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Last revised November 23, 2022

Should you postpone fertility treatment after COVID infection?

The COVID pandemic has had a disruptive or even devastating effect on many people's lives. This was true for those couples undergoing fertility treatment. Early in the pandemic, there was a widespread closure of fertility clinics, as many locations did not deem fertility care an essential service. Now, fertility clinics are up and running once more — but COVID infections are still fairly rampant. Many patients are left wondering how COVID might impact their fertility treatments.

Let's address some of the main concerns regarding COVID infection, the vaccine, and the potential impacts these may have on fertility and treatment options by examining the most up-to-date research.

Key takeaways

  • COVID infection can have a short-term negative effect on male fertility. However, there is a lack of evidence examining the long-term effects. COVID infection does not appear to negatively impact female fertility.
  • Many experts advise patients to postpone fertility treatment for three months following infection to allow for full restoration of male fertility and maximum chances of success.
  • Sperm analysis and freezing are options to consider to minimize the disruption caused by COVID infections on future fertility treatment plans.
  • The COVID vaccine does not affect fertility or fertility treatment outcomes in either sex.

How does COVID infection affect fertility?

We now have some solid evidence to support expert guidance around fertility and COVID infection. To summarize, it appears that COVID infection — especially severe illness — is associated with temporarily reduced male fertility.

A 2022 study of over 2,000 people who were trying to conceive found that COVID infection in the male partner was associated with a reduced chance of pregnancy in the 2–3 months following recovery. If the female partner had COVID, there was no impact on the chances of conception. COVID vaccination didn’t affect fertility for either partner.

Male fertility and COVID infection

Initial studies found that COVID has at least a temporary effect on fertility hormones. Although we are two years down the line, research as to the impact of COVID on fertility long-term is still limited. Some men, post-infection, do show alterations in reproductive hormones, including decreased levels of testosterone alongside raised luteinizing hormone.

A 2022 review of COVID’s impact on male fertility found the male reproductive system to be highly vulnerable in cases of moderate to severe illness. The findings concluded that COVID infection could contribute to the following changes in male fertility:

Another study, carried out in February 2022, analyzed semen samples from men who had contracted COVID. In that study, COVID infection significantly affected both sperm count and quality. It found that sperm quality in affected patients improved over time, but took as long as six months in most cases. The sperm count had a shorter recovery time, of around 150 days.

Researchers believe the effect of COVID-19 on sperm quality may be partially due to the fever experienced during the infection period. Fevers are known to temporarily impact sperm quality and fertility due to the spike in internal body temperature, which affects the process of sperm production. Fevers can lead to:

Thankfully all of these changes are temporary, as the body constantly produces fresh sperm. However, this replenishment process can take 3 months or more.

Female fertility and COVID infection

COVID infection has been shown to disrupt the menstrual cycle. In addition, studies show that recovered women have positive levels of the virus in the follicular fluid. But a recent review of the research into the effect of COVID infection on female fertility has brought some reassuring news: these impacts all normalized within a few months of recovery.

Participating women had no significant alteration in ovarian reserves (how many eggs they had left). And in the aforementioned study of over 2,000 trying to conceive couples, COVID infection in the female partner wasn’t associated with a drop in chances of pregnancy.

Should couples planning IUI or IVF postpone treatment if one partner gets COVID?

Most of the evidence points to a temporary decrease in male fertility following COVID infection. The impact of COVID on chances of pregnancy will vary, depending on the severity of the infection and the baseline sperm quality of the male partner.

One study found that, although male fertility was affected by COVID, there was no significant impact on IVF outcomes in those couples who started treatment within three months of recovery. These studies had small sample sizes and only used participants with mild to moderate infections. Therefore, additional research is necessary to see if larger studies, or studies in those who have experienced severe COVID, mirror the same results.

Fertility treatments like IUI and IVF are expensive, sensitive procedures. Many couples want to do everything they can to maximize their chances of success with these fertility treatments.

Therefore, it may be wise to postpone fertility treatment for 3–6 months if possible, until semen quality recovers, following a bout of COVID in the male partner. Semen analysis after COVID can help hopeful parents identify when sperm quality has recovered. We recommend discussing the impact of COVID on IUI or IVF with your doctor.

Antioxidant therapy after COVID can help sperm quality recover

A study in the journal Human Reproduction compared semen samples from men taken pre- and 3–6 months post-COVID infection, when treated with antioxidant treatment. After three months, the study identified improvements across all three measured semen parameters (sperm count, motility, and morphology). Antioxidant treatment may be beneficial following COVID infection.

What to consider if you've had COVID?

There are a couple of considerations to bear in mind when thinking about fertility and COVID:

  1. Semen analysis can be beneficial after having COVID, due to a potential decrease in sperm quality. Depending on these results, you might want to delay treatment, if not already in motion, until sperm health is back to normal. Male fertility decline due to infection tends to resolve within a few months.
  2. Sperm freezing now may be a good idea. A frozen sperm sample would provide a useful “backup” option, and prevent the need to postpone treatment if there is a COVID viral infection.

Legacy provides mail-in sperm testing and sperm freezing options. Check out the Legacy kit to preserve your fertility within the safety and comfort of your own surroundings.

What about after the COVID vaccine?

A growing evidence base suggests that the vaccine does not affect fertility.

The Society for Male Reproduction and Urology (SMRU) and the Society for the Study of Male Reproduction (SSMR) issued a joint statement indicating that the vaccine should not be withheld from men desiring fertility treatment as the evidence suggest there are no negative impacts on male fertility caused by the COVID vaccine.

A large retrospective study compared 200 women receiving IVF treatment who had received the vaccine against 200 who had not. The encouraging news is that the vaccine did not affect these women's ovarian response or pregnancy rates. 

A study published in October 2022 also found that the inactivated COVID vaccine did not impact the outcomes of women who used frozen-thawed embryo transfer. This is supported by an additional study examining pre-clinical and IVF outcomes in vaccinated and unvaccinated women. There were no statistically significant differences in clinical outcomes between the two groups.

This suggests that women undergoing IVF treatment are also safe to have the COVID vaccine, knowing that it will not impact their fertility treatment outcomes.

If you’re trying to conceive during COVID

If you are trying to conceive during COVID, watch out for fevers. A fever can affect male fertility and may impact your chances of pregnancy. The good news is that any effects of infection appear to resolve within 3–6 months of infection. There is no current evidence to suggest that COVID infection will impact your fertility success in the long term.

It is also encouraging to see that having the vaccine will not impact your fertility plans, and may prevent severe infection (which is more likely to affect male fertility). If you plan to undergo fertility treatment, COVID vaccination and/or sperm freezing may protect against COVID-related disruptions to your fertility treatments.

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