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COVID-19 and Male Fertility

He was upset when his recent semen analysis showed a significant decrease in the quantity and quality of his sperm. T, who is 35, and his wife had been trying for a baby the past 6 months. He had been married for a year and his sperm check eight months was normal.

“Doc, could the decline in my sperm be due to the covid infection I had 2 months ago?” he asked.

A recent study (January 2022) had found that conception was decreased by 18% in the first three months after Covid-19 infection of the male partner.

How does Covid-19 affect male reproduction?

Although Covid-19 infection primarily affects respiratory tissues, other organs such as the kidney, heart, liver and testes have been found to be invaded by the virus too.

As Covid virus shares similarities with SARS virus structurally and the latter has been shown to cause severe damage to the testis, scientists suspect that it may have similar impact on the male reproductive system.

The way Covid virus causes damage to the testis is still not fully understood. However, a few possibilities have emerged from recent studies. They include:

  • Direct invasion of testicular tissue by the virus: The virus could enter the testis through the blood. It may attack the hormone producing cells first, resulting in hormone abnormalities, then cause collateral damage to the sperm producing cells by the intense inflammatory response. Young males were found to have more vulnerable sites for the virus to enter compared to older patients. Thus, young people may have a higher chance of testicular damage.

  • Testicular inflammation: Patients with severe illness were found to have some scrotal discomfort. This is due to the inflammation of the testis (orchitis). Postmortem examination of 12 male patients were reported to have inflammation and cell damage of testis in a study from China.

  • Derangement of male sex hormone: In a recent study on 119 men with COVID, it was observed that infected men had slightly lower overall serum testosterone levels, compared to 273 age-matched healthy men. In patients with severe disease, the reduction can be as high as 50%.

  • Disruption to the hormones in the hypothalamus and pituitary gland of the brain can also affect sperm production

  • Virus found in the semen: Although studies have revealed that the virus was present in the semen in about 5% patients, there has been no records on the sexual transmission of the disease to date. American Society for Reproductive Medicine (ASRM), however, had published warnings regarding the possibility of sexual transmission of Covid.

  • The effects of fever: Fever and elevation of testicular temperature contribute to disruption in sperm production. The sperm concentration and motility had been found to decrease for 72 to 90 days after the viral infection.

I told T that studies have shown that the effects of Covid on semen parameters may be temporary and male fertility seems to return after a few months. These studies, however, are limited by the small sample size and one should await more robust and long-term studies to know the answer. In the meantime, he should continue taking multi-vitamins, trace elements and antioxidants prescribed, which he diligently complied.

In his latest review a month ago, results of his semen analysis showed some improvement. He is still hopeful that the parameters will return to normal soon.

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