Short-term effects of COVID-19 on semen parameters: A multicenter study of 69 cases

A Prospective Cohort Study of COVID-19 Vaccination, SARS-CoV-2 Infection, and Fertility

Some reproductive-aged individuals remain unvaccinated against coronavirus disease 2019 (COVID-19) because of concerns about potential adverse effects on fertility. Using data from an internet-based preconception cohort study, we examined the associations of COVID-19 vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with fertility among couples trying to conceive spontaneously. We enrolled 2,126 self-identified female participants aged 21-45 year residing in the United States or Canada during December 2020-September 2021 and followed them through November 2021. Participants completed questionnaires every 8 weeks on sociodemographics, lifestyle, medical factors, and partner information. We fit proportional probabilities regression models to estimate associations between self-reported COVID-19 vaccination and SARS-CoV-2 infection in both partners with fecundability (i.e., the per-cycle probability of conception), adjusting for potential confounders. COVID-19 vaccination was not appreciably associated with fecundability in either partner (female fecundability ratio (FR) = 1.08, 95% confidence interval (CI): 0.95, 1.23; male FR = 0.95, 95% CI: 0.83, 1.10). Female SARS-CoV-2 infection was not strongly associated with fecundability (FR = 1.07, 95% CI: 0.87, 1.31). Male infection was associated with a transient reduction in fecundability (for infection within 60 days, FR = 0.82, 95% CI: 0.47, 1.45; for infection after 60 days, FR = 1.16, 95% CI: 0.92, 1.47). These findings indicate that male SARS-CoV-2 infection may be associated with a short-term decline in fertility and that COVID-19 vaccination does not impair fertility in either partner.

A Systemic Review and Meta-analysis of the Effect of SARS-CoV-2 Infection on Sperm Parameters

Objective. Several studies examined the putative effects of SARS-CoV-2 infection on sperm parameters. However, the results remain controversial. In this study, we conducted the most up-to-date systematic review and meta-analysis to investigate the effect of SARS-CoV-2 infection on sperm quality in COVID-19-positive and COVID-19-negative male participants. Method. Seven databases were searched for literature released through June 10, 2022, containing estimates for the outcomes of interest. Using a random-effects model (REM) or a fixed-effects model (FEM), we analyzed the pooled results. The quality of all included studies was assessed by the Newcastle-Ottawa scale. In addition, we performed a quantitative and subgroup analysis of semen data across all included studies. Results. Fourteen studies were extracted from 10 publications, involving a total of 1174 participates for meta-analysis. Sperm parameters of 521 COVID-19 male patients and 653 controls were analyzed. In 8 case-control studies, the pooled mean difference (MD) of total sperm motility was -5.37% (95% confidence interval (CI): -8.47 to -2.28; p < 0.05 ), suggesting that total motility was significantly impaired in male COVID-19 cases. Subgroup analysis showed a significant decrease in semen volume, sperm concentration, and total motility in 238 patients with a recovery time of less than 90 days. Moreover, in the other 6 included pre- to post-COVID-19 studies, the pooled MDs of sperm concentration, total sperm count, total motility, progressive motility, and normal morphology were - 6.54 × 10 6/ml (95% CI: -10.27 to -2.81; p < 0.05 ), - 38.89 × 10 6 (95% CI: -59.20 to -18.58; p < 0.05 ), -7.21% (95% CI: -14.36 to -0.07; p < 0.05 ), -5.12% (95% CI: -8.71 to -1.53; p < 0.05 ), and -1.52% (95% CI: -2.88 to -0.16; p < 0.05 ), respectively, which indicate SARS-CoV-2 infection significantly affected these five sperm parameters. Conclusion. Our results revealed that SARS-CoV-2 infection was significantly correlated with decreased sperm quality. Of six sperm parameters, total motility and sperm concentration were the most significantly decreased parameters. These results suggest a possible negative influence of SARS-CoV-2 infection on testicular function and male fertility. Given the potential detrimental effect of SARS-CoV-2 on semen quality, male reproductive health should be monitored closely in patients with COVID-19. This trial is registered with CRD42021275823.

