Does SARS-CoV-2 Affect Human Semen? A Systematic Review and Meta-Analysis

Abstract

Contradictory results have been reported regarding effects of the SARS-CoV-2 upon human semen. A timely and up-to-date systematic review with meta-analysis appears necessary. This study aimed to deliver pooled prevalence (PP) of SARS-CoV-2 in semen and pooled semen parameters as compared with the uninfected. The relevant databases were scanned by two authors for observational studies reporting analysis of semen in COVID-19 patients. The SARS-CoV-2-infected were assigned to group A (exposed arm), whereas the uninfected to group B (unexposed arm). Newcastle–Ottawa Scale was used to address the risk of bias. PRISMA guidelines were adopted. In case of homogenous studies, fixed-effects model was followed, whereas for heterogenous studies random-effects model was used. Of 990 studies, 24 were eligible involving 1589 subjects (947 in group A and 642 in group B). The “comparability” domain was biased the most. SARS-CoV-2 RNA was detected in three studies among 8 individuals producing the PP of 1.76% (95% CI 0.72–3.21). Sperm concentration was reduced significantly (WMD = –16.23 [95% CI –25.56 to –6.89], as well as total sperm in ejaculate (WMD = –34.84 [95% CI − 43.51 to –26.17]) and sperm volume (WMD = − 0.48 [95% CI − 0.59 to − 0.36] in group A as compared with controls. There was a non-significant effect upon progressive motility and leukocyte presence in semen. SARS-CoV-2 RNA in semen among the infected individuals is detected infrequently. By this token, sexual transmission through semen is of low probability and little concern for public health. However, significant decrease in sperm volume, sperm concentration, and total sperm in ejaculate has been noted. The current data, though, are limited, and more studies with longer follow-up are needed to evaluate the further impact.

Systematic analyses of the factors influencing sperm quality in patients with SARS-CoV-2 infection

“…Based on the published studies, we tend to conclude that SARS-CoV-2 has a negative impact on sperm parameters in the short term. This is supported not only by the “material basis” of SARS-CoV-2 infecting testicular cells through TMPRSS2 and ACE2 58 , but also by recent meta-analysis results 18 , 59 – 61 . Interestingly, there are discrepancies between case–control and self-controlled studies.…”

“…Case–control studies show significant debates on the impact of SARS-CoV-2 infection on semen volume, sperm concentration, and sperm vitality, with half of the studies suggesting an impact and the other half indicating no effect. However, more studies suggest a decrease in total sperm count, with no significant effect on forward sperm movement 18 , 59 – 61 . In self-controlled studies, two meta-analyses 59 , 60 suggest a significant decrease in various sperm parameters after SARS-CoV-2 infection, aligning more with our current findings.…”

“…It is therefore currently unclear whether the decrease in semen parameters in infected individuals is due to the viral infection itself or the febrile symptoms. The results of meta-analysis additionally revealed a large heterogeneity in the literature, which may have affected the evaluation of the effects of SARS-CoV-2 on sperm motility 18 . Normal spermatogenesis requires approximately 3 months, and semen volume, concentration, and sperm motility fluctuate under physiological conditions during this timeframe.…”

Does COVID-19 affect sperm quality in males? the answer may be yes, but only temporarily

“…Similarly, a study compared semen samples from COVID-19-recovered males and those who had never had COVID-19, revealing lower sperm concentrations in the COVID-19 group, indicating potential adverse effects on male fertility, while sperm motility and morphology showed no significant differences between the groups [ 11 ]. A recent systematic review and meta-analysis show that even though the viral RNA is usually undetectable in semen, COVID-19 affects sperm concentration, total sperm count, and sperm volume [ 12 ]. However, some studies have shown that mild COVID-19 may have no detrimental effect on semen parameters [ 13 ], and there was no significant difference in spermiogram results between patients who presented for infertility before and during the COVID-19 pandemic [ 14 ], and even during the COVID-19 pandemic the sperm concentration, total sperm count, and total motility in male partners of infertile couples were better than those in the COVID-19 prepandemic [ 15 ].…”

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“…The latest reports even suggest a relationship between SARS-CoV-2 infection and the parameters of human semen. A 2023 meta-analysis found that sperm concentration, their total count per ejaculate, and semen volume were significantly reduced in virus-infected men compared to uninfected men [ 7 ].…”