Evaluation of SARS-CoV-2 in Human Semen and Effect on Total Sperm Number: A Prospective Observational Study

Abstract

Purpose The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created a surge of research to help better understand the breadth of possible sequelae. However, little is known regarding the impact on semen parameters and fertility potential. We sought to investigate for presence of viral RNA in semen of men with SARS-CoV-2 infection and to evaluate its effect on semen parameters in ejaculate. Materials and Methods We prospectively recruited thirty men diagnosed with acute SARS-CoV-2 infection using real-time reverse transcriptase polymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or in-person in office setting. Semen analysis and PCR was performed after samples were received. Results Thirty semen samples from recovered men were obtained 11–64 days after testing positive for SAR-CoV-2 infection. The median duration between positive SAR-CoV-2 test and semen collection was 37 days (interquartile range [IQR]=23). The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=52.1). When compared with age-matched SARS-CoV-2(−) men, TSN was lower among SARS-CoV-2(+) men (p=0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested. Conclusions SARS-CoV-2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting. Whether SARS-CoV-2 can affect spermatogenic function long-term remains to be evaluated.

COVID‐19 vaccine hesitancy linked to increased internet search queries for side effects on fertility potential in the initial rollout phase following Emergency Use Authorization

“…Specifically, the impact of vaccine candidates on future fertility has been commonly raised by patients due to the lack of long‐term data evaluating this outcome. While COVID‐19 infection has been shown to have the ability to affect sperm parameters in the acute phase of infection, the impact on fertility from vaccine uptake is largely uncertain (Best et al., 2021 ). We hypothesised that irrespective of sex, fertility‐related queries would markedly increase during the 48 days following Emergency Use Authorization of the coronavirus vaccine.…”

COVID-19 and the Endocrine System: A Comprehensive Review on the Theme

“…Best et al compared the median of sperm count between men who tested positive for SARS-CoV-2 (sperm collection after positive real-time PCR testing; 11-64 days) and those negative. The median value of total sperm count was lower in SARS-CoV-2-positive than -negative men (12.5 million vs. 59.2 million, p < 0.002) even if this difference was attenuated when another seminal analysis was performed after 3 months from recovery of SARS-CoV-2 (only in five patients) [238]. Other observational studies, case series, and case reports found no evidence of SARS-CoV-2 RNA in sperm specimens, even in the presence of serum testosterone levels, sperm count decline, or both in acute and recovery phases [239][240][241][242][243].…”

SARS-CoV-2 RNA Shedding in Semen and Oligozoospermia of Patient with Severe Coronavirus Disease 11 Weeks after Infection

“…Sperm count recovery was observed in 2 participants, but the other 2 did not provide longitudinal samples. Numerous reports have suggested a detrimental effect on semen quality after COVID-19 ( 9 , 13 , 14 ), hypothesized to occur secondary to viral illness and fever causing spermatogenic dysfunction ( 15 ). Given this transient insult, it is not unexpected that some of these men showed recovery.…”