A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility - PubMed (original) (raw)

. 2022 Jul 23;191(8):1383-1395.

doi: 10.1093/aje/kwac011.

Elizabeth E Hatch, Kenneth J Rothman, Tanran R Wang, Mary D Willis, Jennifer Yland, Holly M Crowe, Ruth J Geller, Sydney K Willis, Rebecca B Perkins, Annette K Regan, Jessica Levinson, Ellen M Mikkelsen, Lauren A Wise

A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility

Amelia K Wesselink et al. Am J Epidemiol. 2022.

Abstract

Some reproductive-aged individuals remain unvaccinated against coronavirus disease 2019 (COVID-19) because of concerns about potential adverse effects on fertility. Using data from an internet-based preconception cohort study, we examined the associations of COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with fertility among couples trying to conceive spontaneously. We enrolled 2,126 self-identified female participants aged 21-45 year residing in the United States or Canada during December 2020-September 2021 and followed them through November 2021. Participants completed questionnaires every 8 weeks on sociodemographics, lifestyle, medical factors, and partner information. 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 (i.e., the per-cycle probability of conception), adjusting for potential confounders. COVID-19 vaccination was not appreciably associated with fecundability in either partner (female fecundability ratio (FR) = 1.08, 95% confidence interval (CI): 0.95, 1.23; male FR = 0.95, 95% CI: 0.83, 1.10). Female SARS-CoV-2 infection was not strongly associated with fecundability (FR = 1.07, 95% CI: 0.87, 1.31). Male infection was associated with a transient reduction in fecundability (for infection within 60 days, FR = 0.82, 95% CI: 0.47, 1.45; for infection after 60 days, FR = 1.16, 95% CI: 0.92, 1.47). 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.

Keywords: COVID-19; SARS-CoV-2; fecundability; fertility; preconception; prospective cohort; vaccination.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

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Figures

Figure 1

Figure 1

Association between female partner receipt of coronavirus disease 2019 (COVID-19) vaccine by first day of menses and fecundability, stratified by selected variables, Pregnancy Study Online, December 2020–November 2021. The reference group comprises individuals who were unvaccinated as of the first day of menses. Estimates are adjusted for age; educational attainment; household income; current smoker; private health insurance; hours/week of work; rotating shift work; night shift work; body mass index; intercourse frequency; doing something to improve chances of conception; sleep duration; Perceived Stress Scale score; Major Depression Inventory score; having had a Pap smear in past 3 years; history of infertility; parity; irregular menstrual cycles; menstrual cycle length; geographic region of residence; last method of contraception; occupation in health-care industry; race/ethnicity; days since December 14, 2020; and ever tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The _x_-axis is plotted on the natural log scale. CI, confidence interval.

Figure 2

Figure 2

Association between male partner receipt of coronavirus disease 2019 (COVID-19) vaccine by first day of menses of the female partner and fecundability, stratified by selected variables, Pregnancy Study Online, December 2020–November 2021. The reference group comprises individuals who were unvaccinated as of the first day of menses of the female partner. Estimates are adjusted for age; educational attainment; household income; current smoker; private health insurance; hours/week of work; rotating shift work; night shift work; body mass index; intercourse frequency; doing something to improve chances of conception; sleep duration; Perceived Stress Scale score; Major Depression Inventory score; having had a Pap smear in past 3 years; history of infertility; parity; irregular menstrual cycles; menstrual cycle length; geographic region of residence; last method of contraception; occupation in health-care industry; race/ethnicity; days since December 14, 2020; and ever tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The _x_-axis is plotted on the natural log scale. CI, confidence interval.

Figure 3

Figure 3

Association between time since female (A) and male (B) partner coronavirus disease 2019 (COVID-19) vaccination and fecundability, fit using restricted cubic splines, Pregnancy Study Online, December 2020–November 2021. The black solid line represents the fecundability ratio (FR), the gray shaded area represents the 95% confidence band, and the black dotted line represents the reference FR of 1.0. The splines have knots at 30, 60, 90, and 120 days. The reference group comprises unvaccinated individuals and individuals who were vaccinated at least 180 days ago. Splines are adjusted for age; educational attainment; household income; current smoker; private health insurance; hours/week of work; rotating shift work; night shift work; body mass index; intercourse frequency; doing something to improve chances of conception; sleep duration; Perceived Stress Scale score; Major Depression Inventory score; having had a Pap smear in past 3 years; history of infertility; parity; irregular menstrual cycles; menstrual cycle length; geographic region of residence; last method of contraception; occupation in health-care industry; race/ethnicity; days since December 14, 2020; and ever tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Figure 4

Figure 4

Association between time since female (A) and male (B) partner severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and fecundability, fit using restricted cubic splines, Pregnancy Study Online, December 2020–November 2021. The black solid line represents the fecundability ratio, the gray shaded area represents the 95% confidence band, and the black dotted line represents the reference fecundability ratio of 1.0. The splines have knots at 30, 60, 90, and 120 days. The reference group comprises individuals who have never tested positive for SARS-CoV-2 and who tested positive at least 180 days ago. Splines are adjusted for age; educational attainment; household income; current smoker; private health insurance; hours/week of work; rotating shift work; night shift work; body mass index; intercourse frequency; doing something to improve chances of conception; sleep duration; Perceived Stress Scale score; Major Depression Inventory score; having had a Pap smear in past 3 years; history of infertility; parity; irregular menstrual cycles; menstrual cycle length; geographic region of residence; last method of contraception; occupation in health-care industry; race/ethnicity; days since December 14, 2020; and received coronavirus disease 2019 (COVID-19) vaccination.

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