The COVID-19 vaccine does not cause sterility! Misinformation spread on social media and false reports circulated have raised questions about whether the COVID-19 vaccine causes female sterility. As a result, there has been a concerning increase in vaccine hesitancy in reproductive-age women. Rest assured, these are unfounded claims. New research has proved that the vaccine does not cause female sterility.
Vaccine hesitancy among this group was largely caused by a false report, shared on social media, that said the spike protein on the coronavirus was the same as another spike protein syncytin-1, which is involved in the development and attachment of the placenta during pregnancy. The report claimed that receiving the COVID-19 vaccine would cause the body and immune system to attack the other spike protein (syncytin-1) and harm fertility. These two spike proteins are different. Receiving the COVID-19 vaccine does not affect the fertility of women hoping to conceive, including through in vitro fertilization (IVF).
Further, when Pfizer was testing vaccines, 23 women volunteer participants became pregnant and did not experience issues with fertility because of the vaccine. The only one who tragically suffered a pregnancy loss did not receive the vaccine, instead receiving the placebo.
Report SARS-CoV-2 spike protein seropositivity from vaccination or infection does not cause sterility published in the American Society for Reproductive Medicine Journal Fertility & Sterility Reports debunks this myth of sterility at the hands of the vaccine.
Randy Morris, M.D. used IVF frozen embryo transfer (FET) to understand the impact of COVID-19 seropositivity (presence of a serological marker for SARS-CoV-2 in the blood) on embryo implantation. He did this by comparing the implantation rates for SARS-CoV-2 vaccine seropositive (received vaccine), infection seropositive (previously infected with COVID-19), and seronegative women. The study found no difference in maternal serum hCG levels after an embryo transfer or sustained implantation rates across the three groups. Serum hCG levels were measured because human chorionic gonadotropin (hCG) is produced by placental syncytiotrophoblasts following embryo implantation and can be used in the early detection of pregnancy.
The research shows that seropositivity to the SARS-CoV-2 spike protein, whether from vaccination or previous infection with COVID-19, did not hinder embryo implantation or the early stages of pregnancy. Neither infection with COVID-19 nor antibodies produced from the vaccine will cause female sterility. Infection with the disease, however, may have an impact on pregnancy and the mother’s health.
“We hope that all reproductive-aged women will be more confident getting the COVID-19 vaccine, given Dr. Morris’s findings that the vaccine does not cause female sterility,” said Hugh Taylor, M.D., president of the American Society for Reproductive Medicine. “This, and other studies of this nature, further reinforce the ASRM COVID Task Force guidance that, no matter where you are in the family-building process, the COVID-19 vaccine is safe and saves lives.”
Sources
Sperm Preparation for ART is necessary! When sperm is ejaculated it is surrounded by fluid (seminal fluid). A typical ejaculate contains cells, debris, dead and damaged sperm, and healthy, motile sperm. Healthy sperm is critical to the success of ART procedures and so we use sperm preparation techniques to separate functional spermatozoa for IUI, IVF, and ART and for cryopreservation. In the IVF lab there are essentially 4 techniques we use commonly; Swim-up, Swim-down, Sucrose and Ficoll-400 density gradient techniques. Each lab finds that one of these techniques will yield more motile, live and normal looking sperm for their procedures.
The density gradient sperm wash is one of the most popular sperm washing methods. This is because it also works to separate dead sperm cells, white blood cells, and other waste products from the sperm. A test tube is filled with multiple layers of liquids of different densities. Semen is then placed on the top layer of liquid and the test tube is spun in a centrifuge. After it is spun, active, healthy sperm will make their way, to the very bottom layer of the liquid in the test tube, while debris and dead sperm will get caught in the top two layers. These layers can be siphoned off, in order to remove the active sperm from the test tube.
Companies like ZyMot sell specialty devices for sperm preparation and separation that can be very expensive. The idea is that they simulate the cervical and uterine pathways that sperm must navigate to naturally fertilize an egg. By mimicking this natural selection method, sperm can be isolated without the use of chemicals or centrifugation that may damage the sperm. Instead they use microfluidic technology to isolate healthy sperm by laminar flow, which creates gradients through channels. These devices have been tested in randomized controlled trials, which is the gold standard of medical research.
