Background The current study aimed to determine the impact of SARS-CoV-2 infection on male fertility. Methods This is a single-center, hospital-based observational study that included autopsied testicular and epididymal specimens of deceased COVID-19 male patients ( n =6) and recruited recovering COVID-19 inpatients ( n =23) with an equal number of age-matched controls, respectively. We performed histopathological examinations on testicular and epididymal specimens, and also performed TUNEL assay and immunohistochemistry. Whereas, we investigated the semen specimen for sperm parameters and immune factors. Findings Autopsied testicular and epididymal specimens of COVID-19 showed the presence of interstitial edema, congestion, red blood cell exudation in testes, and epididymides. Thinning of seminiferous tubules was observed. The number of apoptotic cells within seminiferous tubules was significantly higher in COVID-19 compared to control cases. It also showed an increased concentration of CD3+ and CD68+ in the interstitial cells of testicular tissue and the presence of IgG within seminiferous tubules. Semen from COVID-19 inpatients showed that 39.1% ( n =9) of them have oligozoospermia, and 60.9% ( n =14) showed a significant increase in leucocytes in semen. Decreased sperm concentration, and increased seminal levels of IL-6, TNF-α, and MCP-1 compared to control males were observed. Interpretation Impairment of spermatogenesis was observed in COVID-19 patients, which could be partially explained as a result of an elevated immune response in testis. Additionally, autoimmune orchitis occurred in some COVID-19 patients. Further research on the reversibility of impairment and developing treatment are warranted. Funding This study was supported by Ministry of Science and Technology of China Plan, Hubei Science and Technology Plan, National Key Research and Development Program of China, HUST COVID-19 Rapid Response Call, China and National Natural Science Foundation of China; these funding bodies are public institutions, and they had no role in study conception, design, interpretation of results, and manuscript preparation.
STUDY QUESTION What is the relationship between abnormal BMI and semen quality? SUMMARY ANSWER Underweight was significantly associated with lower sperm concentration, total sperm number and total motile sperm count, while overweight was significantly associated with lower semen volume, total sperm number and total motile sperm count. WHAT IS KNOWN ALREADY Abnormal BMI has been associated with lower semen quality, but the results remain somewhat controversial. In addition, most previous studies have focused on the influence of obesity or overweight on semen quality, and evidence on the association between underweight and semen quality is rare. STUDY DESIGN, SIZE, DURATION This research was an observational study investigating 3966 sperm donors from a large sperm bank in Wuhan city, China. These donors passed the screening for sperm donation and underwent 29 949 semen examinations between 1 January 2013 and 9 April 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS BMI was categorized into four groups: underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2). Semen volume, sperm concentration, total sperm number, total motility, progressive motility and total motile sperm count were determined by trained clinical technicians. Linear mixed models were used to conduct dose–response analyses between BMI and semen quality parameters. MAIN RESULTS AND THE ROLE OF CHANCE Underweight was significantly associated with a 3.0% (95% CI: 0.1%, 5.8%), 6.7% (1.9%, 11.3%) and 7.4% (2.2%, 12.4%) reduction in sperm concentration, total sperm number and total motile sperm count, respectively. Overweight was significantly associated with a 4.2% (1.6%, 6.8%), 3.9% (0.9%, 6.9%) and 3.6% (0.2%, 6.9%) reduction in semen volume, total sperm number and total motile sperm count, respectively. Non-linear models including continuous BMI as a natural cubic spline function yielded similar results. LIMITATIONS, REASONS FOR CAUTION Our study subjects were sperm donors who are typically young and healthy, and therefore not representative of the general male population. Caution should be paid in generalizing our results to other populations. Furthermore, we did not measure the donors’ weight repeatedly along with each semen donation; instead, we only measured it once during the screening, which may cause bias due to the variations of weight across time. WIDER IMPLICATIONS OF THE FINDINGS Our study provides evidence that underweight and overweight are associated with lower semen quality, and highlights the importance of maintaining a normal weight for men. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Health and Family Planning Commission of Hubei Province (Grant number WJ2015MA027), the Hubei Provincial Committee of the Communist Youth League of China, and Center for Global and Regional Environmental Research at the University of Iowa. The authors declare that there are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Coronavirus disease 2019 (COVID-19) has infected over 124 million people worldwide. In addition to the development of therapeutics and vaccines, the evaluation of the sequelae in recovered patients is also important. Recent studies have indicated that COVID-19 has the ability to infect intestinal tissues and to trigger alterations of the gut microbiota. However, whether these changes in gut microbiota persist into the recovery stage remains largely unknown. Here, we recruited seven healthy Chinese men and seven recovered COVID-19 male patients with an average of 3-months after discharge and analyzed their fecal samples by 16S rRNA sequencing analysis to identify the differences in gut microbiota. Our results suggested that the gut microbiota differed in male recovered patients compared with healthy controls, in which a significant difference in Chao index, Simpson index, and β-diversity was observed. And the relative abundance of several bacterial species differed clearly between two groups, characterized by enrichment of opportunistic pathogens and insufficiency of some anti-inflammatory bacteria in producing short chain fatty acids. The above findings provide preliminary clues supporting that the imbalanced gut microbiota may not be fully restored in recovered patients, highlighting the importance of continuous monitoring of gut health in people who have recovered from COVID-19.
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