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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 1-2

Oncofertility and the corona pandemic


Director, Mother and Child Hospital Scientific Director Ferticity Fertility Clinics

Date of Submission29-Dec-2020
Date of Acceptance30-Dec-2020
Date of Web Publication30-Jan-2021

Correspondence Address:
Dr. Nalini Kaul
Mother and Child Hospital D-64 Defence Colony New Delhi

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2589-9597.308412

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How to cite this article:
Kaul N. Oncofertility and the corona pandemic. Onco Fertil J 2020;3:1-2

How to cite this URL:
Kaul N. Oncofertility and the corona pandemic. Onco Fertil J [serial online] 2020 [cited 2021 Feb 28];3:1-2. Available from: https://www.tofjonline.org/text.asp?2020/3/1/1/308412



The year 2020 will go down in history as the year of the corona/SARS-COV-2 pandemic. In November of 2019, reports started filtering in of an outbreak of a highly transmissable viral infection, in Wuhan (China). Shortly thereafter, other countries started reporting cases, and it was realized that this virus was highly transmissible and lethal. Countries ordered lockdowns, banned international travel, and advised people to stay indoors to prevent spread – the whole world came to a virtual standstill, brought to its knees by a small spiky virus, whose nature was still a mystery. Routine medical services were curtailed, hospitals ran only emergency services, and patients avoided going to hospitals/private clinics for fear of exposure to COVID-19.

The advisory on reproductive medicine was that only essential procedures should be carried out.[1] The presence of the virus in semen was reported,[2] increasing the uncertainty about carrying out assisted reproductive technology (ART) procedures. Initial reports of the effect of COVID-19 on pregnancy varied based only on observations made in a small number of cases. It was suggested that the virus did not cross the placental barrier, hence the possibility of vertical transmission was low,[3] though this theory was challenged. Increased risk of miscarriages was also suggested due to the effect of virus on the vascular system.[4] Lack of information coupled with the inability to combat complications arising from COVID-19 infection, led physicians and fertility societies to advise against not only ART but even planning natural conception.[3] It is ironical then that the number of women getting spontaneously pregnant in this period increased and this applied to those waiting for ART as well! Some reports do not suggest an increased risk of severe illness in pregnancy compared to general population,[5] however, updated data from the American Centers for Disease Control (January–October 2020)[6] suggest that although the absolute risks for severe outcomes were low, there was an increased risk for pregnant women for severe COVID-19-associated illness. Mortality[6] and miscarriage rates were similar.[7] As experiences with this infection increase, we will get more robust information; for now, one has to work with what is available.

Offering and conducting fertility preservation procedures during the pandemic faced its own challenges. Although oncofertility was considered an emergency service, only highly motivated patients sought the service. Referrals and fertility preservation counseling in India and perhaps globally were pushed into the background. In an atmosphere filled with fear, oncology treatment took precedence over fertility and even oncology services were subject to enormous delays.

In this context, it is extremely important to know if there is an increased morbidity or mortality in cancer patients who get infected with SARS CoV-2. While it has been established that mortality rates are higher in patients with comorbidities such as diabetes, obesity, cardiovascular disease, and renal disease, there is paucity of such information for cancer patients. Preliminary data from the Italian National Institute of Health (Istituto Superiore di Sanità) suggest that the mortality is more than 20% in cancer patients with hematological disease, due to treatment-induced concurrent immunosuppression.[8] However, a multivariate analysis in patients with other cancers suggests that the oncologic condition is not an independent risk factor of poor prognosis.[9]

The risk of disease transmission to gametes in COVID-19-positive patients is still being debated. Semen cryopreservation should be advised in male COVID-19-positive cancer patients since recent reports do not confirm the presence of virus in seminal fluid.[10] Data on transmission of virus to the oocyte in infected women are not available, hence it is not possible at this time to definitively advise or deny them fertility preservation (FP). Fertility preservation procedures should be initiated after a nasopharyngeal swab has been tested for COVID-19 RNA. It is advisable to evaluate the COVID-19 proteome in the seminal plasma of such samples before freezing to avoid cross-contamination.[5],[11]

Lessons learned from this pandemic will be valuable for any widespread infectious disease in the future. In the meanwhile, providing adequate care in a safe environment remains the goal in oncofertility.



 
  References Top

1.
American Society for Reproductive Medicine (ASRM). Patient Management and Clinical Recommendations During the coronavirus (COVID-19) Pandemic. Update #1 (March 30, 2020 through April 13, 2020). Available from: https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforceupdate1.pdf. [Last accessed on 2020 May 20].  Back to cited text no. 1
    
2.
Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical characteristics and results of semen tests among men with coronavirus disease 2019. JAMA Netw Open 2020;3:e208292.  Back to cited text no. 2
    
3.
Covid- Coronavirus. 19: ESHRE statement on pregnancy and conception. Available from: https://www.eshre.eu/Press-Room/ESHRE-News#COVID19WG. [Last accessed on 2020 May 20].  Back to cited text no. 3
    
4.
Hayakawa S, Komine-Aizawa S, Mor GG. Covid-19 pandemic and pregnancy. J Obstet Gynaecol Res 2020;46:1958-66.  Back to cited text no. 4
    
5.
Rodriguez-Wallberg KA, Wikander I. A global recommendation for restrictive provision of fertility treatments during the COVID-19 pandemic. Acta Obstet Gynecol Scand 2020;99:569-70.  Back to cited text no. 5
    
6.
Zambrano LD, Ellington S, Strid P, Galang RR, Oduyebo T, Tong VT, et al. Update: Characteristics of symptomatic women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status-United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641-7.  Back to cited text no. 6
    
7.
Rotshenker-Olshinka K, Volodarsky-Perel A, Steiner N, Rubenfeld E, Dahan HM. COVID-19 pandemic effect on early pregnancy: Are miscarriage rates altered, in asymptomatic women? Arch Gynecol Obstet 2020;9:1-7.  Back to cited text no. 7
    
8.
von Lilienfeld-Toal M, Vehreschild JJ, Cornely O, Pagano L, Compagno F; EHA Infectious Disease Scientific Working Group, et al. Frequently asked questions regarding SARS-CoV-2 in cancer patients-recommendations for clinicians caring for patients with malignant diseases. Leukemia 2020;34:1487-94.  Back to cited text no. 8
    
9.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.  Back to cited text no. 9
    
10.
Zhu H, Wang L, Fang C, Peng S, Zhang L, Chang G, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr 2020;9:51-60.  Back to cited text no. 10
    
11.
Silvestris E, Dellino M, Depalo R. Fertility preservation in cancer patients at the time of COVID-19 pandemic. J Gynecol Obstet Hum Reprod. 2020; 9;49:101910.  Back to cited text no. 11
    




 

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