Lee Dayong
Department of Obstetrics and Gynecology, Kyungpook National University School of Medicine, Daegu, Korea.
Clin Exp Reprod Med. 2021 Dec;48(4):273-282. doi: 10.5653/cerm.2021.04504. Epub 2021 Nov 26.
Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly, resulting in a pandemic. The virus enters host cells through angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2). These enzymes are widely expressed in reproductive organs; hence, coronavirus disease 2019 (COVID-19) could also impact human reproduction. Current evidence suggests that sperm cells may provide an inadequate environment for the virus to penetrate and spread. Oocytes within antral follicles are surrounded by cumulus cells, which rarely express ACE2 and TMPRSS2. Thus, the possibility of transmission of the virus through sexual intercourse and assisted reproductive techniques seems unlikely. Early human embryos express coronavirus entry receptors and proteases, implying that human embryos are potentially vulnerable to SARS-CoV-2 in the early stages of development. Data on the expression of ACE2 and TMPRSS2 in the human endometrium are sparse. Moreover, it remains unclear whether SARS-CoV-2 directly affects the embryo and its implantation. A study of the effect of SARS-CoV-2 on pregnancy showed an increase in preterm delivery. Thus, vertical transmission of the virus from mother to fetus in the third trimester is possible, and further data on human reproduction are required to establish this possibility. Based on analyses of existing data, major organizations in this field have published guidelines on the treatment of infertility. Regarding these guidelines, despite the COVID-19 pandemic, reproductive treatment is crucial for the well-being of society and must be continued under suitable regulations and good standard laboratory practice protocols.
自2019年12月以来，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）迅速传播，引发了一场大流行。该病毒通过血管紧张素转换酶2（ACE2）和跨膜蛋白酶丝氨酸2型（TMPRSS2）进入宿主细胞。这些酶在生殖器官中广泛表达；因此，2019冠状病毒病（COVID-19）也可能影响人类生殖。目前的证据表明，精子细胞可能无法为病毒的穿透和传播提供适宜环境。窦状卵泡内的卵母细胞被卵丘细胞包围，卵丘细胞很少表达ACE2和TMPRSS2。因此，通过性交和辅助生殖技术传播病毒的可能性似乎不大。早期人类胚胎表达冠状病毒进入受体和蛋白酶，这意味着人类胚胎在发育早期可能易受SARS-CoV-2感染。关于ACE2和TMPRSS2在人子宫内膜中表达的数据很少。此外，SARS-CoV-2是否直接影响胚胎及其着床仍不清楚。一项关于SARS-CoV-2对妊娠影响的研究表明早产有所增加。因此，病毒在妊娠晚期从母亲垂直传播给胎儿是有可能的，需要更多关于人类生殖的数据来证实这种可能性。基于对现有数据的分析，该领域的主要组织已经发布了关于不孕症治疗的指南。关于这些指南，尽管有COVID-19大流行，但生殖治疗对社会福祉至关重要，必须在适当的规定和良好的标准实验室操作规范下继续进行。
