SARS–CoV-2 testing in infertile patients: different recommendations in Europe and America

La Marca, A. and Nelson, S. (2020) SARS–CoV-2 testing in infertile patients: different recommendations in Europe and America. Journal of Assisted Reproduction and Genetics, 37, pp. 1823-1828. (doi: 10.1007/s10815-020-01887-3) (PMID:32681280) (PMCID:PMC7366442)

Abstract

The incorporation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing into patient care algorithms has been proposed to mitigate risk. However, the two main professional societies for human reproduction (ESHRE and ASRM) appear divergent on their clinical utility and whether they should be adopted. In this opinion paper, we review the currently available tests and discuss the strengths and weaknesses of the proposed clinical care pathways. Nucleic acid amplification tests are the cornerstone of SARS-CoV-2 testing but test results are largely influenced by viral load, sample site, specimen collection method, and specimen shipment technique, such that a negative result in a symptomatic patient cannot be relied upon. Serological assays for SARS-CoV-2 antibodies exhibit a temporal increase in sensitivity and specificity after symptom onset irrespective of the assay used, with sensitivity estimates ranging from 0 to 50% with the first 3 days of symptoms, to 83 to 88% at 10 days, increasing to almost 100% at ≥ 14 days. These inherent constraints in diagnostics would suggest that at present there is inadequate evidence to utilize SARS-CoV-2 testing to stratify fertility patients and reliably inform clinical decision-making. The failure to appreciate the characteristics and limitations of the diagnostic tests may lead to disastrous consequences for the patient and the multidisciplinary team looking after them.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nelson, Professor Scott
• Authors: La Marca, A., and Nelson, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Journal of Assisted Reproduction and Genetics
• Publisher: Springer
• ISSN: 1058-0468
• ISSN (Online): 1573-7330
• Published Online: 17 July 2020
• Copyright Holders: Copyright © Springer Science+Business Media, LLC, part of Springer Nature 2020
• First Published: First published in Journal of Assisted Reproduction and Genetics 37:1823–1828
• Publisher Policy: Reproduced in accordance with the publisher copyright policy