COVID-19 AND MALE FERTILITY

DOES COVID-19 AFFECT MALE FERTILITY?

There have been suggestions in newspapers and social media that COVID-19 might impair male fertility, to date, there is no published data directly associating the COVID-19 infection with decreased male fertility.

Some have suggested since fevers are a common symptom of COVID-19, increased testicular temperatures can cause a transient decrease in testicular function, theoretically impairing sperm function. A study conducted in Wuhan compared the levels of reproduction related hormones in 81 men who had COVID-19 and 100 men who did not have the infection1. The study found that the men with COVID-19 did show decreased levels of reproduction-related hormones, but not in testosterone levels. This study, however, did not look at the sperm counts or quality.

Furthermore, long term stress, which is not uncommon or unexpected during this pandemic, can lead to decreased pituitary function. The pituitary gland, amongst other things, stimulates the testicles to produce testosterone and induce sperm production. Hence when pituitary function is decreased due to long term stress, male fertility/testosterone production could negatively be impacted.

Are there any long lasting effects of COVID-19 on male fertility?

There are some viruses, most notably Mumps, that can cause something called viral orchitis. This is a severe inflammation/infection of the testicles, which, when it occurs in adolescents and young boys, can cause permanent damage to the testicles and lead to infertility. Studies on Severe acute respiratory syndrome (SARS), which is from the same coronavirus class as COVID-19, revealed that some patients developed viral orchitis as a part of the disease. Testicular tissue expresses a high amount of the enzyme ACE2, which the SARS-COV-2 viruses bind to as a part of how they infect cells. Therefore, it is theoretically possible that COVID-19 may cause a similar effect on the testicles. However, it is important to note that to date, this is still purely speculative, and there have been no reported cases of testicular infection associated with COVID-19 at this point.

Can COVID-19 be sexually transmitted?

This is still an area of ongoing research at this time, and the data is mixed. Two earlier studies had looked at the semen of COVID-19 positive men one month after diagnosis 2,3. Both studies found that there was no SARS-CoV-2 (the COVID-19 virus) detected in their semen. However, a more recent study looked at both men who have achieved clinical recovery from COVID-19 and those with active COVID-19 infection4. They found that 6 patients (15.8%) had SARS-CoV-2 in their semen, including 4 of 15 patients (26.7%) who were at the acute stage of infection and 2 of 23 patients (8.7%) who were clinically recovering.

These results do not necessarily prove that COVID-19 can be sexually transmitted, nor does it have any implication on sperm quality. More research needs to be done before we can make definitive conclusions in this area. Transmission during sex is most likely to occur by the same mechanism that COVID-19 generally spreads – respiratory droplets spread between partners in close contact.

FINAL THOUGHTS

There is much that is unknown about COVID-19 and male fertility at this time, and research is emerging. Here’s what we know:

  • Fevers associated with acute viral infections of many types can temporarily impair sperm production due to excess heat.
  • There is a theoretical risk of viral orchitis related to COVID-19, but this has not yet been found in patients.
  • There is mixed evidence that SARS-Cov-2 virus may be found in the semen, but the long term implications of this are unclear.

Although we are still learning about how COVID-19 is transmitted, we recommend continued handwashing practices, social distancing measures, covering of the mouth and nose when in public, and regular disinfection of frequently touched surfaces.

Have a question or want to schedule an appointment?

Board-certified, fellowship-trained urologists staff Tower Men’s Health. We will pair you with one of our many experiences physicians to help address any concerns you may have and help you on your journey towards improved quality of life. Feel free to reach out to the physicians at Tower Men’s Health at 310-854-9898.

References:

1 Ma, Ling, et al. “Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study.” medRxiv (2020).

2 Song, Ci, et al. “Detection of 2019 novel coronavirus in semen and testicular biopsy specimen of COVID-19 patients.” medRxiv (2020).

3 Pan, Feng, et al. “No evidence of SARS-CoV-2 in semen of males recovering from COVID-19.” Fertility and Sterility (2020).

4 Diangeng, Meiling, et al. “Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019.” JAMA Network Open (2020).