SARS-CoV-2 effects on sperm parameters: a meta-analysis study

AIM

The rapid outbreak of the coronavirus disease 2019 (COVID-19) pandemic posed challenges across different medical fields, especially reproductive health, and gave rise to concerns regarding the effects of SARS-CoV-2 on male infertility, owing to the fact that the male reproductive system indicated to be extremely vulnerable to SARS-CoV-2 infection. Only a small number of studies have investigated the effects of SARS-CoV-2 on male reproduction, but the results are not consistent. So, we performed this meta-analysis to draw a clearer picture and evaluate the impacts of COVID-19 on male reproductive system.

METHOD

We searched Embase, Web of Science, PubMed, and Google Scholar databases to identify the potentially relevant studies. Standardized mean difference (SMD) with 95% confidence interval (CI) was applied to assess the relationship. Heterogeneity testing, sensitivity analysis, and publication bias testing were also performed.

RESULTS

A total of twelve studies including 7 case control investigations and 5 retrospective cohort studies were found relevant and chosen for our research. Our result showed that different sperm parameters including semen volume [SMD =  - 0.27 (- 0.46, - 1.48) (p = 0.00)], sperm concentration [SMD =  - 0.41 (- 0.67, - 0.15) (p = 0.002)], sperm count [SMD =  - 0.30 (- 0.44, - 0.17) (p = 0.00)], sperm motility [SMD =  - 0.66 (- 0.98, - 0.33) (p = 0.00)], and progressive motility [SMD =  - 0.35 (- 0.61, - 0.08) (p = 0.01)] were negatively influenced by SARS-CoV-2 infection. However, sperm concentration (p = 0.07) and progressive motility (p = 0.61) were not found to be significantly associated with SARS-CoV-2 infection in case control studies. No publication bias was detected.

CONCLUSION

The present study revealed the vulnerability of semen quality to SARS-CoV-2 infection. Our data showed a strong association of different sperm parameters with SARS-CoV-2 infection. The results suggested that SARS-CoV-2 infection in patients may negatively influence their fertility potential in a short-term period, but more studies are needed to decide about the long-term effects.

Can Coronavirus Disease 2019 Effect on Human Reproduction?

Since the main role in the pathogenesis of the coronavirus is attributed to the angiotensin-converting enzyme (ACE) receptor, it could possibly be a hypothesis in the differential sex-based pathogenesis of the coronavirus. The virus inserts its genetic material into the cell through its ACE2 receptors and replicates it by intracellular proteins. ACE2 receptors are highly expressed in cell membranes of various tissues in the body, including cardiovascular, gastrointestinal, renal, macrophage cells, and especially on the surface of type 2 pneumocytes in the lungs, ovaries, uterus, vagina, placenta, and testes. Therefore, cells having a higher expression of the ACE2 may be a specific target for coronavirus binding and infectivity. Due to the increase of infections in males, concerns have been appeared about the potential impact of coronavirus disease 2019 (COVID-19) on their fertility and reproductive organs. Thus, it is necessary to investigate if COVID-19 disturbs female and male fertility, so this review aimed to study the comprehensive evidences on the association of COVID-19 with human reproduction.

Corona and Reproduction, or Why the Corona Vaccination Does Not Result in Infertility

Background As the COVID-19 pandemic persists and new vaccines are developed, concerns among the general public are growing that both infection with the SARS-CoV-2 virus and vaccinations against the coronavirus (mRNA vaccines) could lead to infertility or higher miscarriage rates. These fears are voiced particularly often by young adults of reproductive age. This review summarizes the current data on the impact of SARS-CoV-2 infection and corona vaccinations on female and male fertility, based on both animal models and human data.

Method A systematic literature search (PubMed, Embase, Web of Science) was carried out using the search terms “COVID 19, SARS-CoV-2, fertility, semen, sperm, oocyte, male fertility, female fertility, infertility”. After the search, original articles published between October 2019 and October 2021 were selected and reviewed.

Results Despite the use of very high vaccine doses in animal models, no negative impacts on fertility, the course of pregnancy, or fetal development were detected. In humans, no SARS-CoV-2 RNA was found in the oocytes/follicular fluid of infected women; similarly, no differences with regard to pregnancy rates or percentages of healthy children were found between persons who had recovered from the disease, vaccinated persons, and controls. Vaccination also had no impact on live-birth rates after assisted reproductive treatment. No viral RNA was detected in the semen of the majority of infected or still infectious men; however, a significant deterioration of semen parameters was found during semen analysis, especially after severe viral disease. None of the studies found that corona vaccines had any impact on male fertility.

