In Vitro Fertilisation and Covid-19: Insights From An Embryologist
Prof George Anifandis, Assistant Professor of Embryology, University of Thessaly, School of Health Sciences, Faculty of Medicine, Larissa, Greece
We interviewed clinical embryologist Prof George Anifandis, who discussed some of the key advances and challenges in reproductive medicine and delineated how COVID-19 has impacted fertility treatment and the effects it may have on in vitro fertilisation outcomes.
Written by Evgenia Koutsouki | Editor, EMG-Health
Q: As a person with years of experience in reproductive medicine, what made you chose this speciality and what advice would you give to someone starting a career in reproductive medicine today?
A: I’ve recently been appointed Assistant Professor of Embryology at the Faculty of Medicine of the University of Thessaly, Thessaly, Greece. I’m a member of the Scientific Committee of the University Hospital and also a member of the Research Bioethics Committee of the University of Thessaly. Clinical embryology is a very elegant occupation; nevertheless, everyone should be very dedicated because it comes with many responsibilities, such as gamete manipulation, fertilisation, embryo development, and freezing and thawing of gametes and embryos. In addition, quality control of the embryology lab and maintaining bioethical standards, raised by the aforementioned responsibilities, are core tasks of the embryologist. Therefore, for someone who would like to start a career in clinical embryology, I would first advise them to be familiar with the core embryology skills and second, to be dedicated in what they do. Every year, embryology endures many challenges and the biggest one is to help couples to get pregnant.
Q: Your past research includes studies on the effect of environmental factors such as herbicides and smoking on in vitro fertilisation (IVF) outcomes. To what extent are these determining factors for successful IVF outcomes?
A: As an embryologist, my research interests involve any factors that positively or negatively impact male and female gametes as well as embryos. Lately, my research has been focussed on environmental and lifestyle factors that may impact sperm parameters and IVF outcome. Specifically, cigarette smoking and alcohol consumption, either separately or combined, negatively impacted sperm DNA integrity through the measurement of the percentage of DNA fragmentation. The herbicide Roundup, and its basic constituent glyphosate, negatively affected sperm parameters, but without a significantly increasing of the percentage of DNA fragmentation after 1 hour of exposure. It is likely that more exposure time to glyphosate is needed for it to exert its effect on sperm DNA integrity. These studies confirmed that lifestyle factors and the exposure of herbicides to people may possibly affect the basic characteristics of sperm including DNA integrity, which should be transferred as intact as possible.
Q: In the last few years, what have been the key advances in reproductive medicine and what are the main future challenges to overcome?
A: Reproductive medicine, and especially embryology, has made many steps towards the golden goal: a successful pregnancy. The main advances in the field are the use of bioinformatics which serves as a helpful tool for predicting the IVF outcome and selecting the best, viable, and most potent embryo for implantation and ongoing pregnancy. Furthermore, although time-lapse monitoring does not significantly increase the possibility for achieving pregnancy, it provides the opportunity for the embryologist to examine which embryo is the best to transfer at the very early stages of development. Finally, IVF laboratory quality control measures require urgent advances. I specifically mean that all staff (including the embryology staff) must be trained to follow specific protocols (and not just the already known ones) for managing COVID-19, including the use of face masks to reduce transmission. I think the trajectory of COVID-19 has brought a unique challenge to the global reproductive healthcare community and appears to be the largest challenge to overcome over the next 2 years.
Q: In the UK, all elective fertility treatments have stopped until further notice as a result of COVID-19 creating anxiety and uncertainty to many couples undergoing fertility treatment. What are the grounds for such a decision? Could an infectious disease such as COVID-19 affect the outcomes of IVF?
A: The virus strain SARS-CoV-2, the virus that causes COVID-19, has continued to infect people worldwide; as a result of this, the European Society of Human Reproduction and Embryology (ESHRE) has recommended stopping all elective fertility treatment to limit the spread of COVID-19, which follows the national government advice. COVID-19 patients, or even asymptomatic patients, may possibly transmit the virus to the staff during communication or to the embryology staff. The opposite may also occur and jeopardise not only the spread of the virus but also have possible adverse effects on the gametes, embryos, and overall success rates. This means that an infectious disease such as COVID-19 may directly affect the IVF outcome.
Q: What are the known or potential effects of an infection such as COVID-19 on pregnancy and the foetus? Is there any evidence to support classifying pregnant women as a high-risk group?
A: To date (10th April 2020), limited data exists regarding the possible effect of COVID-19 on pregnancy or the foetus. Even more limited data exists regarding the impact of COVID-19 on early stages of embryo development (from fertilisation to implantation, and from implantation to the first trimester). Nevertheless, specific guidance has been provided by the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) for pregnant women in regard to COVID-19 on the basis and experiences from other childbearing coronavirus (SARS-CoV and MERS-CoV) patients. Women positive for COVID-19 delivered healthy infants, but there have been reports with adverse neonatal outcomes or even transmission of the virus from positive COVID-19 mothers to the baby. This data, although limited and not fully supported, may place pregnant women at a higher risk of illness.
Q: This year’s ESHRE Annual Meeting has, among other congresses, been cancelled. How have you been keeping up to date with progress in the field? What is the likelihood that online learning could eventually replace such events?
A: Indeed, all national, European, and world congresses have been postponed or cancelled. This is logical since COVID-19 has demonstrated a rapid escalation in regard to the number of people affected worldwide. Progress in the field of embryology or assisted reproduction may not be as fast as it was prior to the COVID-19 storm; however, research should still continue in order to have progress in this sensitive field. For instance, research on the impact of COVID-19 on assisted reproductive technologies might become one of the hot topics in the next 2 years. Various sites, including the press room of ESHRE news and other professional bodies (ACOG, RCOG), have formed working groups to monitor and check any scientific reports relevant to COVID-19 and reproductive medicine. Therefore, a way to keep in touch with the field is through the updated news from various sites. I don’t think that online learning can replace events such as the ESHRE Congress. These kinds of events are popular not only for the novel research presented but also for the wide communication between the representatives, something that cannot be replaced through online learning or online presentations.