ICSI was developed for men with poor sperm quality and quantity. Low sperm count, sperm motility, and abnormal morphology can be indications for ICSI. Abnormal morphology (shape of sperm) has been linked to poor fertilization. Fertilization can now be achieved for men where it previously seemed impossible. It is now used exclusively in some clinics, and it is especially important for couples who want to have their embryos genetically tested. One of the reasons why it is so widely used now, is so that the embryologists can look at the eggs and know the quality and maturation right after the egg retrieval. In conventional IVF, the egg quality and maturity is essentially a mystery because the eggs are surrounded by cells until the day after the fertilization. Fertilization rates are generally higher after ICSI compared to conventional IVF. The more embryos you have the better the chance of pregnancy!
One variation of ICSI is called “PICSI” which stands for physiological ICSI, and uses a specialized dish coated in a substance called hyaluronan. Healthy sperm are attracted to that enzyme and stick to it, they are later used to inject the egg with.
Collecting Sperm Samples At Home
Some IVF labs may request that you and your partner collect the semen sample at home. Should patients be worried about the quality of the sample?
Originally, IVF labs insisted on “on site” collection, due to chain of custody and identification requirements. We want to see your husband/ partner face, match it to their ID, and know that the sample left their body and went straight into our own hands.
Should you be worried? It depends on the starting quality of the sperm. 99.9% of samples will be absolutely fine. In fact, once the sample makes it into the lab, it’s going to sit and “liquify” anywhere between 20 minutes to an hour or more. If male factor infertility is present, then it’s probably best to be collected in lab. For example, if retrograde ejaculation is suspected, then we need to collect all the urine AFTER the ejaculation event. Sperm are extremely hardy, and in fact they prefer a bit lower temperatures. Room temperature is perfect. Sperm are designed to withstand days in the punishing and selective vagina, cervix, and reproductive tract. The vagina first tries to kill all the sperm with acidic secretions and white blood cells. Then it sets the sperm on a race through a maze (cervix-uterus-fallopian tube), to reach the egg. In the collection cup, the sperm will be protected in the seminal fluid, and nurtured by the sugars present in it. Just follow all the lab instructions, don’t let the cup get too hot or too cold. Deliver it during the right window of time.
Sperm Preparation Techniques for HIV+ Patients
Data shows that up to 25% of semen specimens from men with an undetectable burden of viral RNA (HIV particles in their blood) are HIV positive. Each semen sample must be tested because those results are not consistent. HIV is detected in some samples and not others from the same man, even when HIV is not detected in the blood. SPAR stands for special program of assisted reproduction. They have developed highly sensitive techniques for sperm preparation, to detect the viral load in semen samples viruses like HIV, CMV, and Hepatitis C, and special procedures to wash the semen samples. This allows the sperm to be used for IVF to decrease or virtually eliminate the risk of transmitting the infection. These specimens can only be used for IVF, they are not appropriate for intrauterine insemination.
Male Fertility and Lifestyle Factors are present in up to half of couples. The prevalence of male infertility makes semen analysis one of the most important fertility tests, and it should be performed prior to any female therapy.
Male infertility means that a man may not deliver the appropriate quantity or quality of sperm to reach and fertilize an egg. Sperm are manufactured in the testicles and travels through the epididymis and the vas deferens when ejaculated. Sperm require three months to develop, which means a semen analysis done today is reflective of the conditions three months earlier. The conditions that originally caused male infertility may no longer be present. The IVF Lab will gently wash and prepare the sperm for your ART procedure. Each lab has a slightly different method to separate the sperm with the highest motility for use in IVF or ICSI.
It seems obvious that heavy alcohol drinking can impair sperm production and disrupt hormones in men while in women it can increase the time it takes to conceive. Smoking can damage sperm DNA in men or damage eggs and affect ovulation in women. Fertility specialists often recommend not consuming caffeine and alcohol during fertility treatments. The study “Alcohol and Caffeine Consumption and Decreased Fertility,” published in Fertility and Sterility demonstrates just that. But did you know about these 5 things that can negatively impact male fertility?
