SARS-CoV2 SALGININDA GEBELİK, İNFERTİLİTE VE YARDIMCI ÜREME TEKNİKLERİNİN KULLANIMI

Yıl 2021, Cilt: 4 Sayı: 2, 147 - 158, 31.12.2021

Nurcan Kırca , Meryem Öngen

Öz

Pandemi sürecinde üreme sağlığının olumsuz yönde etkilenebileceği ve üreme sağlığı hizmetlerinin sunumunda güçlüklerin ortaya çıkabileceği belirtilmiştir. Gebe kadınların genel popülasyona kıyasla daha fazla risk altında olup olmadığı ve SARS-CoV2’nin gebe kadınlar üzerindeki etkisi açık değildir. Bu sebeple, üremeye yardımcı tedaviler dışında, pandemi döneminde gebe kalınmaması gerektiği ile ilgili bir açıklamada bulunulmamıştır. Human Papilloma Visüsü, İnsan İmmün Yetmezlik Virüsü, Herpes Simpleks Virüsü ve Zika virüsü gibi çeşitli viral etkenler fertilite üzerinde olumsuz etkileri gösterebilmektedir. Şimdiye kadar, SARS-CoV2 ile enfekte olan hastalarda üreme sistemine yönelik bir zarar bildirilmemiştir. Ancak, etkenin ACE2 reseptörü aracılığı ile etki etmesi sebebiyle oosit ve spermatozoalar üzerinde olası bir olumsuz etkisinin olabileceği düşünülmektedir. Bu durumlar göz önünde bulundurulduğunda bu süreçte üremeye yardımcı tedavilerin kullanımı ile ilgili tartışmalar ortaya çıkmıştır. Amerikan Üreme Tıbbı Derneği, İnsan Fertilizasyon ve Embriyoloji Kurumu, Avrupa İnsan Üreme ve Embriyoloji Derneği gibi bazı organizasyonlar hem virüsün yayılımını azaltmak hem de infertilite tedavileri ve gebeliğe bağlı gelişebilecek olası komplikasyonları önlemek amacıyla infertiliteye yönelik tedavilerin bu süreçte ara verilmesi gerektiğini belirtmişlerdir. Ancak kemoterapi veya radyoterapi tedavisi gören hastalar gibi acil fertilite koruyucu müdahaleler gerektiren durumlar bunun dışında tutulmuştur. Bu süreçte hemşirelerin halk sağlığı, enfeksiyonların önlenmesi, enfeksiyon kontrolü ve izolasyon önlemleri konularında birçok sorumlulukları bulunmaktadır. Multidisipliner bir ekip içinde yer alan infertilite hemşiresi de infertil bireylerin değerlendirerek eğitim ve gerekli danışmanlık hizmetlerinin verilmesini sağlamaktadır. Pandemi sürecinde mevcut tedavilerin ertelenmesi ya da yapılmamasına bağlı olarak hastaların yaşayacağı psikolojik semptomların azaltılması/önlenmesi ve hastaların enfeksiyonlardan korunabilmesinde hemşireler danışman rollerinden faydalanabilirler.

Anahtar Kelimeler

Gebelik, İnfertilite, SARS-CoV2, yardımcı üreme teknikleri

PREGNANCY, INFERTILITY AND USE OF ASSISTED REPRODUCTIVE TECHNIQUES IN SARS-COV2 OUTBREAK

Öz

It has been stated that reproductive health may be negatively affected and difficulties may arise in the provision of reproductive health services during pandemic process. It is not clear whether pregnant women are at higher risk compared to the general population and the effect of SARS-CoV2 on pregnant women. For this reason, no statement has been made about the need to avoid pregnancy during the pandemic period, except for assisted reproductive treatments. Various viral agents such as Human Papillomavirus, Human Immumodeficiency Virus, Herpes Simplex Virus and Zika virus can have negative effects on fertility. To date, no damage to the reproductive system has been reported in patients infected with SARS-CoV2. However, it is thought that the agent may have a possible negative effect on oocytes and spermatozoa due to its effect through the ACE2 receptor. Considering these conditions, discussions have arisen regarding the use of assisted reproductive therapies in this process. Some organizations such as American Society for Reproductive Medicine, Human Fertilisation and Embryology Authority, European Society of Human Reproduction and Embryology stated that the treatments for infertility should be suspended in this process in order to reduce the spread of the virus and to prevent possible complications due to infertility treatments and pregnancy. However, situations requiring emergency fertility-sparing interventions such as patients undergoing chemotherapy or radiotherapy are excluded. In this process, nurses have many responsibilities in public health, infection prevention, infection control and isolation measures. The infertility nurse, who is in a multidisciplinary team, evaluates infertile individuals and provides training and necessary consultancy services. During the pandemic process, nurses can benefit from consultant roles in reducing/preventing the psychological symptoms that patients will experience and protecting patients from infections, depending on the postponement or non-application of existing treatments.

