Effects of COVID-19 Infection on Live Birth Rates in Fresh Embryo Transfer Cycles

Overview

This retrospective study of 1,025 fresh embryo transfer cycles found that COVID-19 infection was associated with a significantly lower live birth rate (LBR) and higher mid-to-late miscarriage rates compared to non-infected patients. The negative impact on LBR was particularly pronounced when infection occurred 28–84 days before oocyte retrieval with fever ≥ 38.5°C or when both partners were infected.

Background

COVID-19, caused by SARS-CoV-2, has raised concerns regarding its effects on assisted reproductive technology (ART) outcomes due to the virus's affinity for ACE2 receptors expressed in reproductive tissues. Previous studies have shown inconsistent effects of COVID-19 on IVF outcomes, with some reporting no significant differences and others noting increased miscarriage rates. Professional societies have recommended suspending fertility treatments during active infection, highlighting the need for evidence-based guidelines. This study aims to clarify the impact of COVID-19 infection on live birth and neonatal outcomes following fresh embryo transfer cycles.

Data Highlights

Key Findings

• COVID-19 infection was associated with a significantly reduced live birth rate (adjusted OR 0.655; P=0.006) in fresh embryo transfer cycles.
• Mid-to-late miscarriage rates were markedly higher in the COVID-19 infected group (adjusted OR 7.929; P<0.001).
• Infections occurring 28–84 days before oocyte retrieval accompanied by fever ≥38.5°C significantly lowered live birth rates (OR 0.467; P=0.002).
• Couples with both partners infected showed a significant reduction in live birth rates (OR 0.591; P=0.002).
• Neonatal outcomes such as newborn gender, birth height, and birth weight did not differ significantly between infected and non-infected groups.

Clinical Implications

Clinicians should consider the timing and severity of COVID-19 infection when planning fresh embryo transfer cycles, as infection within 28–84 days prior to oocyte retrieval with high fever or dual-partner infection may adversely affect live birth outcomes. These findings support cautious evaluation of proceeding with IVF treatments in recently infected patients and highlight the need for individualized risk assessment. Larger multicenter studies are warranted to further guide clinical decision-making.

Conclusion

COVID-19 infection negatively impacts live birth rates in fresh embryo transfer cycles, especially when infection occurs within a critical window before oocyte retrieval accompanied by fever or when both partners are infected. These results underscore the importance of tailored ART management in the context of COVID-19.

Related Resources & Content

1. Tangdu Hospital, Fourth Military Medical University, 2023 -- Effects of COVID-19 Infection on Live Birth Rates in Fresh Embryo Transfer Cycles