1. Did you know drinking soda has been linked with a 20% reduction in the average monthly probability of conception for both men and women? Energy drinks likely have the same effect but require more study (Boston University, Hatch et al.)
2.The following common medications may cause male fertility problems: some antibiotics, spironolactone, cimetidine, nifedipine, sulfasalazine and colchicine.
3. Very common STIs such as chlamydia, gonorrhea, mumps or HIV and other health conditions, such as diabetes, high blood pressure and depression
4. Enlarged veins in the tested (varicocele).
5. Constant exposure to high temperatures, like saunas or hot tubs, laptop computers, or workers exposed to heat stress.
Male Infertility Diagnoses
Sperm Motility
Sperm motility is important in fertility because sperm need to move through the woman’s reproductive tract to reach and fertilize her egg. Poor sperm motility can be a cause of Male Factor Infertility.
Did you know that infertility due to male factors ranges from 20% to 70% and that the percentage of infertile men ranges from 2·5% to 12% worldwide? Infertility rates are highest in Africa and Central/Eastern Europe. Additionally, according to a variety of sources, rates of male infertility in North America, Australia, and Central and Eastern Europe vary from 4 5-6%, 9%, and 8-12%, respectively.
The causes of low sperm motility vary, and many cases are unexplained.
Damage to the testicles, which make and store sperm, can impact the quality of sperm.
Common causes of testicle damage include:
infection
testicular cancer
testicular surgery
an issue a man is born with
undescended testicles
injury
The long-term use of anabolic steroids can reduce sperm count and motility. Drugs, such as cannabis and cocaine, as well as some herbal remedies, can also affect semen quality.
A varicocele is a swelling of the veins that drain the testicle, which can impact sperm quality. Varicocele has also been associated with low sperm motility.
Sperm DNA Fragmentation
DNA fragmentation can be caused by a variety of factors such as infection, chemotherapy, radiotherapy, smoking, drug use, or advanced age. SDF is linked to impaired fertilization, poor embryo quality, increased spontaneous abortion rates and reduced pregnancy rates after assisted reproduction.
Sexually transmitted infections
STDs can also cause infertility in men. The process can be similar to how PID damages a woman’s fallopian tubes. The structures of the male reproductive tract, including the epididymis and urethra, can be damaged by infection with an untreated STDs. Chlamydia and gonorrhea are the first and second most commonly reported notifiable disease in the United States.
Sexually transmitted infections (STIs) are common. People who have a STI often have no symptoms.
Extremely common STIs like chlamydia, gonorrhea, syphilis, and mycoplasma genitalium can damage the reproductive organs and cause infertility.
Sperm Agglutination
Sperm agglutination refers to the percentage of sperm that stick together. Male infertility is sometimes caused by the male developing antibodies to his own sperm, which increases agglutination in the semen. This usually results after a trauma to the testicles or surgical procedures such as a vasectomy reversal. When present, anti-sperm antibodies can bind to the sperm, essentially interfering with fertilization and motility.
Ejaculation disorders include premature ejaculation, anejaculation (the failure to ejaculate), and retrograde ejaculation, which is when semen enters the bladder during orgasm instead of coming out the tip of the penis.
Prior vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers risk, among others.
Can vitamins impact infertility? Certain vitamins are essential in maintaining fertility and we have included sources where you can find these vitamins to incorporate into your diet.
Vitamin A
Vitamin A is crucial for the functioning of various body systems and organs. One of these systems is the reproductive system.
Spermatogenesis is quite dependent on vitamin a. It is what helps keep structures such as the epididymis and seminal vesicle functioning. without it, instead of finding those structures you might find “stratified squamous keratinizing epithelium.”
In females the problems could be found in ovulation. A study on vitamin A deficient rats showed that the rats were unable to ovulate and form corpora lutea routinely. researchers were also not able to see blastogenesis occur. vitamin A could play a crucial role even after fertilization! it has been shown that a mother’s vitamin A keeps the placenta in good condition.
In studies performed on pigs, it was observed that a lack of vitamin A resulted in several birth defects including cleft palate, lack of eye development etc. embryos observed during days 12.5-20.5 demonstrated a range of defects in vision related structures such as the retina and iris.