Anahtar Kelimeler

Pregnancy, infertility, SARS-CoV2, assisted reproductive tecniques

Kaynakça

• American Society for Reproductive Medicine (ASRM). (2018). Assisted Reproductive Technology. A Guide for Patients Revised. https://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/art-booklet2.pdf Erişim Tarihi: 08.08.2020.
• American Society for Reproductive Medicine (ASRM). (2020a). COVID-19: Suggestions On Managing Patients Who Are Undergoing Infertility Therapy Or Desiring Pregnancy. https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/covid-19-suggestions-on-managing-patients-who-are-undergoing-infertility-therapy-or-desiring-pregnancy/ Erişim Tarihi: 10.08.2020.
• American Society for Reproductive Medicine (ASRM). (2020b). Patient Management and Clinical Recommendations During The Coronavirus (COVID-19) Pandemic. https://www.asrm.org/news-and-publications/covid-19/statements/patient-management-and-clinical-recommendations-during-the-coronavirus-covid-19-pandemic/ Erişim Tarihi: 10.08.2020.
• Anifandis G et al. COVID-19 and fertility: A virtual reality. Reproductive Biomedicine Online 2020;41(2):1-4.
• Andrabi SW et al. COVID-19: New adaptation for IVF laboratory protocols. JBRA Assisted Reproduction 2020;24(3):358-61.
• Ashour HM et al. Insights into the Recent 2019 Novel Coronavirus (SARS-CoV-2) in Light of Past Human Coronavirus Outbreaks. Pathogens 2020;9(3):186.
• Barzon L et al. Zika virus infection in semen: effect on human reproduction. Lancet Infectious Diseases 2017;17(11):1107-9.
• Bloom-Feshbach K et al. Natality decline and miscarriages associated with the 1918 influenza pandemic: the Scandinavian and United States experiences. The Journal of Infectious Diseases 2011;204(8):1157-64.
• Blumenfeld Z. Possible impact of COVID-19 on fertility and assisted reproductive technologies. Fertility and Sterility 2020;114(1):56-7.
• Brown ZA et al. The acquisition of herpes simplex virus during pregnancy. The New England Journal of Medicine 1997;337(8):509-15. Catton H. Global challenges in health and health care for nurses and midwives everywhere. International Nursing Review 2020;67(1):4-6.
• Cejtin HE et al. Effects of human immunodeficiency virus on protracted amenorrhea and ovarian dysfunction. Obstetrics and Gynecology 2006;108(6):1423-31.
• Chan JFW et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395(10223):514-23.
• Chen H et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395(10226):809-15.
• Chen L et al. Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China. The New England Journal of Medicine 2020;382(25):e1-3.
• Chen W et al. Early containment strategies and core measures for prevention and control of novel coronavirus pneumonia in China. Chinese Journal of Preventive Medicine 2020;54(3):239-44.
• Chinese Center for Disease Control and Prevention (CCDC). The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Chinese Journal of Epidemiology 2020;41(2):145-51.
• Chirgwin KD et al. Menstrual function in human immunodeficiency virus-infected women without acquired immunodeficiency syndrome. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 1996;12(5):489-94.
• Coll O et al. Fertility assessment in non-infertile HIV-infected women and their partners. Reproductive Biomedicine Online 2007;14(4):488-94.
• Cui P et al. Clinical features and sexual transmission potential of SARS-CoV-2 infected female patients: a descriptive study in Wuhan, China 2020. https://www.medrxiv.org/content/10.1101/2020.02.26.20028225v1.full.pdf Erişim Tarihi: 25.07.2020.
• Dejucq N, Jégou B. Viruses in the mammalian male genital tract and their effects on the reproductive system. Microbiology and Molecular Biology Reviews 2001;65(2):208-31.
• Depuydt CE et al. Human Papillomavirus Positivity in Women Undergoing Intrauterine Insemination Has a Negative Effect on Pregnancy Rates. Gynecologic and Obstetric Investigation 2016;81(1):41-6.
• De Santis L et al. COVID-19: The perspective of Italian embryologists managing the IVF laboratory in pandemic emergency. Human Reproduction 2020;35(4):1004-5.
• De Souza MCB et al. Management of ART and COVID-19: Infertility in times of pandemic. What now? JBRA Assisted Reproduction 2020;24(3):231-2.
• Ding Y et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. The Journal of Pathology 2004;203(2):622-30.
• Dorostghoal M et al. Oxidative stress status and sperm DNA fragmentation in fertile and infertile men. Andrologia 2017;49(10):e1-9
• Dutta S et al. Oxidative stress and sperm function: A systematic review on evaluation and management. Arab Journal of Urology 2019;17(2):87-97.
