Impact of prior coronavirus disease 2019 infection in females on assisted reproductive outcomes: A systematic review with meta-analysis

ObjectivesTo investigate the relationship between prior coronavirus disease 2019 (COVID-19) infection in females and subsequent treatment outcomes of assisted reproductive technology (ART).MethodsA systematic literature review was carried out up to 16 December 2022, in PubMed, Web of Science, EMBASE, and Cochrane Library. Random-effect models were adopted to estimate the pooled effects as mean differences (MDs) or odds ratios (ORs). I2 statistic and Egger's test were applied to assess heterogeneity and publication bias, respectively.ResultsAfter screening 1480 records, 15 cohort studies totalling 1905 cycles were included in this meta-analysis. In a comparison of previously COVID-19-infected versus uninfected women, no significant differences were observed in the primary outcomes of the retrieved oocytes number (MD = 0.06; 95% confidence interval [CI]: -0.75-0.88; I2 = 0) and clinical pregnancy rate (OR = 0.96; 95% CI: 0.74-1.24; I2 = 0). Pooled analyses of other predefined outcomes, which encompassed four cycle characteristics, six laboratory indicators and four pregnancy results, also showed no adverse effects of prior COVID-19 infection. Most outcomes remained consistent after further sensitivity and subgroup analyses, and no significant publication bias was observed.ConclusionsOur work provides the first systematic evidence that COVID-19 infection history in females may have no measurable detrimental impact on the subsequent ART cycle. More data are needed to assess the live birth outcome and the optimal time interval from infection to assisted reproduction.