The nervous system also uses vitamin A for functions such as neural differentiation. Vitamin A deficient (vad) quail embryos have been observed to have underdeveloped hindbrains. They also did not have many spinal cord neurons. Some other problems were observed in vad rat embryos; these included:
- impaired heart morphogenesis
- non-compartmentalized heart
- embryonic renal hypoplasia
- impaired diaphragm development.
- bilateral lung hypoplasia
There are many more conditions that can develop in embryos. however, making sure that you include sufficient amounts of vitamin A in your diet prevents such birth defects. It is important to keep in mind that eating healthy is very important during early pregnancy and even pre-pregnancy. It is often stressed by health professionals to get your vitamins from food rather than supplements, and the same is true for vitamins and infertility. Vitamin A can be found in variety of foods including:
- green leafy vegetables
- dairy products.
- carrots
- sweet potatoes, tomatoes
- red bell peppers
- squash and pumpkin
- essentially any orange colored food!
References:
1. Clagett-Dame et al. “Vitamin A in Reproduction and Development” Nutrients. Mar 29 2011
2. “Vitamin A” Harvard T.H. Chan School of Public Health
Vitamin D
Scientists are still not completely sure whether vitamin d deficiency is associated with IVF outcomes. The authors of one study did conclude, however, that vitamin D does not affect pregnancy, live birth, and miscarriage rates. They found reason to believe vitamin D is involved in folliculogenesis, oogenesis and endometrial receptivity. Studies are split between whether vitamin D deficiency is a serious issue for individuals who plan on using ART. Certain fertility clinics screen patients for vitamin d deficiency prior to beginning treatment. A good level of vitamin D for fertility treatments is often considered to be 30 ng/ml. It is important to be able to maintain this level even throughout a pregnancy as studies have shown vitamin D deficiency may induce preeclampsia, gestational diabetes and other conditions. The reason for this may be that vitamin D is known to be involved in the embryo implantation process. It controls the genes that generate estrogen and also helps to shift around immune cells in the uterus to fight off infections. Some good sources of vitamin D include:
- oily fish
- red meat
- liver
- egg yolks
- supplements (because it can sometimes be difficult to get sufficient amounts from diet and sunshine). We recommend the BlueBonnet brand available on Amazon.
Serum Vitamin D status is associated with increased blastocyst development rate in women undergoing IVF.
• Strong relationship was observed between blastocyst development and VitD sufficiency- linking vitamins and infertility.
• For every single increase in a blastocyst generated or embryo cryopreserved, the likelihood of VitD sufficiency increased by 32%.
• There was no association between VitD and clinical pregnancy or live birth outcomes.
• Larger studies should investigate whether the effect on blastocyst development may affect subsequent clinical pregnancy and live birth rates.
Nikita L. Walz et al., RBMO 2020
References:
- “Vitamin D in fertility” USC Fertility https://uscfertility.org/fertility-treatments/vitamin-d-fertility/
- “How vitamin D affects your fertility” shady grove fertility https://www.shadygrovefertility.com/blog/fertility-health/how-vitamin-d-affects-your-fertility/
- “Foods high in vitamin D” healthline https://www.healthline.com/nutrition/9-foods-high-in-vitamin-d
- “The Role of Vitamin D in Fertility and During Pregnancy and Lactation: A Review of Clinical data” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210343/
- “Vitamin D” nhs https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
- https://www.focusonreproduction.eu/article/News-in-Reproduction-Vitamin-D
Vitamin E
It is clear that micronutrients, vitamins and infertility go hand-in-hand. Researchers from another study were able to determine an association between recurring abortion and low plasma vitamin e levels and increased lipid peroxidation levels in women. Regarding fetus/embryo growth, it’s important to bring up the study of in vitro matured and fertilized bovine oocytes. The zygotes derived from them when cultured in vitamin E, vitamin C, and EDTA were more likely to enter the blastocyst stage than the control medium. Current studies indicate there is still more we need to know about vitamin E! The University of Rochester is currently conducting trials involving 48 infertile men and 20 fertile men on how vitamin E affects sperm fragmentation. DNA fragmentation occurs due to oxidative stress. Because vitamin E is an antioxidant, it can combat such oxidative stress. It leaves us questioning if vitamin E deficiency perhaps leads to DNA fragmentation? Want to try and incorporate more vitamin E into your diet? Here’s some foods that Healthline listed, which you should eat!
