COVID-19 IN ART

‘Reassuring’ data from ESHRE’s COVID-19 ART pregnancy registry

ESHRE’s COVID-19 Working Group has published its first registry report on infections during assisted reproduction.

Published 27 September 2021

Findings from the first analysis of ESHRE’s registry of COVID-19-affected ART pregnancies ‘offer reassurance’ that outcomes are similar to those found in spontaneous pregnancies.

The first report on ART pregnancies from the ongoing registry data of ESHRE’s COVID-19 Working Group suggests that clinical and safety outcomes in women infected during treatment or pregnancy are no different from those found in natural pregnancies.(1) The findings ‘offer reassurance’, write the authors, despite the limitations of the sample size and the collection of data by voluntary reporting (from ESHRE members).

The registry was initiated in May 2020 at a time when most fertility clinics were resuming services after a short period of lockdown closures. However, although infection rates were running high in most parts of the world, there was still little known with any certainty about the potential effect of SARS-CoV-2 infection in pregnancy. Moreover, according to ESHRE’s Working Group, it was possible that the virus might affect assisted and spontaneous pregnancies differently because of the ‘consistent data suggesting systematic differences’ between assisted and spontaneous pregnancies. Such differences, write the Group, are evident in rates of prematurity, birth weight and obstetric complications. Collection of outcome data from ART pregnancies in infected patients might offer some clarification.

The registry data were collected via an online survey of ESHRE members, which resulted in 80 eligible case deliveries up to the time of writing (June 2021), with a further 25 ongoing pregnancies. The data included information on the patient and her infection, pregnancy and outcomes, which was confirmed after submission.

Analysis of the data showed that most of the cases (72 ex 105 cases, 68.6%) were symptomatic, with fever the most frequent symptom (40.0%) followed by cough (35.2%) and anosmia (28.6%). Of the infected women, 31.4% were hospitalised for COVID-19, including 2.9% who received respiratory support and 1.9% who were treated in ICUs. Of these, 10.5% were detected during their ART treatment (including 15 days after embryo transfer), 30.5% in the first trimester, 20.0% in the second, and the remaining 39.0% during the third trimester or at delivery.

The LBR from the 80 pregnancies was 83.75%, with a 12.5% miscarriage rate. Of all the neonates, 22.2% were born preterm and 18.0% had low birth weight. Nearly half of them were PCR-tested for SARS-CoV-2, with just two positive cases.

The Working Group’s ‘reassurance’ is derived mainly from a comparison of its ART data with ongoing results found in COVID-19 infected mothers or in non-COVID-19 ART pregnancies. Patterns of symptoms, for example, were comparable with those found in a large systematic review of COVID-19 in pregnancy.(2) Rates of both preterm birth and miscarriage bore comparison with ESHRE’s own ART registry findings. However, on the latter the authors note that ‘our data does not suggest an alarming increase in miscarriage rates in MAR pregnancies affected by COVID-19’, although adding that an increased risk of miscarriage ‘cannot be confidently excluded’. Data on spontaneous COVID-19 pregnancies ‘are still dominated by third trimester infections’, which, explains the Working Group, limits firm conclusions on the incidence of miscarriage.

 

1. The ESHRE COVID-19 Working Group. Outcomes of SARS-CoV-2 infected pregnancies after medically assisted reproduction. Hum Reprod 2021; doi.org/10.1093/humrep/deab218

2. Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370: m3320. doi:10.1136/bmj.m3320.

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