COVID-19 Impairs Male Fertility Directly via Sperm Quality

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COVID-19 impairs male fertility directly via sperm quality

Does COVID-19 Worsen the Semen Parameters? Early Results of a Tertiary Healthcare Center


A number of studies to date suggest that COVID-19 may affect the testes including the genital tract, which could indirectly interfere with the male gonadal hormones.

There is also suggestions that SARS-CoV-2 can possibly cross the blood-brain barrier and trigger inflammation in the neural tissues, including the hypothalamus and pituitary gland.

However, the effect of SARS-CoV-2 on the hypothalamic-pituitary-adrenal axis is only speculatory so far with no evidence confirming the inference.


To evaluate the change in semen parameters, of infertile men who had been infected with SARS-CoV-2, and its effect on sex-related hormone levels.


A total of 25 males who attended the Andrology Clinic for male infertility, at the Ankara City Hospital, and subsequently diagnosed with COVID-19 via RT-PCR, were initially included in this study.

During examination: age, smoking status, BMI, medical history and any varicoceles was noted. Semen samples was collected before and after diagnosis of COVID-19, according to WHO guidelines (2010) following 3-5 days of abstinence, with blood samples collected at the same time, in 8 males, for analysis of testosterone, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) hormone levels.

None of the samples were collected during the active phase of the COVID-19 virus to better evaluate the long-term impact.


Of the initial 25 participants, 4 were diagnosed with azoospermia and subsequently excluded from the analysis.

Overall male characteristics was: mean age 32, with BMI = 25.6, 6/21 smokers and 4/21 with varicocele present. 

No clinical signs of orchitis was observed in the males following COVID-19 diagnosis. None of the males required hospitalisation during infection, although 3 and 2 males were administered hydroxychloroquine sulfate and favipiravir respectively, for a maximum of 5 days.

The median time between the first semen analysis and diagnosis of COVID-19 was 116 days. Similarly the median time between the diagnosis of COVID-19 and final semen analysis was 51 days.

Analysis of semen samples revealed significantly reduced sperm quality following COVID-19 diagnosis. 

Specifically a reduction in the following semen parameters (after vs. before):

  • Volume, 2.5 vs. 3.0 mL (P=0.005)
  • Total motility, 34.7 vs. 48.6 % (P=0.001)
  • Progressive motility, 21.8 vs. 35.1 % (P<0.001)
  • Normal morphology, 5 vs. 6 % (P=0.015)

This finding was supported by hormone analysis results showing a significant reduction in testosterone levels (289 vs. 350 ng/dL), following COVID-19 diagnosis, with no change to FSH or LH levels.


In this study, subfertile males subsequently infected with COVID-19, saw a further deterioration in their fertility, with significant reductions in semen volume (2.5 vs. 3.0 mL), total motility (34.7 vs. 48.6 %), progressive motility (21.8 vs 35.1 %) and normal morphology (5 vs. 6 %) post infection.


  1. Small sample number for hormonal analysis
  2. Timing of semen analysis did not match the normal life cycle of spermatozoa


No external funding was declared for this study.


A belief or opinion developed from information.

Inflammation of one or both testicles.

Reverse Transcription-Polymerase Chain Reaction is a laboratory technique primarily used to measure the amount of a specific RNA.

An enlargement of the veins within the scrotum.

Similar studies

Ma L, et al. (2021). Evaluation of sex-related hormones and semen characteristics in reproductive-aged male COVID-19 patients.

Selvaraj K, et al. (2021). Testicular atrophy and hypothalamic pathology in COVID-19: possibility of the incidence of male infertility and HPG axis abnormalities.

Holtmann N, et al. (2020). Assessment of SARS-CoV-2 in human semen-a cohort study.


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