It's hard to even mention the uterus without diving into truckers. But I am going to try not to (too much). The recent Trucker Convoy has brought "pro" and "anti" vaxx clash to a pinnacle, and the media has been in a whirl of confusion about it. Is this a racist movement motivated by selfish individualism, or a working class, inclusive movement to question restrictions on freedoms? Can it be both, or neither? Either way, bodily autonomy and white supremacy was not the pairing we hoped for when we showed up to the wine and cheese.
What I've found difficult about getting information about the vaccine, is that it is hard to strip away ideology and politics from evidence. How do we keep the baby when it’s time to ditch the bath water?
I have received a few requests for my opinion on the vaccine from the standpoint of fertility, and likewise spoke to clients whose doctors have given contradictory information on the matter. I wanted to carve out a small space to share some studies thus far on menstrual and reproductive outcomes of COVID 19 (and its variants) and the COVID vaccine.
The reality is: many of us get our information from social media, and recent whistleblowing on Facebook, for example, has shown us that algorithms determine what comes in our feed. When we swing one way, the information we receive will match our tendencies. If we want to move away from the biases inherent to social media, then going firsthand to the evidence is always a good idea. But what should we ask of the standards of those studies?
Things to look for to assess the quality of a scientific study:
• how many people participants were included in the study? (in other words, can we make generalizations based on the study size)
• how diverse is the demographic? (what ages and identities were included?)
• was it a double blind study? (i.e. one in which neither the participants nor the experimenters know who is receiving a particular treatment)
• which journal was it published in and what is the reputation of that journal? (for example, is the study peer reviewed; the journal well-established, etc.?)
• how long term is the study?
Our current circumstance is that, whether it's the vaccine or COVID, we just don't know and can't know long term effects on reproductive health. But this doesn’t change the fact that we have to make decisions based on the evidence we have..
Working in complementary healthcare, you learn early on that you're working at a disadvantage. There are large corporate interests at play that will put a disproportionate amount of money into trials on drugs and surgeries ($$-makers) versus things like physical therapy, massage therapy or herbal protocols. There was an international race and tons of money thrown at the project of creating a vaccine, but how much money was put towards exploring various herbal protocols to mitigate impacts of or build immunity to COVID 19? Not a lot.
But there's a perfect world, and the one we live in... so here goes! May you be informed about your personal and collective health concerns. I am posting this as a blog post, and will be updating articles. Please send me any pertinent articles as they come to your attention and we can make this a community effort.
MENSTRUAL HEALTH
The global pandemic and changes in women’s reproductive health: an observational study (January 2022)
https://www.tandfonline.com/doi/full/10.1080/13625187.2021.2024161
Study participants from 15 countries contributed to a total of 13,194 cycles. 23.1% (268/1159) responded to the survey focussed on assessing psychosocial distress. 44.4% (119/268) of the study participants reported that they had noticed a change in their menstrual cycle, temperature curve, or menstruation in the past 12 months. Cycle analysis found the average cycle length and pre-ovulation phase length was longer in the first 6 months of 2019, while the average days of menstruation was slightly longer in 2020.
COVID-19 vaccines linked to small increase in menstrual cycle length (January 2022)
Updated study on effect on menstrual cycle – important take away change is temporary and within the range of normal variation (many things can affect cycle – not unusual to vaccine or significant)
FERTILITY
COVID Vaccine and Ovarian Reserve (TBD)
COVID Vaccine and ovarian reserve using AMH levels. This study is coming from Israel, where the population was amongst the first to be vaccinated. It is in the stage of clinical trials.
A prospective cohort study of COVID-19 vaccination, SARS-CoV-2 infection, and fertility (January 2022)
Some reproductive-aged individuals remain unvaccinated against COVID-19 due to concerns about potential adverse effects on fertility. We examined the associations of COVID-19 vaccination and SARS-CoV-2 infection with fertility among couples trying to conceive spontaneously using data from an internet-based preconception cohort study. We enrolled 2,126 self-identified females residing in the U.S. or Canada during December 2020-September 2021 and followed them through November 2021. We fit proportional probabilities regression models to estimate associations between self-reported COVID-19 vaccination and SARS-CoV-2 infection in both partners with fecundability, the per-cycle probability of conception, adjusting for potential confounders. COVID-19 vaccination was not appreciably associated with fecundability in either partner. Female SARS-CoV-2 infection was not strongly associated with fecundability. Male infection was associated with a transient reduction in fecundability. These findings indicate that male SARS-CoV-2 infection may be associated with a short-term decline in fertility and that COVID-19 vaccination does not impair fertility in either partner.
