COVID-19 reduces fertility in men, study suggests
COVID-19 may negatively affect sperm quality and reduce fertility in men, and the magnitude of that effect may depend on the severity of disease, researchers reported.
“Little is known about the virus-host interaction of COVID-19 in sperm cells,” Behzad Hajizadeh Maleki, a doctoral student and research assistant in the department of psychology and sports science at Justus Liebig University in Germany, and Bakhtyar Tartibian, PhD, of the physical education and sports science department at Urmia University in Iran, wrote in in the journal Reproduction.
“We are the first to address the connection between changes in multiple seminal biomarkers and reproductive function in male patients recovering from COVID-19,” they said.
Hajizadeh Malekiand Tartibian conducted a prospective, longitudinal cohort study of 84 men with laboratory-confirmed COVID-19 and 105 men without the disease in Iran. The researchers analyzed changes in angiotensin-converting enzyme 2 (ACE2) activity, markers of inflammation and oxidative stress, apoptotic variables and semen quality, all of which were evaluated at 10-day intervals for up to 60 days.
Most of the men in the study were in their 30s and “differed substantially” in body weight, body fat percent and BMI, according to the researchers. Among those with COVID-19, all but one had either a moderate, severe or critical form of the disease. A urology expert confirmed that all the men were fertile in the study. Men with COVID-19 were treated with corticosteroids and/or antiviral therapies.
The researchers reported that at baseline and during subsequent follow-ups, the COVID-19 group showed significantly higher levels of seminal plasma ACE2 enzyme, as well as higher levels of both pro- and anti-inflammatory cytokines in sperm — including interleukin (IL) 1-beta, IL-6, IL8, IL-10, transforming growth factor (TGF)-beta, tumor necrosis factor-alpha, and interferons alpha and gamma. They also had higher levels of reactive oxygen species and lower superoxide dismutase activity compared with healthy controls.
The markers of inflammation and oxidative stress in sperm cells of men with COVID-19 were increased by more than 100% compared with controls, according to the researchers. Sperm concentration was reduced by 516%, mobility by 209% and sperm cell shape was altered by 400%.
Although these effects tended to improve over time — representing “a transient state of male subfertility like those with oligoasthenoteratozoospermia” — the researchers wrote they remained “significantly and abnormally higher in the COVID-19 patients, and the magnitude of these changes were also related to disease severity.”
In an interview with Healio Primary Care, Hajizadeh Maleki recommended that couples who want to have children should proceed with caution.
“Female partners of men recovering from the disease should decide not to conceive until a specialist carefully examines and certifies their fertility status,” he said.
The reason why COVID-19 affects seminal inflammatory mediators is not yet clear, according to the researchers, but they suggested “the perturbated immune factors may be just a reflection of general immune response, like in serum.”
They acknowledged that antiviral therapies for COVID-19 may have “additional harmful consequences” on male fertility, and that further research is needed.