Does COVID-19 Worsen the Semen Parameters? Early Results of a Tertiary Healthcare Center
doi.org/10.1159/000517276
Main article: Causes of Asthenozoospermia
Background
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.
Aim
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.
Methodology
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.
Results
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.
SUMMARY: DOES COVID-19 AFFECT MALE FERTILITY
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.
Limitations
- Small sample number for hormonal analysis
- Timing of semen analysis did not match the normal life cycle of spermatozoa
Funding
No external funding was declared for this study.
Glossary
Inference
A belief or opinion developed from information.
Orchitis
Inflammation of one or both testicles.
RT-PCR
Reverse Transcription-Polymerase Chain Reaction is a laboratory technique primarily used to measure the amount of a specific RNA.
Varicocele
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. https://doi.org/10.1002/jmv.26259
Selvaraj K, et al. (2021). Testicular atrophy and hypothalamic pathology in COVID-19: possibility of the incidence of male infertility and HPG axis abnormalities. https://dx.doi.org/10.1007/s43032-020-00441-x
Holtmann N, et al. (2020). Assessment of SARS-CoV-2 in human semen-a cohort study. https://dx.doi.org/10.1016/j.fertnstert.2020.05.028
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