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Zeginiadou T, Symeonidis EN, Symeonidis A, Vakalopoulos I. SARS-CoV-2 infection (COVID-19) and male fertility: Something we should be worried about? Urologia 2023; 90:726-734. [PMID: 37278004 PMCID: PMC10247691 DOI: 10.1177/03915603231175941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/19/2023] [Indexed: 06/07/2023]
Abstract
As of 2021, roughly 5 million deaths were linked to SARS-CoV-2 infection based on World Health Organization estimates. The pandemic takes its staggering death toll, severely affecting the healthcare systems and leading to detrimental implications globally. While the severe impact on the respiratory system is well-established, the exact effect on male reproduction is still largely uncharted territory. When it comes to gender, men appear more vulnerable compared to women. Increasing evidence suggests that COVID-19 adversely affects spermatogenesis and hormonal balance in diverse ways. Semen parameters seem to be compromised at least temporarily, while long-term worsening needs to be clarified in studies with extended follow-up. For the time being, no data support the adverse effect of COVID-19 vaccines on a male's reproductive health. In the present article, we examine the available literature and briefly discuss the impact of the virus on reproduction and fertility. We further provide a comprehensive overview of the current status of vaccination and its potential effect on male fertility. Ultimately, we address the need for future well-designed large-scale trials before drawing definite conclusions on the exact impact of the virus on a male's fecundity.
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Affiliation(s)
| | - Evangelos N Symeonidis
- 1st Department of Urology, Aristotle University, “G. Gennimatas” General Hospital, Thessaloniki, Greece
| | - Asterios Symeonidis
- 1st Department of Urology, Aristotle University, “G. Gennimatas” General Hospital, Thessaloniki, Greece
| | - Ioannis Vakalopoulos
- 1st Department of Urology, Aristotle University, “G. Gennimatas” General Hospital, Thessaloniki, Greece
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Kalfas T, Kaltsas A, Symeonidis EN, Symeonidis A, Zikopoulos A, Moustakli E, Tsiampali C, Tsampoukas G, Palapela N, Zachariou A, Sofikitis N, Dimitriadis F. COVID-19 and Male Infertility: Is There a Role for Antioxidants? Antioxidants (Basel) 2023; 12:1483. [PMID: 37627478 PMCID: PMC10451649 DOI: 10.3390/antiox12081483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/27/2023] Open
Abstract
Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), jeopardizes male fertility because of the vulnerability of the male reproductive system, especially the testes. This study evaluates the effects of the virus on testicular function and examines the potential role of antioxidants in mitigating the damage caused by oxidative stress (OS). A comprehensive PubMed search examined exocrine and endocrine testicular function alteration, the interplay between OS and COVID-19-induced defects, and the potential benefit of antioxidants. Although the virus is rarely directly detectable in sperm and testicular tissue, semen quality and hormonal balance are affected in patients, with some changes persisting throughout a spermatogenesis cycle. Testicular pathology in deceased patients shows defects in spermatogenesis, vascular changes, and inflammation. Acute primary hypogonadism is observed mainly in severely infected cases. Elevated OS and sperm DNA fragmentation markers suggest redox imbalance as a possible mechanism behind the fertility changes. COVID-19 vaccines appear to be safe for male fertility, but the efficacy of antioxidants to improve sperm quality after infection remains unproven due to limited research. Given the limited and inconclusive evidence, careful evaluation of men recovering from COVID-19 seeking fertility improvement is strongly recommended.
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Affiliation(s)
| | - Aris Kaltsas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (E.M.); (A.Z.); (N.S.)
| | - Evangelos N. Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.N.S.); (A.S.)
| | - Asterios Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.N.S.); (A.S.)
| | - Athanasios Zikopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (E.M.); (A.Z.); (N.S.)
| | - Efthalia Moustakli
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (E.M.); (A.Z.); (N.S.)
| | | | - Georgios Tsampoukas
- Department of Urology, Oxford University Hospital NHS Trust, Oxford OX3 7LE, UK;
| | - Natalia Palapela
- Medical Faculty, Medical University of Sofia, 1431 Sofia, Bulgaria;
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (E.M.); (A.Z.); (N.S.)
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (E.M.); (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.N.S.); (A.S.)
