Unforeseen effects of COVID-19 on reproductive hormones and health of Indian women


  • Sheela Sharma Department of Obstetrics and Gynecology, Rama Medical College Hospital and Research Centre, Mandhana, Kanpur, Uttar Pradesh, India
  • Nashra Afaq Department of Microbiology and Central Research Laboratory, Rama Medical College Hospital and Research Centre, Mandhana, Kanpur, Uttar Pradesh, India




COVID-19 pandemic, Reproductive hormones, Women health


Numerous systematic probes, clinical studies and research papers have been published to depict, interpret, explain and understand the impacts and underlying mechanism of the coronavirus disease 2019 (COVID-19) pandemic and its long-term effects on the female body. COVID-19 affects a number of organs, including the female reproductive function and hormonal profile. However, less attention has been given to the effects of COVID-19 on the female reproductive system due to their low morbidity. The available results of studies involving correlation that COVID-19 infection and ovarian function holds in women of reproductive age has been shown as harmless in most cases. Although, several studies have reported the involvement of COVID-19 infection in oocyte quality, ovarian function, and dysfunctions in the uterine endometrium and the menstrual cycle. The findings of these studies indicate that COVID-19 infection negatively affects the follicular microenvironment and dysregulate ovarian function. Although the COVID-19 pandemic and female reproductive health have been studied in humans and other animals, very few studies have examined how COVID-19 affects the female reproductive system. Our objective in this review is to enumerate, illustrate and categorize the effects of COVID-19 on the female reproductive system, including the ovaries, uterus, and hormonal profiles. We tried to bring forth the possible impact COVID-19 may have caused from the current literature and surveys published in various scientific reports and peer reviewed journal articles. The effects on oocyte maturation, oxidative stress, which causes chromosomal instability and apoptosis in ovaries, in vitro fertilization cycle, high-quality embryos, premature ovarian insufficiency, ovarian vein thrombosis, hypercoagulable state, women’s menstrual cycle, the hypothalamus-pituitary-ovary axis, and sex hormones, including estrogen, progesterone, and the anti- Müllerian hormone, are circled around here. The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.


Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;15:497-506.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475-81.

Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846-8.

Mortaz E, Tabarsi P, Varahram M, Folkerts G, Adcock IM. The Immune Response and Immunopathology of COVID-19; Front. Immunol. 2020;11:2037.

Wu A, Peng Y, Huang B, Ding X, Wang X, Niu P, et al. Genome composition and divergence of the novel coronavirus (2019-nCoV) originating in China. Cell Host Microbe. 2020;27(3):325-8.

Li F. Structure, function, and evolution of coronavirus spike proteins. Annu Rev Virol. 2016;3(1):237-61.

Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-9.

Phelan N, Behan L A, Owens L. The impact of the COVID-19 pandemic on women's reproductive health. Front Endocrinol. 2021;12:642.

Abu HHA, Mitaeb AA, Al-Hamshri S, Sweileh WM. Prevalence ofdysmenorrhea and predictors of its pain intensity among Palestinian femaleuniversity students. BMC Womens Health. 2018;18(1):18.

Ibrahim NK, Al-Ghamdi MS, Al-Shaibani AN, Al-Amri FA, Alharbi HA, Al-Jadani AK, et al. Dysmenorrhea among female medical students in King Abdulaziz University: Prevalence, Predictors and outcome. Pak J Med Sci. 2015;31(6):1312-7.

Pourmasumi S, Kounis NG, Naderi M, Hosseinisadat R, Khoradmehr A, Fagheirelahee N, et al. Effects of COVID-19 Infection and Vaccination on the Female Reproductive System: A Narrative Review. Balkan Med J. 2023;40:153-64.

Lee WY, Mok A, Chung JPW. Potential effects of COVID-19 on reproductive systems and fertility; assisted reproductive technology guidelines and considerations: a review. Hong Kong Med J. 2021;27: 118-26.

Yan F, Zhao Q, Li Y. The role of oxidative stress in ovarian aging: a review. J Ovarian Res. 2022;15:100.

Pourmasumi S, Sabeti P. The effect of free radicals on sperm DNA and antioxidant protective role; an assessment and review. Rev Clin Med. 2020;7:37-42.

Pourmasumi S, Nazari A, Ahmadi Z. The Effect of Long COVID-19 Infection and Vaccination on Male Fertility; A Narrative Review. Vaccines. 2022;10: 1982.

Herrero Y, Pascuali N, Velázquez C. SARS-CoV-2 infection negatively affects ovarian function in ART patients. Biochim Biophys Acta Mol Basis Dis. 2022; 1868:166.

Vakili S, Savardashtaki A, Parsanezhad ME. SARS-CoV-2 RNA in Follicular Fluid, Granulosa Cells, and Oocytes of COVID-19 Infected Women Applying for Assisted Reproductive Technology. Galen Med J. 2022;11:e2638.

Lew R. Natural history of ovarian function including assessment of ovarian reserve and premature ovarian failure. Best Pract Res Clin Obstet Gynaecol. 2019;55: 2-13.

Wilkins J, Al-Inizi S. Premature ovarian insufficiency secondary to COVID-19 infection: An original case report. Int J Gynaecol Obstet. 2021;154:179-80.

Bellmunt-Montoya S, Riera C, Gil D. COVID-19 Infection in Critically Ill Patients Carries a High Risk of Venous Thrombo-embolism. Eur J Vasc Endovasc Surg. 2021;61:628-34.

