Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong.
Hong Kong Med J. 2021 Apr;27(2):118-126. doi: 10.12809/hkmj209078. Epub 2021 Apr 15.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) employs the angiotensin-converting enzyme 2 (ACE2) receptor in the renin-angiotensin system for viral entry. The ACE2 receptor is present in both female and male reproductive systems, and reports of multi-organ involvement have led to uncertainty regarding its effects on the reproductive system and fertility. We review the existing literature regarding the function of ACE2 and the renin-angiotensin system in the female and male reproductive systems to postulate the possible implications of SARS-CoV-2 regarding fertility. Because of the presence of ACE2 in the ovaries, SARS-CoV-2 infection may disrupt ovarian function and hence oocyte quality. Higher expression of ACE2 in the endometrium with age and during the secretory phase raises concern about increased susceptibility to infection during periods of high ACE2 expression. The possibility of vertical transmission and the presence of ACE2 in the placenta and during pregnancy are also discussed. The presence of SARS-CoV-2 RNA in semen is controversial, but impaired semen quality has been found in men with moderate coronavirus disease 2019 infection. Evidence of orchitis and hormonal changes seen in male coronavirus disease 2019 infection may lead to infertility. The implications of these effects on assisted reproductive technology (ART) outcomes are also explored. The ART guidelines from different fertility societies for the management of patients treated with ART are provided. The importance of prioritising 'time-sensitive' patients for ART, counselling patients about the uncertainty and risks of ART, and pregnancy during the pandemic is discussed. Recommendations are also provided for infection control and safe regulation of ART centres and laboratories.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）利用肾素-血管紧张素系统中的血管紧张素转换酶 2（ACE2）受体进入病毒。ACE2 受体存在于女性和男性的生殖系统中，有关多器官受累的报告导致人们对其对生殖系统和生育能力的影响产生了不确定性。我们回顾了 ACE2 和肾素-血管紧张素系统在女性和男性生殖系统中的功能的现有文献，以推测 SARS-CoV-2 对生育能力的可能影响。由于 ACE2 存在于卵巢中，SARS-CoV-2 感染可能会破坏卵巢功能，从而影响卵母细胞质量。ACE2 在子宫内膜中的表达随着年龄的增长和分泌期的增加而增加，这使人担心在 ACE2 高表达期间感染的易感性增加。垂直传播的可能性以及 ACE2 在胎盘和怀孕期间的存在也在讨论之中。精液中存在 SARS-CoV-2 RNA 存在争议，但在患有中度冠状病毒病 2019 感染的男性中发现了精液质量受损。在男性冠状病毒病 2019 感染中观察到的睾丸炎和激素变化的证据可能导致不育。还探讨了这些影响对辅助生殖技术（ART）结果的影响。提供了来自不同生育协会的关于管理接受 ART 治疗的患者的 ART 指南。讨论了为 ART 患者进行“时间敏感”患者的优先级排序，为患者提供有关 ART 的不确定性和风险的咨询，以及在大流行期间怀孕的重要性。还为 ART 中心和实验室的感染控制和安全监管提供了建议。
