Q&A: Data show SARS-CoV-2 infection may have short-term impact on male fertility
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Recent, albeit limited, data indicate SARS-CoV-2 infection can have a temporary effect on a man’s fertility.
The finding is based on a review of available medical literature investigating the impact of SARS-CoV-2 infection on testes, inflammation and oxidative stress. Researchers also examined how the infection impacts the mechanisms of normal testosterone production.
Alexander B. Collins, of the department of microbiology, immunology and pathology at the Des Moines University College of Osteopathic Medicine in Iowa, and colleagues concluded that “while much is left to be studied, COVID-19 does appear to impact male fertility, at least temporarily.” Specifically, the researchers reported that SARS-CoV-2 infection can result in reduced testosterone production and “a state of temporary hypogonadism.”
However, they cautioned that the lack of large, multicenter studies conducted over long periods of time makes it “unwise to draw definitive conclusions” from the current medical literature.
The results correspond with another recent study that also found SARS-CoV-2 infection may impact male fertility. The researchers examined the association between infection and COVID-19 vaccination on fertility in 2,126 women who were trying to conceive. The participants were recruited from December 2020 to September 2021 and followed through November 2021.
The findings, published in the American Journal of Epidemiology, revealed that couples had a slightly lower chance of conception if the male partner had been infected with SARS-CoV-2 within 60 days before a menstrual cycle. According to the researchers, this suggested that SARS-CoV-2 infection could temporarily reduce male fertility. The researchers also wrote that COVID-19 vaccination did not appear to impair fertility. However, they also advised against drawing long-term conclusions from their results.
With data still emerging in this clinical area, Healio asked Collins to discuss some of the most important things that health care professionals need to know right now about COVID-19 and male fertility.
Healio: How does SARS-CoV-2 infection impact male fertility?
Collins: In summary, the current data does not suggest that a SARS-CoV-2 infection has a lasting impact on male fertility.
The conversation stemmed from recognizing that cells in the testis express the [angiotensin-converting enzyme-2] receptors that serve as the binding site for the spike protein found on SARS-CoV-2. Further studies elucidated that viral entry into a cell requires co-expression of ACE-2 and the molecule [transmembrane serine protease 2].
It has been shown that cellular co-expression of these two molecules is exceedingly low in the testis, indicating that direct infection is unlikely. Several studies have sought to detect SARS-CoV-2 in the testis of patients who succumbed to COVID-19. The overwhelming majority did not find evidence of direct infection.
Circling back to the question, does SARS-CoV-2 impact male fertility? Yes, but indirectly, and the effects are believed to be temporary. Studies have shown that patients suffering from COVID-19 have a reduction in their testosterone levels. Additionally, studies of semen parameters in patients recovering from COVID-19 have shown a decrease in sperm count and mobility. However, these effects have been shown to be temporary.
Healio: What are the clinical implications of your review?
Collins: It is worthwhile for health care professionals to consider past COVID-19 infections in patients who may be struggling with fertility. Although the disruption of sperm parameters and reductions in testosterone appear to be temporary, it is possible for other patterns to arise in the future. At this time, none of the many medications that have been trialed for the treatment of COVID-19 presents undo concern. However, with the breadth of novel and unique medications trialed, potential lasting impacts should be considered.
Healio: What questions remain unanswered?
Collins: This remains a dynamic situation and the long-term implications remain unclear. Overall, most of the available data have small sample sizes and need to be reproduced.
Healio: Your review identified a small number of men who had SARS-CoV-2 RNA in their semen. What considerations should be made for people who are trying to conceive or donate sperm during the pandemic?
Collins: Based on a review of the available literature, it seems likely that these findings are attributable to sampling error. Unlike the Zika virus, SARS-CoV-2 is not thought to be transmissible through semen. That said, based on studies showing deficiencies in sperm parameters in recovering patients, one may want to consider waiting a couple of months after the resolution of symptoms before working towards starting a family or donating semen.
Healio: Previous studies have shown that mRNA COVID-19 vaccination does not impact fertility or sperm quality. Are there any new updates in this area of research?
Collins: This remains true. A clinical study out of the University of Miami analyzed male subjects’ semen before their initial COVID-19 vaccination and again 70 days after the second dose was administered. These researchers found no change in semen volume, sperm concentration, sperm motility and total motile sperm count.
Healio: Anything else to add?
Collins: Issues such as fertility are hot topics and misinformation can run rampant from poorly interpreted studies. We hope our review can provide a digestible summary of the data for this issue.
Collins AB, et al. Urology. 2022;doi:10.1016/j.urology.2021.12.025.
COVID-19 vaccination does not reduce chances of conception, study suggests. https://www.nih.gov/news-events/news-releases/covid-19-vaccination-does-not-reduce-chances-conception-study-suggests. Published Jan. 20, 2022. Accessed Jan. 27, 2022.
Wesselink AK, et al. Am J Epidemiol. 2022;doi:10.1093/aje/kwac011.