Zabihi MH, Najjari K, Oklah E, Kor F. Ovarian vein and IVC thrombosis due to normal vaginal delivery; a case report and literature review. Int J Surg Case Rep. 2021;83:105975.

DeBoer RE, Oladunjoye OO, Herb R. Right Ovarian Vein Thrombosis in the Setting of COVID-19 Infection. Cureus. 2021;13:e12796.

Von Meijenfeldt FA, Havervall S, Adelmeijer J. Prothrombotic changes in patients with COVID-19 are associated with disease severity and mortality. Res Pract Thromb Haemost. 2020;5:132-41.

Storey RF, Gurbel PA. Current and novel biomarkers of thrombotic risk in COVID-19: a Consensus Statement from the International COVID-19 Thrombosis Biomarkers Colloquium. Nat Rev Cardiol. 2022;19:475-95.

Pradhan A, Olsson PE. Sex differences in severity and mortality from COVID-19: are males more vulnerable? Biol Sex Differ. 2020;11:53.

Li F, Boon ACM, Michelson AP, Foraker RE, Zhan M, Payne PRO. Estrogen hormone is an essential sex factor inhibiting inflammation and immune response in COVID-19. Sci Rep. 2022;12:9462.

Abramenko N, Vellieux F, Tesařová P. Estrogen Receptor Modulators in Viral Infections Such as SARS-CoV-2: Therapeutic Consequences. Int J Mol Sci. 2021;22:6551.

Cattrini C, Bersanelli M, Latocca MM, Conte B, Vallome G, Boccardo F. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers. 2020;12:2325.

Lovre D, Bateman K, Sherman M, Fonseca VA, Lefante J, Mauvais-Jarvis F. Acute estradiol and progesterone therapy in hospitalised adults to reduce COVID-19 severity: a randomised control trial. BMJ. 2021;11:e053684.

Li K, Chen G, Hou H. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed. 2021;42:260-7.

Cedars MI. Evaluation of Female Fertility-AMH and Ovarian Reserve Testing. J Clin Endocrinol Metab. 2022;107:1510-9.

WHO-convened global study of origins of SARS-CoV-2: China Part. Available at: https://www.who.int. Accessed on 20 November 2023.

Saadedine M, El Sabeh M, Borahay MA, Daoud G. The influence of COVID-19 infection-associated immune response on the female reproductive system. Biol Reprod. 2023;108:172-82.

Bentov Y, Beharier O, Moav-Zafrir A. Ovarian follicular function is not altered by SARS-CoV-2 infection or BNT162b2 mRNA COVID-19 vaccination. Hum Reprod. 2021;36:2506-13.

Orvieto R, Segev-Zahav A, Aizer A. Does COVID-19 infection influence patients’ performance during IVF-ET cycle?: an observational study. Gynecol Endocrinol. 2021;37:895-7.

Karagiannis A, Harsoulis F. Gonadal dysfunction in systemic diseases. Eur. J. Endocrinol. 2005;152:501-13.

Shah NM, Lai PF, Imami N, Johnson MR. Progesterone-Related Immune Modulation of Pregnancy and Labor. Front Endocrinol. 2019;10:198.

Moulton VR. Sex Hormones in Acquired Immunity and Autoimmune Disease. Front Immunol. 2018;9: 2279.

Bereshchenko O, Bruscoli S, Riccardi C. Glucocorticoids, Sex Hormones, and Immunity. Front Immunol. 2018;9:1332.

Franceschi S, Herrero R, Clifford GM, Snijders PJ, Arslan A, Anh PT, et al. Variations in the age-specific curves of human papillomavirus prevalence in women worldwide. Int J Cancer. 2006;119(11):2677-84.

Smith JS, Melendy A, Rana RK, Pimenta JM. Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health. 2008;43(4):S5-25.

González P, Hildesheim A, Rodríguez AC, Schiffman M, Porras C, Wacholder S, et al. Behavioral/lifestyle and immunologic factors associated with HPV infection among women older than 45 years. Cancer Epidemiol Biomark Prevent. 2010;19(12):3044-54

Meditz AL, Moreau KL, MaWhinney S, Gozansky WS, Melander K, Kohrt WM, et al. CCR5 expression is elevated on endocervical CD4+ T cells in healthy postmenopausal women. J Acquir Immune Defic Syndr. 2012;59(3):221-8

Seeland U, Coluzzi F, Simmaco M, Mura C, Bourne PE, Heiland M, et al. Evidence for treatment with estradiol for women with SARS-CoV-2 infection. BMC Med. 2020;18(1):369.

Dambha-Miller H, Hinton W, Joy M, Feher M, Lusignan Sd. Mortality in COVID-19 amongst women on Hormone Replacement Therapy or Combined Oral Contraception: A cohort study. MedRxiv. 2021;2021: 21251853.

Comparison of female to male and male to female transmission of HIV in 563 stable couples. European Study Group on Heterosexual Transmission of HIV. BMJ. 1992;304(6830):809-13.

Chico-Sordo L, Polonio AM, Córdova-Oriz I, Medrano M, Herraiz S, Bronet F, et al. Telomeres and oocyte maturation rate are not reduced by COVID-19 except in severe cases. Reproduction. 2022;164(5):259-67.






Review Articles