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Zhang Z, Yang YZ, Zhang HT, Xi Y, Wang CT, Liu DF, Mao JM, Lin HC, Tang WH, Zhao LM, Zhang XS, Dai YT, Jiang H. Psychological status of infertile men during the Coronavirus Disease 2019 Pandemic in China: a cross-sectional investigation. Basic Clin Androl 2023; 33:8. [PMID: 36792987 PMCID: PMC9931448 DOI: 10.1186/s12610-022-00177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 11/24/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak has had a widespread and profound impact on people's mental health. The factors associated with mental symptoms among men diagnosed with infertility, a disease closely related to psychological conditions, remain unclear. The aim of this study is to investigate the risk factors associated with mental symptoms among infertile Chinese men during the pandemic. RESULTS A total of 4,098 eligible participants were recruited in this cross-sectional, nationwide study, including 2,034 (49.6%) with primary infertility and 2,064 (50.4%) with secondary infertility. The prevalence of mental health conditions was 36.3%, 39.6%, and 6.7% for anxiety, depression, and post-pandemic stress, respectively. Sexual dysfunction is associated with a higher risk with adjusted odds ratios (ORs) of 1.40 for anxiety, 1.38 for depression, and 2.32 for stress. Men receiving infertility drug therapy displayed a higher risk for anxiety (adjusted OR, 1.31) and depression (adjusted OR, 1.28) symptoms, while those receiving intrauterine insemination had a lower risk of anxiety (adjusted OR, 0.56) and depression (adjusted OR, 0.55) symptoms. CONCLUSION The COVID-19 pandemic has had a significant psychological impact on infertile men. Several psychologically vulnerable populations were identified, including individuals with sexual dysfunction, respondents receiving infertility drug therapy, and those experiencing control measures for COVID-19. The findings provide a comprehensive profile of the mental health status of infertile Chinese men during the COVID-19 outbreak and provide potential psychological intervention strategies.
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Affiliation(s)
- Zhe Zhang
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Yu-Zhuo Yang
- grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Hai-Tao Zhang
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Yu Xi
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Cun-Tong Wang
- grid.411054.50000 0000 9894 8211School of Social Development, Central University of Finance and Economics, Beijing, China
| | - De-Feng Liu
- grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Jia-Ming Mao
- grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Hao-Cheng Lin
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Wen-Hao Tang
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Lian-Ming Zhao
- grid.411642.40000 0004 0605 3760Department of Urology, Peking University Third Hospital, Beijing, China ,grid.411642.40000 0004 0605 3760Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Xian-Sheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Yu-Tian Dai
- Department of Andrology, Nanjing Drum Tower Hospital, Nanjing, China.
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing, China. .,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China.
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Haeri F, Nouri M, Nezamoleslami S, Moradi A, Ghiasvand R. Role of dietary antioxidants and vitamins intake in semen quality parameters: A cross-sectional study. Clin Nutr ESPEN 2022; 48:434-440. [DOI: 10.1016/j.clnesp.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
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Symeonidis EN, Evgeni E, Palapelas V, Koumasi D, Pyrgidis N, Sokolakis I, Hatzichristodoulou G, Tsiampali C, Mykoniatis I, Zachariou A, Sofikitis N, Kaltsas A, Dimitriadis F. Redox Balance in Male Infertility: Excellence through Moderation-"Μέτρον ἄριστον". Antioxidants (Basel) 2021; 10:antiox10101534. [PMID: 34679669 PMCID: PMC8533291 DOI: 10.3390/antiox10101534] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/02/2022] Open
Abstract
Male infertility, a relatively common and multifactorial medical condition, affects approximately 15% of couples globally. Based on WHO estimates, a staggering 190 million people struggle with this health condition, and male factor is the sole or contributing factor in roughly 20–50% of these cases. Nowadays, urologists are confronted with a wide spectrum of conditions ranging from the typical infertile male to more complex cases of either unexplained or idiopathic male infertility, requiring a specific patient-tailored diagnostic approach and management. Strikingly enough, no identifiable cause in routine workup can be found in 30% to 50% of infertile males. The medical term male oxidative stress infertility (MOSI) was recently coined to describe infertile men with abnormal sperm parameters and oxidative stress (OS), including those previously classified as having idiopathic infertility. OS is a critical component of male infertility, entailing an imbalance between reactive oxygen species (ROS) and antioxidants. ROS abundance has been implicated in sperm abnormalities, while the exact impact on fertilization and pregnancy has long been a subject of considerable debate. In an attempt to counteract the deleterious effects of OS, urologists resorted to antioxidant supplementation. Mounting evidence indicates that indiscriminate consumption of antioxidants has led in some cases to sperm cell damage through a reductive-stress-induced state. The “antioxidant paradox”, one of the biggest andrological challenges, remains a lurking danger that needs to be carefully avoided and thoroughly investigated. For that reason, oxidation-reduction potential (ORP) emerged as a viable ancillary tool to basic semen analysis, measuring the overall balance between oxidants and antioxidants (reductants). A novel biomarker, the Male infertility Oxidative System (MiOXSYS®), is a paradigm shift towards that goal, offering a quantification of OS via a quick, reliable, and reproducible measurement of the ORP. Moderation or “Μέτρον” according to the ancient Greeks is the key to successfully safeguarding redox balance, with MiOXSYS® earnestly claiming its position as a guarantor of homeostasis in the intracellular redox milieu. In the present paper, we aim to offer a narrative summary of evidence relevant to redox regulation in male reproduction, analyze the impact of OS and reductive stress on sperm function, and shed light on the “antioxidant paradox” phenomenon. Finally, we examine the most up-to-date scientific literature regarding ORP and its measurement by the recently developed MiOXSYS® assay.
