Article Text

Impact of COVID-19 on female fertility: a systematic review and meta-analysis protocol
  1. Fangyuan Li1,2,
  2. Hua Lu1,2,
  3. Qi Zhang1,2,
  4. Xinyun Li1,2,
  5. Tong wang1,2,
  6. Qianchen Liu1,
  7. Qian Yang1,2,
  8. Lingxia Qiang1,2
  1. 1Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
  2. 2Chengdu University of Traditional Chinese Medicine, Chengdu, China
  1. Correspondence to Dr Hua Lu; lh18980880525{at}


Introduction The increased social and economic burden caused by the novel COVID-19 outbreak is gradually becoming a worrisome issue for the health sector. The novel coronavirus invades the target cell by binding to ACE2, which is widely expressed in the ovaries, uterus, vagina and placenta. Significantly, the SARS-CoV-2 is said to interrupt female fertility through regulating ACE2. Thus, it is essential to investigate if the novel COVID-19 hampers female fertility, given that there is no systematic and comprehensive evidence on the association of COVID-19 with female fertility.

Methods and analysis We will systematically search cohort studies, cross-sectional studies, case–control studies and self-controlled case series designs in the following databases: Web of Science, PubMed, EMBASE, Cochrane Library, Ovid, EBSCO, WHO COVID-19 Database, Chinese Biomedical Databases, China National Knowledge Internet, VIP and WanFang Database. Medical Subject Headings and free-text terms for “COVID-19” AND “female” AND “fertility” will be performed. Eligibility criteria are as follows: population (female patients aged 13–49 years); exposure (infection with SARS-CoV-2); comparison (population without SARS-CoV-2 infections or latent SARS-CoV-2 infections); and outcome (female fertility, such as ovarian reserve function, uterine receptivity, oviducts status and menstruation status). Article screening and data extraction will be undertaken independently by two reviewers, and discrepancies will be resolved through discussion. We will use the I2 statistics to assess the heterogeneity and perform a meta-analysis when sufficiently homogeneous studies are provided. Otherwise, a narrative synthesis will be performed. We will explore the potential sources of heterogeneity using subgroup analyses and meta-regression.

Ethics and dissemination Formal ethical approval is not required, and findings will be published in a peer-reviewed journal.

PROSPERO registration number CRD42020189856.

  • COVID-19
  • gynaecology
  • epidemiology

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  • Contributors The study concept was developed by FL. The manuscript of the protocol was drafted by FL and critically revised by QZ and XL. HL developed and provided feedback for all sections of the review protocol and approved the final manuscript. The search strategy was developed by FL and QZ. Study selection will be performed by QY and LQ. Data extraction and quality assessment will be performed by FL and TW, with QL as a third party in case of disagreements. All authors have approved the final version of the manuscript.

  • Funding This study is financially supported by the Ministry of Science and Technology of the People's Republic of China (grant number: 2018YFC1704305).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.