• Ellington S et al. Characteristics of Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status - United States, January 22-June 7, 2020. Morb Mortal Wkly Rep 2020;69(25):769-75. https://www.cdc.gov/mmwr/volumes/69/wr/mm6925a1.htm Erişim Tarihi: 31.07.2020.
• European Society of Human Reproduction and Embryology (ESHRE). Coronavirus Covid-19: ESHRE statement on pregnancy and conception. https://www.eshre.eu/Press-Room/ESHRE-News#COVID19WG Erişim Tarihi: 05.08.2020.
• Fan C et al. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection 2020. https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v1 Erişim Tarihi: 25.07.2020.
• Gianzo M et al. Human sperm testicular angiotensin-converting enzyme helps determine human embryo quality. Asian Journal of Andrology 2018;20(5):498-504.
• Guazzone VA et al. Cytokines and chemokines in testicular inflammation: A brief review. Microscopy Research and Technique 2009;72(8):620-8.
• Göngör İ, Kızılkaya-Beji N. İnfertilite hemşirelerinin gelişen rolleri ve sertifikasyon programı. Florence Nightingale Hemşirelik Dergisi 2015;23(2):152-9.
• Gürsoy E, Gençalp NS. Cinsel sağlık eğitiminin önemi. Sosyal Politika Çalışmaları Dergisi 2010;23(23):29-36.
• Huang C et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
• Human Fertilisation & Embryology Authority (HFEA). Coronavirus (COVID-19) guidance for patients. https://www.hfea.gov.uk/treatments/covid-19-and-fertility-treatment/coronavirus-covid-19-guidance-for-patients/ Erişim Tarihi: 10.08.2020.
• Isakbaeva ET et al. SARS-associated Coronavirus Transmission, United States. Emerging Infectious Diseases 2004;10(2):225-31.
• International Planned Parenthoof Federation (IPPF). COVID-19 pandemic cuts access to sexual and reproductive healthcare for women around the world. https://www.ippf.org/news/covid-19-pandemic-cuts-access-sexual-and-reproductive-healthcare-women-around-world?mc_cid=f53e83a4b2&mc_eid=4d0ccae341 Erişim Tarihi: 05.08.2020.
• Iqbal SN et al. An Uncomplicated Delivery in a Patient with Covid-19 in the United States. The New England Journal of Medicine 2020;382(16):e1-3.
• Jamieson DJ et al. H1N1 2009 influenza virus infection during pregnancy in the USA. Lancet 2009;374(9688):451-8.
• Köhn FM et al. Effect of angiotensin converting enzyme (ACE) and angiotensins on human sperm functions. Andrologia 1998;30(4-5):207-15.
• Kwon JY et al. New insights into the relationship between viral infection and pregnancy complications. American Journal of Reproductive Immunology 2014;71(5):387-90.
• Li D et al. Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019. JAMA Network Open 2020;3(5):e1-3.
• Li R et al. Potential risks of SARS-CoV-2 infection on reproductive health. Reproductive Biomedicine Online 2020;41(1):89-95.
• Li Y et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases 2020;26(6):1335-6.
• Liu D et al. Pregnancy and Perinatal Outcomes of Women With Coronavirus Disease (COVID-19) Pneumonia: A Preliminary Analysis. American Journal of Roentgenology 2020:1-6.
• Liu H et al. Why are pregnant women susceptible to COVID-19? An immunological viewpoint. Journal of Reproductive Immunology 2020;139:e1-4.
• Liu M et al. The role of oxidative stress in influenza virus infection. Microbes and Infection 2017;19(12):580-6.
• Liu W et al. Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Case Series. Preprints 2020;e1-28.
• Liu Y et al. Clinical manifestations and outcome of SARS-CoV-2 infection during pregnancy. The Journal of Infection 2020:e1-9.
• Lu J et al. A novel and compact review on the role of oxidative stress in female reproduction. Reproductive Biology and Endocrinology 2018;16(1):80.
• Meinhardt A. Infection: A new threat on the horizon - Zika virus and male fertility. Nature Reviews Urology 2017;14(3):135-6.
• McGinn T. Reproductive health of war-affected populations: what do we know? International Family Planning Perspectives 2000;26(4):174-80.
• Pan F et al. No evidence of severe acute respiratory syndrome-coronavirus 2 in semen of males recovering from coronavirus disease 2019. Fertility and Sterility 2020;113(6):1135-9.
• Peccatori FA et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology: Official Journal of the European Society for Medical Oncology 2013;24(Suppl 6):160-70.
• Pérez CV et al. Dual role of immune cells in the testis: Protective or pathogenic for germ cells? Spermatogenesis 2013;3(1):e1-12.
• Rubin S et al. Molecular biology, pathogenesis and pathology of mumps virus. The Journal of Pathology. 2015;235(2):242-52.
