Covid and fertility
Many of my patients ask how covid might be affecting their fertility so I have prepared a blog to help answer some questions based on latest research and studies.
Why might covid affect fertility?
Whilst we know well that covid effects the lungs it is less well known that other areas of the body can be affected too
This is because Covid-19 (SARS-CoV02) encloses a spike protein (S protein) which allows for viral binding to Angiotensin-converting enzyme (ACE)
ACE-2 is a viral receptor that is widely expressed on the surface of MANY organs and tissues including cardiac, renal, intestinal, endothelial cells (arteries, veins, capillaries)
ACE-2 is also expressed to varying degrees in the OVARY, UTERUS, VAGINA, PLACENTA AND TESTIS
it has a role in regulating follicle development and ovulation
it modulates luteal angiogenesis (development of new blood vessels) and degeneration
it influences changes to the endometrial tissue and embryo development
it is also expressed in medium to high levels oocytes
It is because of the connection between Covid, ACE-2 and the reproductive system that there has been concern about how the virus may be negatively influencing fertility in terms of menstrual cycle, hormones, endometrium, ovarian reserve in terms of quality and quantity.
There have been some initial studies with differences in findings, but my feeling is that more concrete studies providing a clearer picture will be released over the next 6 months. This is what we know so far:-
How it affects the menstrual cycle
There have been many articles published mainly showing the results of online questionnaires and surveys, but they do cover thousands of women and reflect what I am seeing in my clinic.
All of the articles showed that covid can have an effect on menstrual cycles including:-
- cycles becoming longer
- cycles becoming shorter
- increased pain and new period pain
- changes in discharge across the month
- heavier bleeding
- decrease in menstrual flow
- absence of period
- increased pre-menstrual symptoms
- spotting throughout the cycle
- bleeding for more days
It seems that there is no ‘one issue’ that is arising from covid and the menstrual cycle. This would be in line with the Chinese medicine diagnostic framework and understanding that every person is different, and every person responds to illness differently too.
Exactly how long these variations in cycles last post covid is still not completely clear either but one point that came out of the studies very loudly was that the increase in stress, insomnia, and anxiety due to covid can also lead to issues with the menstrual cycle.
How covid effects ovarian reserve and its related hormones
Here is what research says about covid and its effects on ovarian reserve and those hormones that are measured when considering ovarian reserve. This is not a discussion on what is a good measure of ovarian reserve here so I will leave that at the door and report the findings!
It seems the jury is a still out in this regard. There were several studies that found very little difference in ovarian reserve and its related hormones in connection with covid which at first glances feels like very positive news, but these were the smaller studies (cohort under 120) unfortunately. Another study (1118 cohort) found the levels of AMH were significantly lower and basal follicle-stimulating hormone (FSH) levels were increased suggesting an impact on ovarian research hormones.
Again it is felt that more research needs to be carried out to fully understand covid’s impact here as it is not clear whether there is a long term implication to ovarian reserve or just temporary issues with the follicles that were active during covid.
Covid and it’s effects of embryos and oocytes
The research out there is again a bit sketchy and so we cannot currently see a clear picture to understand exactly what happens with covid and its effects on embryos and oocytes
My advice, as always, is to try and allow time between covid and IVF or other ART to get the you back on track health wise and to allow the reproductive system to recover as best it can. Whilst this is very disappointing when you have been trying to conceive for a long time, IVF can be a huge expense and rushing straight in post covid may not be beneficial.
When looking at a review of the literature published earlier in 2022 (therefore reviewing studies in 2020/21);
The amount of retrieved and mature oocytes and the fertilization rate were unharmed in three studies, except for one study, where the quantity of retrieved and mature oocytes was reduced in patients with higher levels of SARS-CoV-2 antibodies.
Unfortunately, it also says that the numbers of blastocysts, top-quality embryos, and euploid embryos were affected in most of the studies reviewed.
I strongly feel that more funding should be put towards studies to help understand exactly how covid affects fertility and research a wider spectrum of solutions to try and support those who are going through an extremely difficult time trying to conceive. Chinese medicine has a long and valuable history in supporting fertility issues and I am sure that its approach to improving chances of conceiving could be one solution that could reverse some of the negative effects of this virus.
Can Chinese herbal medicine help?
Chinese herbal medicine has 1000's of herbs in its materia medica and these herbs have been tried and tested over thousands of years so they can safely be combined to work synergistically to support the immune system, not only warding off illness but also treating during infection too. Chinese herbal medicine has also been used to aid fertility and support pregnancies for just as long.
Traditional Chinese medicine (TCM) uses a complex and thorough diagnostic framework, meaning each person’s health can be considered individually. It’s holistic approach allows different areas of health and illness to be considered within one treatment strategy in a way that would more than likely be treated by different specialisations in the West. This puts TCM in a unique position to potentially offer support for fertility during our covid times. It has a wealth of knowledge and experience that can highlight herbs that may work at different stages during and post a viral infection as well as potentially nourish the reproductive system.
Long covid – a lingering pathogen?
TCM going back thousands of years has understood that pathogens can becoming lingering in the body. This could be considered akin to ‘Long covid’. There are many routes into the body but a common route for a pathogen to take over its host is to initially comes in at a very superficial (Wei level – sore throat, aches) quickly spreading to the slightly deeper level in the body such as the mucous membranes that line the lungs and digestive system (Qi level – fever, sweating, diarrhoea etc) that quickly dries up the body fluids and other resources making the body defences weaker. The pathogen then is considered to lodge itself in this level continually fighting with the immune system. The immune system not being strong enough to clear it completely endures a long-term battle which weakens the system further creating ongoing fatigue and other symptoms.
I would love to see more research in this area to help provide solutions for those trying to conceive during these difficult times.
I always offer a free mini consultation where you have a chance to ask me any questions before we start bespoke herbal treatment. If you would like to find out more about how I might be able to support your health and fertility. Why don’t you get in touch? Email kate@katefreemantle.co.uk
ref: The Effects of SARS-CoV-2 Infection on Female Fertility. Int. J. Environ. Res. Public Health 2022
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