- Sunflower seeds
- Almonds
- Sunflower oil
- Hazelnuts (I’m going to go eat that Ferrer Rocher now!)
- Pine nuts
- Peanuts
- Avocado
- Brazil nuts
- Kiwi
References:
1. Mutalip et al. “Vitamin E as an Antioxidant in Female Reproductive Health” Antioxidants. Feb 2018.
2. Vitamin E and Male Fertility study on ClinicalTrials.gov
3. Olson et al. “Culture of in vitro-produced bovine embryos with Vitamin E improves development in vitro and after transfer to recipients.” Biol Reproduction. Feb 2000.
Sperm DNA fragmentation (SDF) can be caused by a variety of factors such as infection, chemotherapy, radiotherapy, smoking, drug use, or advanced age. SDF is linked to impaired fertilization, poor embryo quality, increased spontaneous abortion rates and reduced pregnancy rates after assisted reproduction.
Currently, there seems to be insufficient evidence to support the routine use of SDF in male factor evaluation nevertheless the importance of DNA fragmentation in spermatozoa has been acknowledged in the latest American Urological Association (AUA) and European Association of Urology (EAU) guidelines on male infertility.
Several strategies have been proposed to minimize the influence of abnormal chromatin integrity on ART outcomes. Obesity, smoking, toxins, pollutants, and Bisphenol A (BPA). They include intake of oral antioxidants, varicocele ligation, frequent ejaculation, and sperm sorting.
Sperm DNA Fragmentation is caused by oxidative stress, a topic we explore at length in our vitamins and fertility post! Navigating the world of supplements is tough work. That doesn’t mean that all supplements are “good” or all of them are “bad”. Finding out what works and what doesn’t is important and it’s always important to confide in your physician.
The following dietary supplements seem to have the most evidence for male fertility in general.
L-Carnitine
Analysis showed that carnitines significantly improve total sperm motility, progressive sperm motility and sperm morphology, but don’t sperm concentration. Meat, poultry, fish, and dairy products are the richest sources of L-carnitine. Tempeh, wheat, and avocados contain some L-carnitine, while fruits, vegetables, and grains contain little. It is primarily made in the liver and kidneys and plays an important role in energy production by mitochondria.
Vitamin E
Studies have shows that vitamin E improves sperm motility (movement). Vitamin C functions to regenerate vitamin E; thus, these vitamins may work together to improve sperm function. Vitamin C has been shown to increase sperm count, motility, and morphology. Antioxidants, such as Vitamin E, which are present in some foods, can prevent damage to cells from “free radicals”, which are naturally present by-products of metabolism. Numerous studies have reported beneficial effects of antioxidant drugs on semen quality, but there is no well-defined therapeutical protocol in male infertility.
Vitamin C
Vitamin C may aid male fertility. A 2016 study found that men with obesity who consumed vitamin C had improved sperm concentration and mobility.
Vitamin D
Vitamin D status has been linked with sexual function, testosterone levels and fertility. In addition, studies have found vitamin D deficiency is more prevalent among men with low semen production, quality and motility, along with lower inhibin B levels. Most of these studies we found highlighted a potential beneficial role of vitamin D on male reproductive health, particularly through a better sperm motility.
CoQ10
Coenzyme Q10 (CoQ10) helps generate energy in human cells. Recent studies on this enzyme’s ability to treat infertility have been very positive.
Zinc
Getting enough zinc is one of the cornerstones of male fertility. Observational studies show that low zinc status or deficiency is associated with low testosterone levels, poor sperm quality, and an increased risk of male infertility.
Folic Acid
Folic Acid is a B-vitamin that is necessary for DNA synthesis. Low levels of folic acid have been associated with a decreased sperm count and decreased sperm motility. In a recent study, the combination of zinc and folic acid results in a 75% increase in total normal sperm count in sub-fertile men.