Discussion Neither the animal models nor the human data presented in recent studies provide any indications that fertility decreases after being vaccinated against coronavirus. However, there is a growing body of evidence that severe SARS-CoV-2 infection has a negative impact on male fertility and there is clear evidence of an increased risk of complications among pregnant women with SARS-CoV-2 infection. The counseling offered to young adults should therefore take their fears and concerns seriously as well as providing a structured discussion of the current data.

The COVID-19 pandemic - what have urologists learned?

On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.

The Impact of the SARS-CoV-2 Pandemic on Reproduction, Sexual Function and Behaviors: A Review of the Main Trends and Findings

Objective: This review sought to describe the main trends and findings on the SARS-CoV-2 and the pandemic's effect on reproduction (i.e., effects on fertility, reproductive tissue, pregnancy, vertical and sexual transmission) and sexual function and behaviors. Methods: A review was conducted on studies assessing these variables through the Scopus and PubMed databases between the years 2019-2021. Results: Results showed SARS-CoV-2 pandemic and social distancing measures have affected-and in some cases not-different aspects of people's reproductive function, sexual function and behaviors. Conclusions: Suggestions are offered for researchers and professionals focused on future research and clinical practice.

Investigating the impact of SARS-CoV-2 infection on basic semen parameters and in vitro fertilization/intracytoplasmic sperm injection outcomes: a retrospective cohort study

BACKGROUND

This study aimed to evaluate the influences of SARS-CoV-2 infection on semen parameters and investigate the impact of the infection on in vitro fertilization (IVF) outcomes.

METHODS

This retrospective study enrolled couples undergoing IVF cycles between May 2020 and February 2021 at Tongji Hospital, Wuhan. Baseline characteristics were matched using propensity score matching. Participants were categorized into an unexposed group (SARS-COV-2 negative) and exposed group (SARS-COV-2 positive) based on a history of SARS-CoV-2 infection, and the populations were 148 and 50 after matching, respectively. IVF data were compared between the matched cohorts. Moreover, semen parameters were compared before and after infection among the infected males. The main measures were semen parameters and IVF outcomes, including laboratory and clinical outcomes.

RESULTS

Generally, the concentration and motility of sperm did not significantly differ before and after infection. Infected males seemed to have fewer sperm with normal morphology, while all values were above the limits. Notably, the blastocyst formation rate and available blastocyst rate in the exposed group were lower than those in the control group, despite similar mature oocytes rates, normal fertilization rates, cleavage rates, and high-quality embryo rates. Moreover, no significant differences were exhibited between the matched cohorts regarding the implantation rate, biochemical pregnancy rate, clinical pregnancy rate, or early miscarriage rate.

CONCLUSIONS

The results of this retrospective cohort study suggested that the semen quality and the chance of pregnancy in terms of IVF outcomes were comparable between the males with a history of SARS-CoV-2 infection and controls, although a decreased blastocyst formation rate and available blastocyst rate was observed in the exposed group, which needs to be reinforced by a multicenter long-term investigation with a larger sample size.

Necrozoospermia: The tree that hides the forest

BACKGROUND

Necrozoospermia is a condition found in 0.2 to 0.4 % of male infertility cases. The causes of necrozoospermia are multiple: they can be related to testicular and/or post-testicular damage. Additionally, these causes most often involve the production of reactive oxygen species (ROS) and/or sperm DNA fragmentation (SDF) which can reduce the chances of spontaneous pregnancy or affect the outcome of assisted reproductive technologies.

OBJECTIVE

To focus on potential etiologies of necrozoospermia, its diagnosis and its therapeutic management especially before the employment of ICSI.

METHODS

Authors searched PubMed/Medline, Web of Science, Cochrane Library, Google and Institutional websites for medical subheading terms and free text words referred to "necrozoospermia", "sperm vitality", "sperm viability", "sperm DNA fragmentation" and "ICSI".

