COVID-19 and Male Infertility: Is There a Role for Antioxidants?

Abstract

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), jeopardizes male fertility because of the vulnerability of the male reproductive system, especially the testes. This study evaluates the effects of the virus on testicular function and examines the potential role of antioxidants in mitigating the damage caused by oxidative stress (OS). A comprehensive PubMed search examined exocrine and endocrine testicular function alteration, the interplay between OS and COVID-19-induced defects, and the potential benefit of antioxidants. Although the virus is rarely directly detectable in sperm and testicular tissue, semen quality and hormonal balance are affected in patients, with some changes persisting throughout a spermatogenesis cycle. Testicular pathology in deceased patients shows defects in spermatogenesis, vascular changes, and inflammation. Acute primary hypogonadism is observed mainly in severely infected cases. Elevated OS and sperm DNA fragmentation markers suggest redox imbalance as a possible mechanism behind the fertility changes. COVID-19 vaccines appear to be safe for male fertility, but the efficacy of antioxidants to improve sperm quality after infection remains unproven due to limited research. Given the limited and inconclusive evidence, careful evaluation of men recovering from COVID-19 seeking fertility improvement is strongly recommended.

From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology

“…Not surprisingly, SARS-CoV-2 may contribute to decreased testosterone and sperm production, as ACE2 is expressed in numerous tissues, including the testis. There is evidence that the virus can cause a localized, intense inflammatory response in the testis, which can then promote the development of viral orchitis and lead to vasculitis or an autoimmune response, both of which can damage the testis and impair testosterone production [135].…”

“…It cannot be ruled out that low testosterone in the acute phase of viral infection may represent an adaptive and resilient mechanism to mitigate external impairments by eliminating testosterone-dependent functions such as reproduction and/or physical and sexual activity that are not needed when the physical state deteriorates [136][137][138][139][140]. Men who have recovered from SARS-CoV2 infection should be carefully monitored to rule out the possibility of long-term andrological effects such as decreased sperm count or testosterone levels [135,141].…”