If you’re trying to start or expand your family, you probably want to know whether COVID-19 could affect your fertility.

So far, it’s hard to say for sure. COVID-19 has only been around for a little over a year, so scientists haven’t had time to see if it has any long-term effects on fertility.

There are 3 main areas of concern for COVID-19 and fertility:

• Female fertility and damage to the female reproductive system
• Male fertility and erectile dysfunction
• Harm to the fetus and increased rates of miscarriage or stillbirth.

However, so far no studies have found that COVID-19 has a significant impact on any of these issues.

COVID-19 and female fertility

There are two reasons why scientists were concerned that COVID-19 could reduce fertility in women:

• The impact on ACE-2 receptors in the reproductive system
• The impact of inflammation on egg production

The coronavirus attacks the body by binding on to the ACE-2 receptors inside the cells, and the female reproductive system has a high concentration of ACE-2 receptors.

In women, ACE-2 receptors are part of the system that produces and matures new oocytes (egg cells) and controls ovulation and the regeneration of the endometrium, which is the lining of the uterus which receives the fertilized egg.

Inflammation is also known to affect egg production.

But no studies have found that COVID-19 has a noticeable effect on female fertility, which is good news.

COVID-19 and male fertility

Just like with female fertility, scientists were worried that inflammation, together with the effect of COVID-19 on ACE-2 receptors, could affect male fertility.

The male reproductive system has a very high concentration of ACE-2 receptors. In men, ACE-2 receptors can play a role in sperm production, so men who’ve had COVID-19 could see a drop in sperm quantity, quality, and motility.

Fever, inflammation, and disruption to the hypothalamic-pituitary-gonadal (HPG) axis, which controls the release of sex hormones, can affect testosterone levels and sperm production. That’s why other viral illnesses which cause fever and inflammation, like mumps and measles, can affect male fertility.

But so far, there’s very little evidence that male fertility is affected by COVID-19.

A recent study from January 2021 found that men who had severe COVID-19 saw both sperm concentration and sperm motility drop, and that sperm cell shape was altered following the illness. However, the same study found that all of these elements improved over time.

Other scientists pointed out that the study doesn’t make a clear link between COVID-19 and the impact on sperm production, because:

• The study size was very small
• The effects could come from COVID-19 treatments instead of from the virus itself
• It could be an association, since people with obesity and general poor health are more prone to severe COVID-19, and both obesity and poor health can also affect sperm production.

Once again, we’ll have to wait for more studies.

Erectile dysfunction

One study found that COVID-19 could be associated with erectile dysfunction (ED), causing a condition that’s being called “COVID penis.” The coronavirus attacks the inner walls of small blood vessels called endothelium, which play an important role in penile erection.

But stress and anxiety can cause ED, and the pandemic has increased everyone’s stress levels.

Scientists also point out that men who are generally in poor health are more at risk of ED, and they are also more likely to experience severe COVID-19, so it’s possible that their general ill health is the true cause of ED.

Pregnancy and COVID-19

There’s some evidence that pregnant women suffer from more severe COVID-19 than women who aren’t pregnant, but they aren’t more likely to catch it, and so far, there’s no sign that COVID-19 has a significant impact on pregnancy outcomes.

Doctors have seen a slightly higher rate of preterm birth among pregnant women with symptomatic COVID-19, but not among women with asymptomatic COVID-19. This could be caused by comorbidities which make COVID-19 more serious, instead of by the virus itself, especially since women who are asymptomatic aren’t more likely to give birth early.

There’s also no clear evidence that the fetus can be infected by COVID-19 through the placenta. The studies are very small, but they don’t show that the fetus is harmed by maternal COVID-19. Babies born to mothers with COVID-19 aren’t significantly smaller or showing signs of distress, and a study by the CDC found that there’s no greater risk of miscarriage for women with COVID-19.

COVID-19 lifestyle changes

COVID-19 changed the way we live, and that can have a knock-on effect on your fertility in a number of ways:

• Increased stress and anxiety about your health, work, and/or finances
• Unhealthy eating habits and alcohol consumption in reaction to higher stress levels
• Increasing or resuming smoking to calm your nerves
• Lack of exercise leading to weight gain and obesity

If you’re trying to start or add to your family, it’s important to follow COVID-19 guidelines and as always, continue caring for your physical and mental health. Whether you’re using IVF or hoping to conceive naturally, COVID-19 doesn’t need to derail your plans.