LETTER

Indirect Factors Affecting Fertility in the Era of COVID-19

Amirali Karimi, Ali Nowroozi, Sanam Alilou, Erfan Amini*

Dear Editor,
A portion of the patients might experience spermatogenic failure and impairment of follicular and luteal processes 
after SARS‐CoV‐2 infection. Although the exact pathophysiology is poorly understood, these effects are hypothet-
ically mediated through an alteration in the ACE2 cascade(1). 
In addition to the adverse effects of SARS‐CoV‐2 infection on gametogenesis, several other factors may also indi-
rectly affect the fertility in men and women during COVID-19 pandemic. Patients with other causes of infertility 
are not willing to seek medical care due to fear and anxiety associated with the pandemic(2). In addition, several 
institutions suspended elective surgeries and interventions related to infertility. Overall, this situation would result 
in irreversible consequences and higher rates of infertility. Therefore, researchers and health policy makers should 
assess factors that indirectly increase the rate of infertility in the era of COVID-19. These factors may also have 
a greater impact and should be addressed through multiple pathways, including: 1) ensuring safe access to health 
care for those who are suffering from infertility, 2) reassuring patients through media to decrease the anxiety relat-
ed to the pandemic, 3) focusing on treatments that are effective and has the potential to reduce the harmful effects 
of the SARS‐CoV‐2 infection.

REFERENCES 
 1. Singh B, Gornet M, Sims H, Kisanga E, Knight Z, Segars J. Severe Acute Respiratory Syndrome-Corona 

Virus-2 (SARS-CoV-2) and its Effect on Gametogenesis and Early Pregnancy. American journal of 
reproductive immunology (New York, NY : 1989). 2020:e13351.

 2. Campi R, Tellini R, Grosso AA, Amparore D, Mari A, Viola L, et al. Deferring Elective Urologic Surgery 
During the COVID-19 Pandemic: The Patients' Perspective. Urology. 2021;147:21-6.

Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 
*Correspondence: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 
E-mail: amini.erfan@gmail.com
Received February 2021 & Accepted April 2021

Urology Journal/Vol 18 No. 3/ May-June 2021/ pp. 358-358. [DOI: 10.22037/uj.v18i.6737]