RESULTS

We identified twelve main etiologies of necrozoospermia responsible for either a decrease of sperm vitality, a mild a moderate or a severe necrozoospermia. In case of a confirmed decreased vitality, a thorough check-up should be conducted and if available, etiological treatment should be proposed. Therapeutic management could also include repeated ejaculations, drug treatments, the use of ICSI with ejaculated or surgically extracted spermatozoa in case of a non-treatable necrozoospermia.

DISCUSSION AND CONCLUSION

The potential causes of necrozoospermia should be investigated because many of them could be corrected, thus avoiding the use of ICSI. Moreover, if ICSI procedure remains necessary, the therapeutic management of necrozoospermia could also improve the chances of success by reducing oxidative stress and/or sperm DNA fragmentation. This article is protected by copyright. All rights reserved.

COVID-19 Vaccination Does Not Affect Reproductive Health Parameters in Men

With the implementation of COVID-19 vaccine up-take, doubts regarding the impact of immunization on future fertility have begun to emerge. We have examined vaccine safety on male reproductive health. We set up a multicentre (three infertility centers), retrospective study in order to assess semen parameters and fertilization rate of one hundred-six men in a pairwise comparison between the first and second assisted reproduction technology (ART) attempt, performed respectively before and after COVID-19 vaccination. Median time (range) between the first vaccine dose and the second ART cycle was 75 days (39-112). Semen parameters did not change before and after the exposure. Fertilization rate was also similar before and after vaccination. Twenty-five patients (24%) were oligozoospermic before the vaccination while 26 (25%) after the exposure (P = 0.87). Severe asthenozoospermia were present in 11 patients before as well as after the exposure. No difference was observed even after considering different types of vaccines (mRNA or viral vector). COVID-19 vaccination did not affect sperm quality and fertilization capacity of men undergoing ART treatments and should be considered safe for men's reproductive health.

Could SARS-CoV-2 infection affect male fertility and sexuality?

Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is the cause of coronavirus infectious disease (COVID‐19) and has rapidly spread worldwide, causing serious problems to the healthcare systems of many countries and hundreds of thousand deaths. In this review we discuss data from the literature to understand whether the various districts of the male reproductive system may represent another vulnerable target for SARS‐CoV‐2. Studies were searched from electronic databases such as Google Scholar, PubMed, Scopus, and COVID‐19 specific databases such as LitCovid, until July 31, 2021. It appears that SARS‐CoV‐2 virus infection not only causes damage to the respiratory system, but could have a serious impact on the reproductive system of male patients modulating many physiological processes. Like some other infections, SARS‐CoV‐2 also leads to a worsening of semen quality and an increase in oxidative stress (OS) levels. However, due to the limited number of studies, it is unclear whether this deterioration in semen parameters is temporary or lasts over time. It is certainly important that patients' reproductive function is monitored after coronavirus infection to avoid problems in reproductive health in the future.

Implications of testicular ACE2 and the renin-angiotensin system for SARS-CoV-2 on testis function

Although many studies have focused on SARS-CoV-2 infection in the lungs, comparatively little is known about the potential effects of the virus on male fertility. SARS-CoV-2 infection of target cells requires the presence of furin, angiotensin-converting enzyme 2 (ACE2) receptors, and transmembrane protease serine 2 (TMPRSS2). Thus, cells in the body that express these proteins might be highly susceptible to viral entry and downstream effects. Currently, reports regarding the expression of the viral entry proteins in the testes are conflicting; however, other members of the SARS-CoV family of viruses - such as SARS-CoV - have been suspected to cause testicular dysfunction and/or orchitis. SARS-CoV-2, which displays many similarities to SARS-CoV, could potentially cause similar adverse effects. Commonalities between SARS family members, taken in combination with sparse reports of testicular discomfort and altered hormone levels in patients with SARS-CoV-2, might indicate possible testicular dysfunction. Thus, SARS-CoV-2 infection has the potential for effects on testis somatic and germline cells and experimental approaches might be required to help identify potential short-term and long-term effects of SARS-CoV-2 on male fertility.

