieved oocyte (P<0.001 and P=0.023, respectively). Binary logistic regression analysis indicated that COVID-19 convalescence did not significantly impact clinical pregnancy rates in fresh transfer cycles (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.68-1.96, P=0.5874). However, smooth curve-fitting and threshold effect analysis revealed an age-related decline in clinical pregnancy rates in both groups, more pronounced in the COVID-19 group, for women aged over 38 years, with the likelihood of clinical pregnancy decreasing by 53% with each additional year of age (odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.61–1.08, P=0.1460; odds ratio [OR] = 0.47, 95% CI = 0.21–1.05, P=0.0647).

          Conclusions

          Our findings present no substantial evidence of adverse effects on clinical pregnancy outcomes in fresh ART cycles in patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) during the period of convalescence from COVID-19. However, age emerges as a significant factor influencing these outcomes. Notably, for women above 38 years of age, the likelihood of clinical pregnancy in patients with a prior COVID-19 infection decreased by 53% with each additional year. This highlights the importance of considering maternal age, especially in the context of COVID-19, when evaluating the likelihood of successful pregnancy following ART treatments.

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          Most cited references41

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          Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues

          Background Since its discovery in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 2 180 000 people worldwide and has caused more than 150 000 deaths as of April 16, 2020. SARS-CoV-2, which is the virus causing coronavirus disease 2019 (COVID-19), uses the angiotensin-converting enzyme 2 (ACE2) as a cell receptor to invade human cells. Thus, ACE2 is the key to understanding the mechanism of SARS-CoV-2 infection. This study is to investigate the ACE2 expression in various human tissues in order to provide insights into the mechanism of SARS-CoV-2 infection. Methods We compared ACE2 expression levels across 31 normal human tissues between males and females and between younger (ages ≤ 49 years) and older (ages > 49 years) persons using two-sided Student’s t test. We also investigated the correlations between ACE2 expression and immune signatures in various tissues using Pearson’s correlation test. Results ACE2 expression levels were the highest in the small intestine, testis, kidneys, heart, thyroid, and adipose tissue, and were the lowest in the blood, spleen, bone marrow, brain, blood vessels, and muscle. ACE2 showed medium expression levels in the lungs, colon, liver, bladder, and adrenal gland. ACE2 was not differentially expressed between males and females or between younger and older persons in any tissue. In the skin, digestive system, brain, and blood vessels, ACE2 expression levels were positively associated with immune signatures in both males and females. In the thyroid and lungs, ACE2 expression levels were positively and negatively associated with immune signatures in males and females, respectively, and in the lungs they had a positive and a negative correlation in the older and younger groups, respectively. Conclusions Our data indicate that SARS-CoV-2 may infect other tissues aside from the lungs and infect persons with different sexes, ages, and races equally. The different host immune responses to SARS-CoV-2 infection may partially explain why males and females, young and old persons infected with this virus have markedly distinct disease severity. This study provides new insights into the role of ACE2 in the SARS-CoV-2 pandemic.
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            Neuroinvasion of SARS-CoV-2 in human and mouse brain

            Neurological symptoms are frequently observed in COVID-19. Here, we examine the neuroinvasive potential of SARS-CoV-2 and demonstrate infection of neurons in three separate approaches: mouse model, human brain organoid, and autopsy of COVID-19 patients.
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              Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019

              This cohort study examines the clinical characteristics of men with coronavirus disease 2019 whose semen tested positive for severe acute respiratory syndrome coronavirus 2.
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                Author and article information

                Contributors
                Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/2553080Role: Role: Role: Role:
                Role: Role: Role:
                Role: Role: Role:
                Role: Role:
                Role: Role:
                URI : https://loop.frontiersin.org/people/1333778Role: Role:
                Role:
                Journal
                Front Endocrinol (Lausanne)
                Front Endocrinol (Lausanne)
                Front. Endocrinol.
                Frontiers in Endocrinology
                Frontiers Media S.A.
                1664-2392
                29 January 2024
                2023
                : 14
                : 1298995
                Affiliations
                [1] 1 Department of Reproductive Medicine, The Second Hospital of Hebei Medical University , Shijiazhuang, China
                [2] 2 Second Department of Respiratory and Critical Care Medicine, The Second Hospital of Hebei Medical University , Shijiazhuang, China
                Author notes

                Edited by: Emanuele Garzia, Santi Paolo e Carlo Hospital, Italy

                Reviewed by: Arup Acharjee, Allahabad University, India

                Federico Cirillo, Humanitas Research Hospital, Italy

                *Correspondence: Zhiming Zhao, doctor_zhaozhao@ 123456sina.com ; Wensen Pan, deeprespiration@ 123456163.com

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fendo.2023.1298995
                10860335
                38348053
                7cb3c7e8-81dc-4a3f-8f27-a3e50f91475c
                Copyright © 2024 Cao, Han, Feng, Lu, Wang, Sun, Zhao and Pan

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 22 September 2023
                : 20 December 2023
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 41, Pages: 10, Words: 5387
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by S&T Program of Hebei (22377742D) and Government Funded Clinical Medical Talents Training Project of Hebei Province in 2023 (ZF2023107)
                Categories
                Endocrinology
                Original Research
                Custom metadata
                Reproduction

                Endocrinology & Diabetes
                sars-cov-2,covid-19,fertility,ivf,clinical outcomes
                Endocrinology & Diabetes
                sars-cov-2, covid-19, fertility, ivf, clinical outcomes

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