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Covid-19’s impact on male fertility

28 Dec 2021

  • Study reveals drop in sperm count caused by virus, but not by vaccine
BY Sumudu Chamara Among other things, scientists have been discussing whether, and to what extent, Covid-19 and the Covid-19 vaccines can affect a person’s health in the long run, especially after recovering from Covid-19 and in the few months after vaccination. While a large number of these discussions have focused mainly on a person’s immune system, scientists are also evaluating the impact Covid-19 and Covid-19 vaccines can have on a person’s fertility. While the notion that Covid-19 vaccines can affect a person’s fertility has been rejected by medical experts as a myth, according to data available for the time being, they agree and several studies have indicated that Covid-19 – depending on the severity of complications and symptoms, among other factors – can in fact affect a person’s fertility. A recent study has found that Covid-19 has the ability to affect fertility in men by reducing men’s sperm counts, and that such a decline in sperm counts can be observed even three months after recovery from Covid-19. According to the study, higher amounts of Covid-19 antibodies in a patient’s blood serum can be correlated to a reduced sperm function. These findings were presented in a study report that was made public last week. The study, titled “Sperm quality and absence of severe acute respiratory syndrome coronavirus two (SARS-CoV-2) ribonucleic acid (RNA) in semen after Covid-19 infection: A prospective, observational study and validation of the sperm Covid-19 test”, was carried out by a team of researchers (G.G.G. Donders, E. Bosmans, J. Reumers, F. Donders, J. Jonckheere, G. Salembier, N. Stern, Y. Jacquemyn, W. Ombelet and C.E. Depuydt) attached to several institutions in Belgium. The study attempted to determine if SARS-CoV-2 could be detected in the semen of adult men who had recovered from the Covid-19 infection, and assessed the influence of Covid-19 on fertility parameters and deoxyribonucleic acid (DNA) damage in semen, among other objectives. It was carried out in a university medical centre environment, and 120 Belgian men who had recovered from a proven Covid-19 infection participated in it. As per the results of the study, SARS-CoV-2 RNA had not been detected in the semen of the participants during the period shortly after Covid-19 infection, nor at a later time. However, the mean (average) progressive motility (refers to sperm that are swimming in a mostly straight line or large circles) had reduced in 60% of the men who tested shortly (in less than a month) after the Covid-19 infection, 37% of the men who tested one to two months after the infection, and 28% of the men who tested two months after the infection. The study had also found that the mean sperm count had reduced in 37% of the men who were tested shortly (in less than a month) after the Covid-19 infection, and in 29% of the men who tested one to two months after the infection. In addition, a decline in the mean sperm count in 6% of the men who tested more than two months after the infection had also been observed. The findings also noted that the severity of the Covid-19 infection and the presence of fever were not correlated with sperm characteristics, and that high levels of anti-sperm antibodies had developed in three men who had participated in the study, which constitutes 2.5% of the sample. The study concluded that semen is not infectious with SARS-CoV-2 at one week or more after the Covid-19 infection (mean – 53 days), adding that, however, couples with a desire for pregnancy should be warned that sperm quality after Covid-19 infection can be suboptimal. The estimated recovery time, according to the researchers, is three months, and further follow-up studies are underway to confirm this and to determine if permanent damage had occurred in a minority of men. The researchers said: “Despite the absence of the detection of SARS-CoV-2 RNA in the semen, we found evidence of severely decreased quality parameters after convalescence from the SARS-CoV-2 infection. The negative impact of Covid-19 on sperm quality mainly affected the sperm concentration, motility, and the sperm DNA Fragmentation Index (DFI – a method used to evaluate male fertility or infertility by evaluating the percentage of sperm in a particular semen sample with fragmented DNA), whereas the correlation with abnormal morphology was less clear.” Moreover, they noted that these results confirmed data from another study – titled “Assessment of SARS-CoV-2 in Human Semen: A Cohort Study” by German researchers N. Holtmann, P. Edimiris, M. Andree, C. Doehmen, D. Baston-Buest, O. Adams, J.S. Kruessel, and A.P. Bielfeld – which had found decreased concentration and motility of spermatozoa (male sex cells that carry a man’s genetic material) in men who had had a moderate Covid-19 infection. “In that study (“Assessment of SARS-CoV-2 in Human Semen: A Cohort Study”), such abnormalities were not found in men with mild Covid-19 infection or in Covid-19 negative controls. In contrast, in our study, we found no differences in sperm quality parameters between patients who had to be admitted to the hospital and those who could stay home with the Covid-19 infection, and no correlations between the sperm quality parameters and the total Covid-19 symptom score (created by adding the number of different symptoms each patient had during the acute episode of the Covid-19 disease, resulting in a total symptom score between zero [no symptoms] and 15 [maximal symptoms]). During other viral infections, such as influenza, sperm motility can be linked to the severity of the fever, with a maximal decrease of motility seen at day 37 and the normalisation of motility by day 54 after the fever. However, in our study, the presence and severity of the fever and the symptom score during the Covid-19 disease were not correlated with the sperm quality parameters, indicating that mechanisms other than fever which are linked to the Covid-19 infection could be involved in the pathogenesis of the sperm damage,” they added. Furthermore, other studies suggest that Covid-19 may have other forms of impacts on different parts of the male reproductive system, including the penis. This was suggested by several studies conducted by a group of researchers and physicians at Miami University. One study – titled “Histopathology and Ultrastructural Findings of Fatal Covid-19 Infections on Testis” and conducted by J.K. Achua, K.Y. Chu, E. Ibrahim, K. Khodamoradi, K.S. Delma, O.A. Iakymenko, O.N. Kryvenko, H. Arora, and R. Ramasamy – had analysed the autopsy tissues of the testicles of six men who died of Covid-19 infection, and had observed the virus in the testicle tissues of one of the men and decreased numbers of sperm in three of the men. According to an article published in The Conversation by R. Ramasamy, who is an Associate Professor of Urology at Miami University, another patient who had survived Covid-19 had had a testis biopsy about three months after his initial Covid-19 infection cleared up, and the biopsy had shown that the virus was still in his testicles. Meanwhile, another study – titled “Covid-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis” and conducted by researchers from the same university, namely, E. Kresch, J. Achua, R. Saltzman, K. Khodamoradi, H. Arora, E. Ibrahim, O.N. Kryvenko, V.W. Almeida, F. Firdaus, J.M. Hare, and R. Ramasamy – found that Covid-19 can affect the penis as well. Regarding the findings of this study, R. Ramasamy said that this was an analysis of penile tissue taken from two men receiving penile implants. The study had shown that the virus was present seven to nine months after their Covid-19 diagnosis, and that both men had developed severe erectile dysfunction, which he said was probably because Covid-19 infection had caused reduced blood supply to the penis. The study’s conclusion said that this is the first study to demonstrate the presence of the virus in the penis long after the initial infection in humans. “Notably, one of the men had only mild Covid-19 symptoms. The other had been hospitalised. This suggests that even those with a relatively light case of the virus can experience severe erectile dysfunction after recovery,” he said, adding that these findings are not entirely surprising, in a context where scientists know that other viruses invade the testicles and affect sperm production and fertility. Explaining this further, he said: “One example is that investigators studying testes tissues from six patients who died from the 2006 SARS-CoV virus found that all of them had widespread cell destruction, with few to no sperm. It is also known that Mumps and Zika viruses can enter the testicles and cause inflammation. Up to 20% of men infected with these viruses will have impaired sperm production.” He added: “The research is only a first step on how Covid-19 might affect male sexual health; the samples were small. Studies should continue. Still, for men who have had Covid-19 and then experienced testicular pain, it is reasonable to consider that the virus has invaded testes tissue. Erectile dysfunction can be the result. Those men should see an urologist (doctors specialised in diagnosing and treating diseases of the urinary tract in both men and women).” He also noted that even though one of the reasons for vaccine hesitancy is the perception among many that Covid-19 vaccines might affect male fertility, research shows the opposite. He added that there is no evidence that the vaccine harms a man’s reproductive system, cautioning that ignoring the vaccine and contracting Covid-19, however, could cause such harm. In addition to the abovementioned studies, a number of studies looking into Covid-19’s impacts on fertility in men and women have been conducted in different contexts, and some of them have pointed out the importance of paying more attention to female fertility, paying more attention to different variants the study participants were infected with, and engaging men of more age groups in future studies. Even though several studies have suggested different impacts on the male reproductive system and fertility due to Covid-19 infection, many researchers are of the opinion that more studies are necessary to gauge the extent and longevity of such impacts. However, men should be more vigilant about their safety than women, because available research on Covid-19-caused infertility in men and women have not found that women are facing the same risk as men. In fact, multiple research studies have mentioned that the risk men are facing is far higher than the risk faced by women, adding, however, that that does not mean studies focusing on female fertility-related risks posed by Covid-19 should not continue. They also recommend that regardless of the availability or unavailability of such in-depth data regarding infertility, getting vaccinated should receive utmost attention, because available data has led to the conclusion that vaccines do not cause infertility.

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