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Women who were previously infected with COVID-19 did not have decreased chances of success with assisted reproduction treatment, according to a small observational study.

Among a cohort of 46 patients with prior SARS-CoV-2 infection, there were no significant differences in average anti-Mullerian hormone (AMH) levels before and after they got sick (1.73 vs 1.61 ng/ml, respectively), reported Maria Cruz Palomino, PhD, of the IVI Madrid fertility clinic.

For women with a normal ovarian reserve, AMH levels -- which indicate a woman's ovarian reserve status -- declined from 4.6 to 3.1 ng/ml. However, this decrease was unlikely to compromise a patient's ability to produce eggs for fertilization, said Palomino during her presentation at the annual meeting.

"Generally, the data showed no variation in AMH levels before and after SARS-CoV-2 infection," Palomino said in a press release. "We could assume that the chances of success in [patients'] fertility treatment remained intact."

Palomino added that while the researchers did observe a small drop in AMH levels among recovered COVID-19 patients with normal ovarian reserve, the decrease likely would not affect the chances of achieving pregnancy, and may not even be attributed to SARS-CoV-2 infection.

Albert Hsu, MD, an assistant professor of clinical ob/gyn at the University of Missouri in Columbia, who was not involved in this study, said that while these findings provide some information about SARS-CoV-2 and fertility, more data are needed before stating that COVID-19 infection does not impact chances of IVF success. Additionally, Hsu stated that AMH levels, which the study authors used to indicate ovarian reserve status, may not actually convey how likely it is for in vitro fertilization (IVF) patients to conceive.

"Anti-Mullerian hormone is a great predictor of how many eggs I am going to get when I stimulate a woman with IVF," Hsu told 番茄社区app. "It very much does not predict pregnancy."

Because SARS-CoV-2 binds to the ACE-2 receptor, which is widely expressed in the ovaries, some have raised concerns about how COVID-19 infection might affect ovarian reserve, Palomino's group stated. However, initial studies have shown between COVID-19 and loss of fertility in reproductive-age women.

In this study, Palomino and colleagues recruited patients from 11 clinics in Spain who had IVF between May and June of 2020. All 46 study participants had documented baseline hormone levels before receiving a positive test for COVID-19.

Researchers analyzed AMH levels as an indicator of their response to fertility treatment. Around 16 participants had a low ovarian reserve (AMH <1 ng/ml), and 30 had normal ovarian reserve status (AMH ≥1 ng/ml). The average age for patients with low and normal ovarian reserve was 39 and 35, respectively.

AMH levels remained stagnant in women with low ovarian reserve, from 0.8 ng/ml before infection to 0.7 ng/ml afterward.

Palomino and colleagues emphasized that this was a small study, and is not robust enough to inform public health recommendations. Additionally, because this is an observational study, results are limited by potential confounding.

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