Can we forget about Covid or is it still relevant in the surrogacy journey?

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Even though masks are no longer mandatory and enforced isolation a thing of the past, Covid remains ever present. But how does that affect the world of reproductive medicine? Advisory Board Member Carole Gilling-Smith from The Agora Clinic discusses …

Covid is a bit like the weather, everyone likes to talk about it, it affects our daily lives and when it gets bad, it can really mess up our plans. So whilst Covid no longer keeps us indoors and isolated, it certainly hasn’t gone away and the continued emergence of new variants means that statistically, most people of reproductive age who are out and about and socialising normally are unlikely to get through the next 12 months without being infected, whether they are vaccinated or not.

In the world of fertility care I inhabit, the two most common ‘Covid’ questions I get asked is ‘how long should I wait after getting Covid before starting fertility treatment’ and ‘Can Covid vaccination affect my fertility or chances of treatment working?’. The answer to the second question is simple; none of the available Covid vaccinations have been shown to have any negative impact on reproductive health or treatment cycle outcome, either in the short or long term and we advise all our patients to go for the full vaccination schedule. This is because not being vaccinated could lead to more severe infection and significantly affect sperm health and the health of the developing baby. Within the context of surrogacy, the answer to the first question really depends on the role you are playing in that journey. In other words, are you the provider of sperm, eggs and/or the surrogate carrying the pregnancy? In this blog, I have reviewed the latest science on Covid and fertility to provide some answers and guidance to those planning a surrogacy journey.

The impact of Covid on sperm

The behaviour of SARS-CoV-2, the virus that causes Covid, has been extensively studied since it first emerged as a virus of concern in early 2020 and in terms of reproductive health, the main focus has been on understanding whether the virus can attach to the reproductive organs ie the testicles, ovaries and uterus and/or enter and attack eggs, sperm or embryos. It is now well established that SARS-CoV-2 can enter the testicles and attack the sperm forming cells, and indeed the sperm itself as they mature and develops within the testicles. As a result, a single episode of Covid can have quite significant knock on effects on sperm volume and count as well as sperm motility and genetic health. Sperm volume, count and motility can be measured using a home sperm test or laboratory based semen analysis but sperm genetic health can only be measured using a laboratory based DNA fragmentation test, which is not part of the routine sperm test. However this test is increasingly relevant in preparing for treatment as we know that good sperm genetic health increases the chances of good embryo genetic health and this in turn increases the chances of a successful treatment outcome. The degree of damage to sperm health by Covid depends on how many viral particles get into the testicle which is related to how severe the Covid infection has been. The damage to sperm health can last for at least 3 months after a single bout of
infection, as this is the time it takes for sperm to develop within the testicle. There have also been reports of Covid causing epididymitis, an infection of the coiled tubes that sit on top of the testicle and hold the sperm before they are ejaculated. The symptoms of epididymitis are a hot, red, tender swollen testicle.
Advice for those providing the sperm: The impact of Covid infection if you are providing sperm in the surrogacy pathway should not be underestimated. That is why it is really important to do a Covid test before you provide a sperm sample for treatment. Not only can the SARS-CoV-2 virus be present in the semen sample, having Covid can temporarily, negatively affect sperm quantity and quality. My advice to anyone providing sperm in a surrogacy arrangement is to consider freezing and quarantining the sperm samples when you know you are in peak health and as a result your sperm health is at its best and certainly when you know you have not had Covid in the preceding 3 months. Always do a Covid test on the morning you provide your sample and only proceed if the result is negative. I would also advise completing the course of vaccination as it will reduce the chances of severe infection and more severe, longer lasting damage to sperm health.

The impact of Covid on eggs

SARS-CoV-2 has not been shown to enter the ovary or attach itself to eggs and has not been found in the fluid or cells around the eggs. The latest research has concluded that there is no short or long term impact of Covid infection on egg genetic health or on ovarian reserve and egg yield in a treatment cycle. The markers of egg reserve such as AMH and antral follicle numbers are not impacted by infection with Covid. In terms of the menstrual cycle, both Covid and the Covid vaccinations have been reported to have a short lived effect on the menstrual cycle and many report a longer or shorter cycle for a couple of months after either infection or vaccination but the important thing is that neither in any way impact fertility or chances of conception.

Advice for those providing the eggs

Firstly, complete the Covid vaccination course before you start treatment. Secondly, if you get Covid in your lead up to treatment, you only need to delay starting treatment until you feel well in yourself and of course you are testing negative. I would advise doing a Covid test during your cycle if you develop any symptoms suggestive of Covid, as you do not want to be unwell on the day of egg collection. If you are
also planning to carry the pregnancy, then you should stop treatment and fully recover (see next section).

The impact of Covid on the embryo and developing baby

If you get Covid in early pregnancy, there is no real evidence to suggest that the virus could attach to and infect the embryo and lead to cycle failure or miscarriage. However, if you are unvaccinated and develop Covid during later pregnancy, you could develop much more severe symptoms and these could be life threatening. In addition, there could be some significant consequences on the baby such as an increased risk of stillbirth and, long term, an impact on the neurological health of the baby.

Advice for surrogates

I would advise all surrogates to complete the full course of Covid vaccinations to protect themselves and the developing baby. It has been shown to reduce the risk of stillbirth by 15%. In fact in some countries, Covid vaccination is mandatory to receive fertility care.