July 11, 2020
I remember a funny Ellen Degeneres story in which the gynecologist talks about his golf game while doing a pap smear on Ellen. I remember thinking that the gynecologist must have done thousands of paps and they became so routine he forgot about how the patient was feeling during the experience.
Now, 22 years from medical school and thousands (probably close to 25,000) of speculum and ultrasound exams combined, I am now at the stage in my career where talking about my golf game seems very reasonable. I don’t golf but I do watch Netflix, listen to podcasts, wonder about people’s jobs, like to chat about the weather and can answer easy medical questions while in the midst of an exam like a pap smear. I truly try to “read” the patient. Many patients, I think, need me to shut up during an exam, many need me to tell them every detail of the procedure and, I think, some like some banter to get through the experience with their mind elsewhere. I’m pretty sure I don’t always read patients correctly, but I hope I do 90% or more of the time.
A couple of days ago I was doing hysteroscopy on a lovely woman. I had the scope way up inside her uterus checking out her tube openings and she said “you ought to blog about COVID and pregnancy.” So, here goes. Thanks to that patient for the topic suggestion and reminding me that chatter is sometimes appropriate in the midst of a deeply personal, uncomfortable medical exam. Here goes….
Let’s break down the points we should worry about COVID-19 and reproduction:
1. If you are pregnant and have COVID will it harm the pregnancy?
Likely not. Research published in April examined 118 pregnant women in Wuhan, China, with a COVID-19 infection and found they did not exhibit an increased risk of complications or severe disease versus non-pregnant women with similar age and infection.
Reference: Chen L, Li Q, Zheng D, Jiang H, Wei Y, Zou L, et al. Clinical characteristics of pregnant women with COVID-19 in Wuhan, China [letter]. N Engl J Med. Published online April 17, 2020.
Reports from the CDC in the USA have been less positive, suggesting that pregnant women in the third trimester who become infected with COVID-19 and have severe illness are more likely to deliver prematurely.
Corridor chat among obstetricians I know here in Vancouver would suggest that COVID-19 is like other respiratory tract infections in pregnancy. Respiratory tract infections in the third trimester can be more severe as the woman’s lungs are compressed by the baby pushing up, making them more likely to develop more severe symptoms.
So pregnant women in the third trimester should be especially vigilant to avoid COVID-19 infection.
2. If you are pregnant and have COVID-19 will it harm the baby/fetus?
There is no evidence of harm, from what we know so far. There have been babies born with COVID-19 antibodies suggesting a fetus could be exposed to the virus through the placenta but there has been no evidence of illness in the newborns. Some newborns have become infected after the birth and their outcomes have been excellent.
3. Can COVID-19 harm fertility?
The best and really the first study to examine whether the virus could impact sperm and eggs was published this month in Fertility & Sterility. It is known that the COVID-19 virus (SARS-CoV-2) requires two receptors on cells to enter. These receptors are ACE-2 and TMPRSS2. They are commonly both expressed in the lungs, hence COVID-19 is most commonly seen as a respiratory tract illness. That being said the virus has been identified in other tissues like bowel, heart and kidney. It has not been identified in the uterus nor the ovaries but no one has really gone looking. It has been found in the semen but the sperm in those semen samples appeared unaffected. This recent study found that these two receptors are NOT both (co-expressed) found in ovarian tissue and immature sperm. This is very reassuring.
Based on their results, the authors concluded that COVID-19 infection is unlikely to have long-term effects on male and female reproductive function.
Reference: Stanley KE, Thomas E, Leaver M, Wells D. Coronavirus disease-19 and fertility: viral host entry protein expression in male and female reproductive tissues. Fertil Steril. 2020;114(1):33-43.
SUMMARY: So far so good. We have a lot more (sadly) to learn about COVID-19 and fertility and pregnancy but what we know now has been quite reassuring. Perhaps this should not surprise us as there are hundreds of other similar viruses, respiratory and otherwise, that infect humans every year and the vast majority do not impact fertility.
Stay tuned. We will.
Dr. Beth Taylor MD, FRCSC
Reproductive Endocrinology & Infertility
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