|Year : 2020 | Volume
| Issue : 1 | Page : 1-2
Oncofertility and the corona pandemic
Director, Mother and Child Hospital Scientific Director Ferticity Fertility Clinics
|Date of Submission||29-Dec-2020|
|Date of Acceptance||30-Dec-2020|
|Date of Web Publication||30-Jan-2021|
Dr. Nalini Kaul
Mother and Child Hospital D-64 Defence Colony New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kaul N. Oncofertility and the corona pandemic. Onco Fertil J 2020;3:1-2
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. The presence of the virus in semen was reported, 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, though this theory was challenged. Increased risk of miscarriages was also suggested due to the effect of virus on the vascular system. 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. 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, however, updated data from the American Centers for Disease Control (January–October 2020) 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 and miscarriage rates were similar. 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. However, a multivariate analysis in patients with other cancers suggests that the oncologic condition is not an independent risk factor of poor prognosis.
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. 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.,
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.
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