Infeção por SARS-CoV-2 e fertilidade: o seu impacto na Medicina da Reprodução
DOI:
https://doi.org/10.25753/BirthGrowthMJ.v31.i3.27747Palavras-chave:
COVID-19, fertilidade, medicina da reproduçãoResumo
Aproximadamente 0,3% da taxa anual de nados-vivos corresponde a recém-nascidos concebidos por técnicas de procriação medicamente assistida, pelo que o novo coronavirus trouxe repercussões negativas aos serviços de saúde que garantem tratamentos de fertilidade. Além do seu impacto em relação ao cancelamento de novos ciclos, pensa-se que o coronavírus 2 associado a síndrome respiratória aguda (SARS-CoV-2) pode também afetar os sistemas reprodutivo humano através do recetor da enzima conversora de angiotensina 2 (ACE2) e, consequentemente, conduzir a infertilidade. A infeção por SARS-CoV-2 pode afetar o eixo hipotálamo-hipófise-ovário (HHO) e, portanto, a qualidade dos ovócitos. Além disso, a expressão endometrial de ACE2 pode estar associada a quadros de disfunção endometrial e placentária que podem conduzir a complicações obstétricas quando a gravidez é alcançada. Também foi observada uma associação entre a COVID-19 e alterações nos padrões menstruais das mulheres. Contudo, nos homens, os níveis de expressão da ACE2 nas células testiculares são baixos e a presença do mRNA da SARS-CoV-2 no sémen é controversa. Ainda assim, sinais imagiológicos de orquite e epididimite em doentes recuperados da COVID-19, ou casos de hipogonadismo clínico podem ser responsáveis por prejudicar a fertilidade masculina durante a pandemia.
As recomendações internacionais começaram por encorajar o restabelecimento gradual dos tratamentos de fertilidade, identificando os doentes que deveriam ser priorizados. Por conseguinte, avaliámos a importância da preservação da fertilidade durante a pandemia em subgrupos urgentes de doentes (principalmente doentes oncológicos e em doentes autoimunes) que são geralmente submetidos a tratamentos gonado-tóxicos e teratogénicos, que não podem ser adiados indefinidamente enquanto se aguarda o fim da pandemia. As implicações dos efeitos da SARS-CoV-2 nos resultados das técnicas de procriação medicamente assistida são também exploradas nesta revisão.
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