Since a new type of coronavirus, SARS-CoV-2, was identified in December 2019 in Wuhan, China, this infection has spread to more than 190 countries and there are currently 29,737,453 infected people, producing 937,391 deaths. Coronaviruses have caused epidemics in the past such as SARS-CoV in 2003 or MERS-CoV in 2012. SARS-CoV and SARS CoV-2 recognize the same receptor in human cells which is the angiotensin converting enzyme type 2 (ACE2), while MERS-CoV binds to the receptor called dipeptidyl peptidase type 4.
Initial scientific reports indicated that the main organ affected in COVID-19 was the lungs, now it has been seen that it also affects other organs such as the liver, kidney, blood vessels, therefore any organ or tissue that expresses the angiotensin 2 receptor easily it could be linked with the virus and produce the whole process of affection at the cellular level. It is in this context that research arises that relate the ability of SARS-CoV-2 to affect the reproductive cells of men and possibly those of women; as occurs with other viruses such as herpes simplex (decreases in seminal volume), papillomavirus (decreases sperm mobility), human immunodeficiency virus (produces morphological changes in sperm). The risk of vertical transmission of SARS-CoV-2 between women and fetuses is possible knowing that the ACE2 receptor is also expressed in the placenta and the uterus of pregnant women as established by Levy in 2008 (American Journal of Physiology), therefore could influence the increased frequency of gestational losses (abortions) in pregnant women with COVID-19.
The effects on sex cells have been demonstrated in studies in China and Italy, where it is highlighted that the male is the most affected, SARS-CoV-2 would produce orchitis which in turn reduces the sperm count and increases the fragmentation index sperm DNA (indicator of the degree of breakage or damage of the sperm DNA). In the case of women, the degree of affection of the ovarian reserve has not yet been determined, that is, the reduction in oocytes that this virus could produce. In males, COVID-19 specifically affects a group of cells that are the precursors of spermatozoa called spermatogonia, as well as Sertoli and Leydig cells that express high concentrations of ACE2, while spermatozoa express low concentrations of ACE2 ; which is why there are few reports of SARS-CoV-2 findings in semen.
The reproductive health services in the world have been affected by this pandemic as the health systems through governmental and scientific organizations (American Society for Reproductive Medicine) have given priority to the treatment of patients with coronavirus; indicating the suspension of elective procedures and assisted reproductive techniques (ART) to avoid a possible admission to Intensive Care Units due to ART complications. Despite this, it is undeniable that there was a group of patients in the process of preparing to undergo both low (intrauterine insemination) and highly complex fertility procedures (oocyte aspiration, in vitro fertilization, embryo transfer) which have been suspended to reorient efforts to control and prevent the spread of this disease according to directives from the World Health Organization, which indicate that fertility procedures should be restricted for those patients diagnosed with cancer. It is true that there is an unsatisfied demand for fertility services in the world and this reality is not alien to what happens in Peru, where some private fertility centers have the required security measures; They are already performing office care, low complexity procedures, ovarian stimulation, etc. Considering the context of the pandemic, the psychological impact that has been accentuated in couples with fertility problems is highlighted, as shown by the study published in August 2020 in the European Journal of Obstetrics and Gynecology and Reproductive Biology that indicates that the The level of depression and anxiety is more pronounced, especially in women of advanced reproductive age or those with reduced oocytes.
In sum, the need to suspend fertility procedures during the COVID-19 pandemic have contributed to increasing emotional stress and anxiety in infertile couples, effects that should not be underestimated, psychological support in these patients should be considered; For this reason, I consider it valid that these specialized health services are gradually opened, not only in the public part but also in the private sphere, since they are enormously beneficial for families who have difficulties in achieving a pregnancy.