Evaluation of SARS-CoV-2 in semen, seminal plasma, and spermatozoa pellet of COVID-19 patients in the acute stage of infection

To date, there is limited information about the presence of SARS-CoV-2 in semen especially in the acute phase of the infection. While available data from cohort studies including a total of 342 patients in the acute or recovery phase of the infection are reassuring, one study mentioned detecting virus in the semen of 6/38 COVID-19 patients. Here we assessed SARS-CoV-2 presence in the semen of COVID-19 positive patients in the acute stage of infection, within 24 hours of the positive nasopharyngeal swabs. Semen, seminal plasma and spermatozoa pellet were screened for SARS-CoV-2 and manual or airborne contamination during semen sampling. Among the 32 COVID-19 volunteers, the median interval from the onset of symptoms to semen collection was 4 days [IQR: 0-8]. Only one presented positive SARS-CoV-2 PCR in semen and seminal plasma fractions, although the spermatozoa pellet was negative. Viral cultures were all negative. We observed slightly higher concentrations of bacterial DNA in the SARS-CoV-2 positive specimen than in all negative samples. The bacteria identified neither confirm nor rule out contamination by oropharyngeal secretions during collection. SARS-CoV-2 was rarely present in semen during the acute phase of the disease. This very rare situation could be connected to oral or manual contamination during semen collection. The possible presence of SARS-CoV-2 in semen calls for nasopharyngeal viral testing and strict hygiene protocols during semen collection before assisted reproductive attempts.

Semen parameters in men recovered from COVID-19: a systematic review and meta-analysis

BACKGROUND

The novel beta-coronavirus disease (COVID-19) has infected millions of people globally with high risk among males than females. However, the effect of COVID-19 andrology is still a subject of dispute. We planned to analyze the overall consequences of COVID-19 on semen parameters and male sex hormones.

MAIN TEXT

Systematic search was performed on MEDLINE and Scopus database until 11 June 2021. We included observational studies, which reported mean ± standard deviation of the semen parameters and serum sex hormones of those reproductive-aged males recovered from COVID-19 and controls who did not suffered from COVID-19. We used Random-effect model to pool the studies, as heterogeneity was present. The Q test and I 2 evaluated heterogeneity. All articles were assessed with their quality and publication bias.We assessed 966 articles for eligibility and found seven eligible studies. These 7 studies included 934 participants with mean age 37.34 ± 10.5 years. Random-effect model meta-analysis showed that men who recovered from COVID-19 had semen parameters less than those who had not suffered from COVID-19. The overall mean difference (MD) [95% confidence interval (CI)] in semen volume, sperm concentration, sperm number, and progressive sperm motility was - 0.20 (- 0.45, 0.05) ml, - 16.59 (- 34.82, 1.65) millions/ml, - 45.44 (- 84.56, - 6.31) millions per ejaculate, - 1.73 (- 8.20, 4.75) percentage respectively. Considering sex hormones, luteinizing hormone and prolactin levels were higher among those recovered with a significant MD (95% CI) of 3.47 (1.59, 5.35)U l-1 and 3.21 (1.71, 4.72)ng ml-1 respectively.

CONCLUSION

We found that COVID-19 affects both semen parameters and sexual hormones. However, the mechanism for testicular involvement remains doubtful.

TRIAL REGISTRATION

PROSPERO CRD42021259445.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s43043-021-00089-w.

Human semen quality as affected by SARS-CoV-2 infection: An up-to-date review

Revealing the effect of SARS‐CoV‐2 infection on semen quality is a dynamic priority for many healthcare providers in the field as well as subfertile patients. Therefore, the collective summary in this research approach is still highly needed, especially with the continuous increase in original publications. Here, we provide an up‐to‐date review and discussion to collectively reveal the effect of SARS‐CoV‐2 infection on human semen quality. To do this, we reviewed all articles and abstracts published in Scopus and PubMed using the keywords ‘SARS‐CoV‐2’ and ‘COVID’ versus ‘sperm’ and ‘semen’. In summary, it can be revealed that, at both symptomatic and recovery stages of infection, no investigational evidence of SARS‐CoV‐2 shedding in human semen. Also, the mainstream of the up‐to‐date published work reveals a negative impact of SARS‐CoV‐2 infection on semen quality parameters, particularly sperm count and motility. However, long‐term post‐recovery comparative studies seem very important in this particular setting.