SPERM HEALTH
Sperm Parameters Before and After COVID-19 mRNA Vaccination (June 2021)
In this study of sperm parameters before and after 2 doses of a COVID-19 mRNA vaccine, there were no significant decreases in any sperm parameter among this small cohort of healthy men. Because the vaccines contain mRNA and not the live virus, it is unlikely that the vaccine would affect sperm parameters. While these results showed statistically significant increases in all sperm parameters, the magnitude of change is within normal individual variation and may be influenced by regression to the mean.5 Additionally, the increase may be due to the increased abstinence time before the second sample. Men with oligospermia did not experience further decline.
The limitations of the study include the small number of men enrolled; limited generalizability beyond young, healthy men; short follow-up; and lack of a control group. In addition, while semen analysis is the foundation of male fertility evaluation, it is an imperfect predictor of fertility potential. Despite this, the study’s time frame encompasses the full life cycle of sperm.
Covid-19 vaccination BNT162b2 temporarily impairs semen concentration and total motile count among semen donors
We found a selective temporary decline of sperm concentration and total motile count 3 months post-vaccination followed by recovery among SD. While on first look, these results may seem concerning, from a clinical perspective they confirm previous reports regarding vaccines' overall safety and reliability despite minor short-term side effects. Since misinformation about health-related subjects represents a public health threat,23 our findings should support vaccinations programs. Further studies concentrating on different vaccines and populations (ex. subfertile patients) are urgently required.
MISCARRIAGE
COVID-19 and miscarriage: From immunopathological mechanisms to actual clinical evidence (November 2021)
Infections by other coronaviruses, such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV), appear to increase the risk of miscarriage.
The estimate of the overall miscarriage rate in pregnant women with COVID-19 was 15.3 % (95 % CI 10.94-20.59) and 23.1 (95 % CI 13.17-34.95) using fixed and random effect models, respectively. Based on the data in the current literature, the miscarriage rate (<22 weeks gestation) in women with SARS-CoV-2 infection is in the range of normal population. Well-designed studies are urgently needed to determine whether SARS-CoV-2 infection increases the risk of miscarriage during periconception and early pregnancy.
COVID-19 and cause of pregnancy loss during the pandemic: A systematic review (August 2021)
There is an increased risk of abortion in mothers with a positive test result of SARS-CoV-2, which several case reports and case series have identified during the pandemic. Placental inflammation during the viral infection may result in fetal growth retardation and induce abortion. There has not been any consistent evidence of vertical transmission of the virus from mother to fetus, which requires further investigation.
Increased incidence of first-trimester miscarriage during the COVID-19 pandemic
(April 2021)
Did not find increased miscarriage rates
Spontaneous Abortion Following COVID-19 Vaccination During Pregnancy (September 2021)
Among women with spontaneous abortions, the odds of COVID-19 vaccine exposure were not increased in the prior 28 days compared with women with ongoing pregnancies. Strengths of this surveillance include the availability of a multisite diverse population with robust data capture. Several limitations should be noted. endations and to counsel patients.
Covid-19 Vaccination during Pregnancy and First-Trimester Miscarriage (November 2021)
Our study found no evidence of an increased risk for early pregnancy loss after Covid-19 vaccination and adds to the findings from other reports supporting Covid-19 vaccination during pregnancy.
PREGNANCY
Placental Tissue Destruction and Insufficiency from COVID-19 Causes Stillbirth and Neonatal Death from Hypoxic-Ischemic Injury: A Study of 68 Cases with SARS-CoV-2 Placentitis from 12 Countries (February 2022)
The pathology abnormalities composing SARS-CoV-2 placentitis cause widespread and severe placental destruction resulting in placental malperfusion and insufficiency. In these cases, intrauterine and perinatal death likely results directly from placental insufficiency and fetal hypoxic-ischemic injury. There was no evidence that SARS-CoV-2 involvement of the fetus had a role in causing these
Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons (June 2021)
Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes.
The Incidence, Severity, and Management of COVID-19 in Critically Ill Pregnant Individuals (September 2021)
The rate of SARS-CoV-2 infection in pregnancy does not appear to be higher than in the general population; however, compared to their non-pregnant counterparts, pregnant individuals have higher morbidity and mortality, with a higher risk of intensive care unit (ICU) admission, mechanical ventilation, and need for extracorporeal membrane oxygenation (ECMO). They also have a higher frequency of pre-eclampsia, Cesarean delivery, and a higher rate of preterm birth.
Care of the critically ill pregnant patient with COVID-19 requires a multidisciplinary team that includes obstetrics, neonatology, anesthesia, infectious diseases, medicine, and critical care.
Potentially life-saving evidence-based therapies such as corticosteroids and tocilizumab should not be withheld from pregnant individuals with severe COVID-19.
Vaccines against SARS-CoV-2 are safe to use among pregnant individuals and vaccination is highly recommended in this population.