Semen parameters after SARS‐CoV‐2 infection: A literature review

Abstract

Background and Aims The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is known to affect multiple organs by binding to angiotensin‐converting enzyme 2 receptors and might therefore affect male fertility. This review aims to collect all original articles on the effects of SARS‐CoV‐2 infection on male fertility, including the duration of time after infection required for these effects to begin to manifest and recommend how clinicians should approach cases with a recent illness. Methods This review was developed according to the preferred reporting items for systematic reviews and meta‐analyses guidelines. The search string was applied to four online databases—namely Pubmed, Embase, Medline, and the Cochrane COVID‐19 Register—and screened using the online tool Covidence.org . Articles were eligible for inclusion if they were cohort studies involving a healthy male population diagnosed with COVID‐19, each of whom had semen samples collected before and after the infection or two different semen samples collected after the diagnosis. Results Nine cohort studies were eventually included. Five articles had pre‐ and post‐COVID‐19 data while four had two sets of post‐COVID‐19 data. The three largest studies found a statistically significant decrease in all semen parameters when waiting less than 3 months from diagnosis before sample collection, and no significant differences in results when the ejaculate was analyzed more than 3 months after recovery. One study compared the COVID‐19 patients with a control group and found a significant decrease in semen parameters in the COVID‐19 group. Conclusion Spermatogenesis seems to be affected by SARS‐CoV‐2 infection, but the impact tends to reverse within 3–4 months. It is still unclear why male fertility is affected by SARS‐CoV‐2 infection, and it might be the result of several different components. Clinicians should consider recent SARS‐CoV‐2 infection as a possible reason for the low semen quality of patients' semen samples, and might therefore need to collect new samples after 4 months before further treatment.

The impact of acute SARS‐CoV‐2 on testicular function including insulin‐like factor 3 (INSL3) in men with mild COVID‐19: A longitudinal study

“…There are several case reports describing the negative impact of SARS-CoV-2 infection on the male reproductive system. 7,19 Most of the studies during the first wave of the pandemic included hospitalised men with severe COVID-19 and were characterised by wide variations in study methods and limited follow-up. 21,[33][34][35][36] Later studies tended to focus on men who had recovered from milder manifestations of the disease.…”

“…Coronavirus disease 2019 (COVID- 19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020.…”

“…17 Indeed, studies of reproductive function in men recovering from both mild and severe COVID-19 have reported a negative effect on semen parameters, such as sperm count and motility, and reproductive hormone profile. 18,19 Notably, COVID-19 patients had higher levels of luteinising hormone (LH) and lower testosterone (T) concentrations compared to controls. 20,21 Most of the studies researching the effect of SARS-CoV-2 infection on male reproductive function have recruited men who were…”

“…As both ACE2 and Mas are expressed in the testes, 15,16 concerns have been raised that SARS‐CoV‐2 infection may affect male fertility 17 . Indeed, studies of reproductive function in men recovering from both mild and severe COVID‐19 have reported a negative effect on semen parameters, such as sperm count and motility, and reproductive hormone profile 18,19 . Notably, COVID‐19 patients had higher levels of luteinising hormone (LH) and lower testosterone (T) concentrations compared to controls 20,21 …”

Angiotensin Converting Enzyme 2 (ACE2) - A macromolecule and its impact on human reproduction during COVID-19 pandemic

“…Male infertility term cannot be missed during COVID 19 pandemic since fertility is already going down worldwide due to various abnormalities and this infection further decreases the number (Tufvesson et al 2022). But at the same time, a decline in sperm quality may be temporary in many cases and we cannot consider the count as infertility during this period (Purvis and Christiansen 1993).…”