• Sadeghi MR. Implications of Assisted Human Reproduction During Coronavirus Disease 2019 (COVID-19) Pandemic. Journal of Reproduction & Infertility 2020;21(3):155-6.
• Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from (Wuhan) Coronavirus 2019-nCoV Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses 2020;12(2):1-16.
• Shek CC et al. Infants born to mothers with severe acute respiratory syndrome. Pediatrics 2003;112(4):e254-256.
• Silasi M et al. Viral infections during pregnancy. American Journal of Reproductive Immunology 2015;73(3):199-213.
• Smith GD et al. COVID-19: Emerging compassion, courage and resilience in the face of misinformation and adversity. Journal of Clinical Nursing 2020;29(9-10):1425-8.
• Song C et al. Absence of 2019 novel coronavirus in semen and testes of COVID-19 patients. Biology of Reproduction 2020;103(1):4-6.
• Society for Assisted Reproductive Technology (SART). A Special Message to SART Members. https://www.sart.org/professionals-and-providers/covid-19-resources/message-to-SART-members/ Erişim Tarihi: 05.08.2020.
• Stanley KE et al. Coronavirus disease-19 and fertility: viral host entry protein expression in male and female reproductive tissues. Fertility and Sterility 2020;114(1):33-43.
• Sun P et al. Understanding of COVID-19 based on current evidence. Journal of Medical Virology 2020;92(6):548-51.
• Swatzyna RJ, Pillai VK. The effects of disaster on women's reproductive health in developing countries. Global Journal of Health Science 2013;5(4):106-13.
• T.C. Sağlık Bakanlığı (SB). Türkiye Koronavirüs Tablosu. https://covid19.saglik.gov.tr/ Erişim Tarihi: 25.08.2021.
• Tesarik J. After corona: there is life after the pandemic. Reproductive Biomedicine Online 2020;40(6):760-2.
• Thanenthiran S et al. (2013). ICPD + 20: Status of Sexual and Reproductive Health and Rights in Asia Pacific Asia-Pacific Resource & Research Centre for Women (ARROW). https://arrow.org.my/wp-content/uploads/2015/04/ICPD-20-Asia-Pacific_Monitoring-Report_2013.pdf Erişim Tarihi: 05.08.2020.
• United Nations Population Fund (UNFPA). Protecting sexual and reproductive health and rights, and promoting gender equality. https://www.unfpa.org/resources/covid-19-gender-lens Erişim Tarihi: 05.08.2020.
• United Nations Fund for Population Activities (UNFPA). (1994). Programme of Action: Adopted at the International Conference on Population and Development. https://www.unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf Erişim Tarihi: 05.08.2020.
• Vaz-Silva J et al. The Vasoactive Peptide Angiotensin-(1–7), Its Receptor Mas and the Angiotensin-converting Enzyme Type 2 are Expressed in the Human Endometrium. Reproductive Sciences 2009;16(3):247-56.
• Wang Z, Xu X. scRNA-seq Profiling of Human Testes Reveals the Presence of the ACE2 Receptor, A Target for SARS-CoV-2 Infection in Spermatogonia, Leydig and Sertoli Cells. Cells 2020;9(4):920.
• Wong SF et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome. American Journal of Obstetrics and Gynecology 2004;191(1):292-7.
• World Health Organization (WHO). (2020a). COVID-19: Operational guidance for maintaining essential health services during an outbreak: Interim guidance, 25 March 2020. https://apps.who.int/iris/bitstream/handle/10665/331561/WHO-2019-nCoV-essential_health_services-2020.1-eng.pdf?sequence=1&isAllowed=y Erişim Tarihi: 30.07.2020.
• World Health Organization (WHO). (2020b). Transmission of SARS-CoV-2: Implications for infection prevention precautions. https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions Erişim Tarihi: 02.08.2020.
• World Health Organization (WHO). (2021). WHO Coronavirus Disease (COVID-19) Dashboard. https://covid19.who.int Erişim Tarihi: 25.08.2021.
• Xiao F et al. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020;158(6):1831-3.e3.
• Xu H et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International Journal of Oral Science 2020;12(1):1-5.
• Yu N et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: A retrospective, single-centre, descriptive study. The Lancet Infectious Diseases 2020;20(5):559-64.
• Zambrano LI et al. A pregnant woman with COVID-19 in Central America. Travel Medicine and Infectious Disease 2020;36:01639.
• Zhao S et al. Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. International Journal of Infectious Diseases 2020;92:214-7.
• Zhu H et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Translational Pediatrics 2020;9(1):51-60.
• Zotti ME et al. Post-Disaster Reproductive Health Outcomes. Maternal and Child Health Journal 2013;17(5):738-96.