COVID-19 Baby Boomers? Far From It…

Scientific Background

COVID-19 is harming the sperm of patients, even weeks after recovery, Israeli doctors have concluded, raising concerns that the disease could reduce fertility. In an interview provided to The Times of Israel, Prof. Dan Aderka of Sheba Medical Center said “Men who had the mild disease had a broadly normal sperm quality…But those who had the disease in moderate or serious form often didn’t, even after recovery...These men had a reduction of around 50% on average of the number of sperm per millilitre, total volume of ejaculate, and motility of sperm”. This figure reflects testing that was carried out around a month after diagnosis.

Aderka, a Tel Aviv University professor, further said he is concerned that a minority of men who had COVID-19 could face fertility problems or even “permanent sterility” Aderka is now starting to implement ongoing sperm monitoring for some recovered Sheba patients, to assess the long-term impact of the disease on male fertility.

In a single-centre, hospital-based observational study that included autopsied testicular and epididymal specimens of deceased COVID-19 male patients (n=6) and recruited recovering COVID-19 inpatients (n=23) with an equal number of age-matched controls, impairment of spermatogenesis was observed in COVID-19 patients, which could be partially explained as a result of an elevated immune response in testis. Additionally, autoimmune orchitis occurred in some COVID-19 patients. Further research on the reversibility of impairment and developing treatment are warranted.

There is growing body of evidence, testifying towards the mechanisms of increased male infertility, related to COVID-19 infection, such as direct virus-induced testicular damage, virus-induced damage of spermatogenesis, virus-induced damage of the epididymis, indirect cytokine-mediated infertility, inflammation-mediated infertility, antibody-mediated infertility by SARS-CoV-2, high-fever and steroid-mediated infertility.


Baby Boom? On the Contrary

Back in March `20, when first entering lockdown to prevent the novel coronavirus’ spread, headlineafter headlineafter headline forecast a massive baby boom in about nine months. Recently it become more and more apparent how flawed that prediction was. Far from surging, fertility in the United States – which recently hit a 35-year low – continues to drop.

A Forbes article dated Oct 13 `20 reported that The Brookings Institution has estimated that the U.S. birth rate is expected to decline by approx. 7-10% in `21, which would amount to about 300,000 to 500,000 fewer births. Further reported there is A Guttmacher Institute survey that found 34% of women reported their interest to get pregnant later or wanted fewer children because of the COVID-19 pandemic (source: The expected Coronavirus Baby Boom Isn’t Planning Out – Here’s Why, Forbes, Oct 13th, `20

In June, Brookings - the public policy nonprofit - published a report that predicted a decline of between 300,000 and 500,000 births as a result of the pandemic. To arrive at that number, the researchers looked at how birth rates were affected after both the Great Recession of 2008, which led to a 9% drop in births over the next four years, and the 1918 Spanish flu pandemic, which resulted in a 12.5% decline.

This article by Brookings cites Phillip Levine, an economics professor at Wellesley College and a co-author of the report, said the theory that birth rates will go up as a result of the pandemic is inconsistent with the economics of fertility. Prof Levine commented "We decided to investigate and draw our own conclusions". Prof Levine further commented in this report "We concluded the exact opposite. ... The main takeaway we should be expecting out of this is a significant decline in the number of births next year".

But there are competing elements at work, said Jennifer Horney, an epidemiology professor at the University of Delaware.

"We do expect to see a reduction in fertility when we have a reduction in work-life balance, which many people are probably seeing," Horney said. "The stress and the mental and physical health effects of this are going to be really longstanding," she said. "For example, the response of some employers to what's happened with the economy has been to reduce and stop contributions to employees' retirement plans. That may set people back in their plans for a family." For those seeking fertility services, demand has remained steady throughout the pandemic, said Allison Bloom, an attending physician at Main Line Fertility.


What does this all mean for the QART?

Prior to effects of COVID-19, contemporary clinical outcome of IVF, and in particular, ICSI, stands at approx. 1 live birth per 5 ÷ 6 per embryo transfers. Taken together with the reduced sperm quality caused by COVID-19, we believe the need to optimize gamete identification and characterization would significantly increase. QART technology stands at the heart of such a trend and believes its technology would prove a critical instrument in improving the clinical success rate.