It is essential to provide adequate awareness of the implications of rheumatic diseases on reproductive health. For that purpose, the “11th International conference on Reproduction Pregnancy and Rheumatic Diseases” took place in August 2021 as an online event, due to the COVID-19 regulations. Hundreds of virtual delegates participated and interacted remotely with experts and presenters, making the conference a successful educational event.

In this introduction, issues related to the impact of COVID-19 on the immunology of reproduction and course of pregnancy in women with autoimmune rheumatic diseases (ARD) are addressed.

Firstly, although much is still unknown about SARS-CoV-2 and COVID-19, it is well understood that the virus can trigger a hyperstimulated immune response and lead to broadly diverse autoimmune

manifestations, more commonly in severely ill COVID-19 patients [1]. The disruption of the physiological immune response is key to severe COVID-19 and mortality. Thus, many immunoregulatory therapies have been investigated as therapeutic options for COVID-19 patients [2]. Angiotensin-converting enzyme 2 (ACE-2) is widely distributed in numerous cells types of the human body and acts as a port of entry to cells for SAR-CoV-2. ACE-2 is found in both the reproductive organs of males and females, which may lead to direct injury by the virus followed by a hyperinflammation immune response against it. One of the highest ACE-2 expressing cells are those located in the testis; thus, SARS-CoV-2 may cause significant inflammation and possibly spermatogenic impairment. Accordingly, there is evidence of short-term reproductive damage in male individuals [3] alongside impairment of sperm quality in COVID-19 patients compared to other infections, such as some influenza viruses [4]. However, there is evidence that semen quality will gradually recover to normal [5]. Furthermore, molecular resemblance was found between viral peptides of SARS-CoV-2 and proteins necessary for female reproduction, which may lead to cross-activation of immune components [6].