Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review

Soheila Pourmasumi

doi:10.4274/balkanmedj.galenos.2023.2023-3-4

Soheila Pourmasumi^1,2, Nicholas G. Kounis³, Monavar Naderi⁴, Robabe Hosseinisadat⁵, Arezoo Khoradmehr⁶, Niloofar Fagheirelahee⁷, Sophia N. Kouni⁸, Cesare de Gregorio⁹, Periklis Dousdampanis¹⁰, Virginia Mplani¹¹, Marina A. Michalaki¹², Panagiotis Plotas¹³, Stelios Assimakopoulos¹⁴, Christos Gogos¹⁵, Georgios Aidonidis¹⁶, Pavlos Roditis¹⁷, Nikos Matsas¹⁸, Dimitrios Velissaris¹⁹, Gianfranco Calogiuri^20,21, Ming-Yow Hung^22,23,24, Ioanna Koniari²⁵

¹Social Determinants of Health Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
²Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
³Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
⁴Knowledge and Information Science, Vice Chancellor for Science and Technology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
⁵Department of Obstetrics and Gynecology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
⁶The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
⁷Department of Anatomy, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
⁸Speech Therapy Practice, Queen Olgas Square, Patras, Greece
⁹Department of Clinical and Experimental Medicine, University of Messina Medical School, Messina, Italy
¹⁰Department of Nephrology, Saint Andrews State General Hospital, Patras, Greece
¹¹Intensive Care Unit, Patras University Hospital, Patras, Greece
¹²Department of Internal Medicine, Division of Endocrinology, Fculty of Health Sciences, University of Patras, Patras, Greece
¹³Department of Speech Therapy, University of Patras, Patras, Greece
¹⁴Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, Patras, Greece
¹⁵COVID-19 Unit, Papageorgiou General Hospital, Thessaloniki, Greece
¹⁶Interbalkan Medical Center, Thessaloniki, Greece
¹⁷Department of Cardiology, Mamatsio Kozanis General Hospital, Kozani, Greece
¹⁸Cardiology Private Practice, Agrinion, Greece
¹⁹Department of Internal Medicine, University of Patras, Patras, Greece
²⁰Pneumonology Department, Civil Hospital “Ninetto Melli”, Pietro Vernoti, Brindisi, Italy
²¹Department of Internal Medicine, Immunology and Infectious Diseases, Section of Allergology and Clinical Immunology, University of Bari Medical School, Bari, Italy
²²Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
²³Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
²⁴Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan
²⁵Departmentof Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK

DOI : 10.4274/balkanmedj.galenos.2023.2023-3-4

Pages : 153-164

Abstract

Several studies and research papers have been published to elucidate and understand the mechanism of the coronavirus disease 2019 (COVID-19) pandemic and its long-term effects on the human body. COVID-19 affects a number of organs, including the female reproductive system. However, less attention has been given to the effects of COVID-19 on the female reproductive system due to their low morbidity. The results of studies investigating the relationship between COVID-19 infection and ovarian function in women of reproductive age have shown the harmless involvement of COVID-19 infection. Several studies have reported the involvement of COVID-19 infection in oocyte quality, ovarian function, and dysfunctions in the uterine endometrium and the menstrual cycle. The findings of these studies indicate that COVID-19 infection negatively affects the follicular microenvironment and dysregulate ovarian function. Although the COVID-19 pandemic and female reproductive health have been studied in humans and animals, very few studies have examined how COVID-19 affects the female reproductive system. The objective of this review is to summarize the current literature and categorize the effects of COVID-19 on the female reproductive system, including the ovaries, uterus, and hormonal profiles. The effects on oocyte maturation, oxidative stress, which causes chromosomal instability and apoptosis in ovaries, in vitro fertilization cycle, high-quality embryos, premature ovarian insufficiency, ovarian vein thrombosis, hypercoagulable state, women’s menstrual cycle, the hypothalamus-pituitary-ovary axis, and sex hormones, including estrogen, progesterone, and the anti-Müllerian hormone, are discussed in particular.

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