Infectious Disease

COVID-19 reduces fertility in males, the examine mentioned

January 29, 2021

2 min read

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COVID-19 can negatively impact sperm quality and decrease fertility in men, and the extent of this effect may depend on the severity of the condition, researchers reported.

“Little is known about the virus-host interaction of COVID-19 in sperm.” Behzad Hajizadeh Maleki, PhD student and research assistant at the Institute for Psychology and Sports Science at the Justus Liebig University in Germany, and Bakhtyar Tartibian, PhD, from the Department of Physical Education and Sports Science at Urmia University in Iran, wrote in Reproduction magazine.

“We are the first to investigate the relationship between changes in multiple seminal biomarkers and reproductive function in male patients recovering from COVID-19,” they said.

Hajizadeh Maleki and Tartibian conducted a prospective longitudinal cohort study in Iran of 84 men with laboratory-confirmed COVID-19 and 105 men without the disease. Researchers analyzed changes in angiotensin converting enzyme 2 (ACE2) activity, markers of inflammation and oxidative stress, apoptotic variables, and semen quality, all of which were assessed at 10-day intervals for up to 60 days.

Most of the men in the study were in their thirties and, according to the researchers, “differed significantly” in terms of body weight, body fat percentage and BMI. Among those with COVID-19, all but one had either moderate, severe, or critical form of the disease. A urologist confirmed that all of the men in the study were fertile. Men with COVID-19 were treated with corticosteroids and / or antiviral therapies.

Researchers reported that the COVID-19 group had significantly higher levels of the ACE2 enzyme in seminal plasma, as well as higher levels of pro- and anti-inflammatory cytokines – including interleukin (IL) – in sperm at baseline and during subsequent follow-up visits. 1-beta, IL-6, IL8, IL-10, transforming growth factor (TGF) -beta, tumor necrosis factor-alpha, and interferons alpha and gamma. They also had higher levels of reactive oxygen species and lower superoxide dismutase activity compared to healthy controls.

The markers for inflammation and oxidative stress in sperm from men with COVID-19 were increased by more than 100% compared to controls, according to the researchers. The sperm concentration was reduced by 516%, the mobility by 209% and the shape of the sperm by 400%.

Although these effects tended to improve over time – representing “a transient state of male subfertility like oligoasthenoteratozoospermia” – the researchers wrote that they remained “significantly and abnormally higher, and the magnitude of these changes, in the COVID-19 patients related severity of the disease. “

In an interview with Healio Primary Care, Hajizadeh Maleki advised couples planning to have children to proceed with caution.

“Female partners of men who are recovering from the disease should choose not to become pregnant until a specialist carefully examines and certifies their fertility status,” he said.

The reason COVID-19 affects seminal inflammation mediators is not yet clear, according to the researchers, but they suggested that “the disturbed immune factors may just be a reflection of the general immune response, like in serum”.

They acknowledged that antiviral therapies for COVID-19 may have “additional harmful effects” on male fertility and that further research is needed.

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Neel Parekh, MD)

Neel Parekh, MD

The full spectrum of the consequences of a SARS-CoV-2 infection is currently not fully known. While COVID-19 has been reported in testicular tissue, Maleki and colleagues are taking the first steps to assess its harmful effects on male reproductive health. This included significantly reduced sperm parameters (concentration, motility and morphology) and increased oxidative semen stress after COVID-19 infection.

Even with the introduction of the vaccine, health care providers should use these findings to advise couples of childbearing age on the importance of properly following CDC guidelines on social distancing, masking, and hand washing. Many questions remain unanswered, and larger studies with longer follow-up times to assess hormone profiles and semen analysis are needed to determine the long-term consequences for male fertility after recovery from COVID-19.

In addition, most of the patients in this study received treatment with corticosteroids and / or antiviral therapies that have been associated with testicular dysfunction. Healthcare providers should reassure patients that there are no randomized trials with adequate controls that can draw firm conclusions about the short- and long-term effects of drugs used to treat COVID-19 on male reproduction. As andrology laboratories take steps to ensure reproductive care is safe and effective, men with COVID-19 and fertility problems should be evaluated by a male reproductive urologist.

Neel Parekh, MD

Urologist, Cleveland Clinic

Disclosure: Parekh does not report any relevant financial information.

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Jamin Brahmbhatt, MD, FACS

First and foremost, kudos to the research team for publishing this comprehensive analysis of changes in the male reproductive system after an acute COVID-19 infection over a period of 60 days. The study highlights changes in known indicators of fertility potential in the male testicle, and the researchers are honest about the limitations of their study protocols. It was encouraging to see that the initially significant decrease in semen parameters showed progressive improvement over the duration of the study.

Aside from providing a starting point for conversations about fertility risk factors, we cannot draw general population conclusions about how COVID-19 infection will affect future fertility potential or pregnancy rates. I fear that by headings or summaries of the data, the public could draw alarming conclusions about their fertility. As a male infertility specialist, I believe that the information presented in this study will not lead to any significant change in the way we treat patients.

It is known that any acute stress condition such as viral infections can lead to a decrease in fertility parameters such as sperm count / quality as well as a decrease in the environment in which the sperm are nourished. In the case of COVID-19 or any other infection, the treatments (steroids, antivirals, etc.) can also affect fertility parameters. In addition, the sheer psychological stress caused by a diagnosis can also contribute to a decline in fertility parameters.

Fertility is a complex and intimate process. As doctors, we need to emphasize that there are much stronger, known and research-proven risk factors for declining fertility status, which include poor lifestyle choices, obesity, and general stress. Fortunately, these risk factors have proven effective as treatment strategies such as smoking cessation, limiting alcohol consumption, losing weight through exercise and diet, and focusing on mental wellbeing.

Jamin Brahmbhatt, MD, FACS

Urology and Sexual Health Departments, Orlando Health
President of the Florida Urological Society

Disclosure: Brahmbhatt does not report any relevant financial information.

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Allen D. Seftel, MD, FACS)

Allen D. Seftel, MD, FACS

Although the data in this article is somewhat worrying at first glance, some of the issues that make these data less meaningful include the lack of a control group of young men with inflammatory or respiratory diseases such as rheumatoid arthritis, diabetes, COPD, or a control group of young men who who were taking medications such as steroids and / or antiviral therapy.

Furthermore, we are not told whether the patients who tested positive for COVID-19 remained on their steroids and antiviral therapy during the 60-day course of the study, confusing the data.

While this data is fascinating, there are a few flaws in the study that affect the value of the data. Therefore, these data should be interpreted with extreme caution until an appropriate control group has been studied.

Allen D. Seftel, MD, FACS

Senior Consultant Urologist, Cooper University Health Care, Camden, NJ

Disclosure: Seftel does not report any relevant financial information.

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