Sperm cryopreservation during the SARS-CoV-2 pandemic

Abstract

Purpose Sperm cryopreservation is fundamental in the management of patients undergoing gonadotoxic treatments. Concerns have risen in relation to SARS-CoV-2 and its potential for testicular involvement, since SARS-CoV-2-positive cryopreserved samples may have unknown effects on fertilization and embryo safety. This study therefore aimed to analyze the safety of sperm cryopreservation for cancer patients after the onset of the pandemic in Italy, through assessment of the risk of SARS-CoV-2 exposure and viral RNA testing of semen samples. Methods We recruited 10 cancer patients (mean age 30.5 ± 9.6 years) referred to our Sperm Bank during the Italian lockdown (from March 11th to May 4th 2020) who had not undergone a nasopharyngeal swab for SARS-CoV-2 testing. Patients were administered a questionnaire on their exposure to COVID-19, and semen samples were taken. Before cryopreservation, SARS-CoV-2 RNA was extracted from a 150 µl aliquot of seminal fluid in toto using QIAamp viral RNA kit (Qiagen) and amplified by a real time RT PCR system (RealStar SARS-CoV2 RT PCR, Altona Diagnostics) targeting the E and S genes. Results The questionnaire and medical interview revealed that all patients were asymptomatic and had had no previous contact with COVID-19 infected patients. All semen samples were negative for SARS-CoV-2 RNA. Conclusion This preliminary assessment suggests that a thorough evaluation (especially in the setting of a multidisciplinary team) and molecular confirmation of the absence of SARS-CoV-2 in seminal fluid from asymptomatic cancer patients may assist in ensuring the safety of sperm cryopreservation.

Relationship between betacoronaviruses and the endocrine system: a new key to understand the COVID-19 pandemic—A comprehensive review

“…Moreover, the authors were not able to detect COVID-19 RNA in testicular tissue from deceased subjects [ 113 ]. A case report showed that a 31-year-old man recovering a mild form of COVID-19 had no detectable virus in his ejaculate within fifteen days from the onset of the disease [ 114 ].…”

Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis

“…Sperm banking should be offered; however, preliminary assessment and molecular confirmation of the absence of COVID-19 in seminal fluid in asymptomatic men should be performed, as viruses stored in liquid nitrogen have been shown to retain their pathogenic properties [ 27 28 ]. Prior studies have shown this preliminary evaluation to aid in the safety of sperm cryopreservation [ 29 ]. Still, larger cohorts of current or previously COVID-19 infected men are needed to confirm the safety of cryopreservation and assisted reproduction techniques in this population.…”

Molecular diagnosis of SARS-CoV-2 in seminal fluid

“…Bwire et al reported a low (1.0%) detection of SARS-CoV-2 in blood samples [6]. It could be that the virus only spreads to blood under certain circumstances, such as the acute phase or severe disease, and then to other organs such as the testis [39].…”