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Affiliation(s)
- Evangelos N. Symeonidis
- Department of Urology, “G. Gennimatas” General Hospital, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (E.N.S.); (I.M.)
| | - Evangelini Evgeni
- Cryogonia Cryopreservation Bank, 11526 Athens, Greece; (E.E.); (D.K.)
| | - Vasileios Palapelas
- 3rd Department of Obstetrics and Gynecology, Hippokration General Hospital, School of Medicine, Aristotle University, 54642 Thessaloniki, Greece;
| | - Dimitra Koumasi
- Cryogonia Cryopreservation Bank, 11526 Athens, Greece; (E.E.); (D.K.)
| | - Nikolaos Pyrgidis
- Department of Urology, ‘Martha-Maria’ Hospital Nuremberg, 90491 Nuremberg, Germany; (N.P.); (I.S.); (G.H.)
| | - Ioannis Sokolakis
- Department of Urology, ‘Martha-Maria’ Hospital Nuremberg, 90491 Nuremberg, Germany; (N.P.); (I.S.); (G.H.)
| | | | | | - Ioannis Mykoniatis
- Department of Urology, “G. Gennimatas” General Hospital, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (E.N.S.); (I.M.)
| | - Athanasios Zachariou
- Department of Urology, School of Medicine, Ioannina University, 45500 Ioannina, Greece; (A.Z.); (N.S.); (A.K.)
| | - Nikolaos Sofikitis
- Department of Urology, School of Medicine, Ioannina University, 45500 Ioannina, Greece; (A.Z.); (N.S.); (A.K.)
| | - Ares Kaltsas
- Department of Urology, School of Medicine, Ioannina University, 45500 Ioannina, Greece; (A.Z.); (N.S.); (A.K.)
| | - Fotios Dimitriadis
- Department of Urology, “G. Gennimatas” General Hospital, Aristotle University of Thessaloniki, 54635 Thessaloniki, Greece; (E.N.S.); (I.M.)
- Correspondence: ; Tel.: +30-23-1041-1121
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The Effect of Antioxidant Supplementation on Operated or Non-Operated Varicocele-Associated Infertility: A Systematic Review and Meta-Analysis. Antioxidants (Basel) 2021; 10:antiox10071067. [PMID: 34356300 PMCID: PMC8301171 DOI: 10.3390/antiox10071067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023] Open
Abstract
In patients with varicocele-associated infertility, the effect of antioxidant supplementation on fertility is unknown. We performed a systematic review and meta-analysis to explore their role in patients with operated or non-operated varicocele. We searched major databases and sources of grey literature until May 2021 (PROSPERO: CRD42021248195). We included 14 studies (980 individuals) in the systematic review. Of the 14 studies, 2 explored the effect of antioxidant supplementation in patients with non-operated varicocele, 1 compared antioxidants versus surgical repair of varicocele, while 11 explored antioxidants after surgical repair of varicocele and were also included in the meta-analysis. Regarding pregnancy rates, no significant differences were demonstrated after treatment with antioxidants versus no treatment at three (OR: 2.28, 95% CI: 0.7-7.48) and six months (OR: 1.88, 95% CI: 0.62-5.72). Accordingly, contradictory findings were reported in sperm concentration, morphology, and motility, as well as DNA fragmentation. Our findings indicate that antioxidant supplementation does not improve pregnancy rates and semen parameters in patients with varicocele-associated infertility, in the absence of previous screening for oxidative stress. Based on the previous notion, most included studies also raised methodological concerns. Therefore, definitive conclusions about the efficacy of antioxidant supplementation in this setting cannot be drawn and further research on the field is mandatory.
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