IMPORTANCE: The effect of coronavirus disease 2019 (COVID-19) vaccination on fertility warrants clarification in women undergoing assisted reproductive treatment. OBJECTIVE: To study the association between female COVID-19 vaccination and outcomes of assisted reproductive treatment. DATA SOURCES: PubMed, EMBASE, Web of Science, Cochrane Library, and medRxiv & bioRxiv were searched for eligible studies from December 1, 2019 to November 30, 2022 with no language restrictions. STUDY SELECTION AND SYNTHESIS: Observational studies comparing assisted reproductive outcomes between women with and without COVID-19 vaccination were included. The pooled estimates were calculated by random-effects models as mean differences (MDs), standardized MDs or odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was evaluated by the I2 statistic. MAIN OUTCOMES: The number of oocytes retrieved and clinical pregnancy rate. RESULTS: Twenty-one cohort studies involving a total of 19687 treatment cycles were included. In a comparison of vaccinated versus unvaccinated group, the pooled MD for oocyte number was -0.06 (95% CI -0.51-0.39; I2 = 0%), and the pooled OR for clinical pregnancy was 0.95 (95% CI 0.85-1.05; I2 = 0%). Similarly, there were no statistically significant adverse effects identified in other outcomes determined a priori, including four cycle characteristics, six laboratory parameters, and three pregnancy indicators. The majority of results were consistently unchanged in subgroup and sensitivity analyses, with no evidence of publication bias according to Egger's test. CONCLUSION AND RELEVANCE: Our work did not find significant differences in assisted reproductive outcomes between vaccinated and unvaccinated women. However, more data are warranted to confirm the safety of COVID-19 vaccination for assisted reproductive treatment and in female fertility in general.

  • Adults
  • Vaccine/vaccination
  • Safety
  • COVID-19