The Impact of COVID-19 on Male Fertility
Since the first reported cases of the COVID-19 virus in the early months of 2020, scientists, clinicians, and academics have done their best to elucidate the unknowns of this deadly disease. We now know, for example, that COVID-19 affects not just the respiratory system, but can also damage the nervous, cardiac, and even renal systems. There has been an understandable concern about whether this complex infection could also affect the reproductive system and fertility. As such, much attention has been given to how COVID-19 impacts pregnancy and females trying to conceive. In fact, the CDC currently states that pregnant women are at an increased risk for severe illness from COVID-19 and death compared to non-pregnant women. This begs the question: What about men?
Mounting evidence has emerged suggesting this virus might affect the male reproductive system and fertility. A study published in January 2021 in the journal Reproduction suggests the COVID-19 infection impairs semen quality and male reproductive potential. This study, coupled with other publications, raises concern regarding the negative impact of COVID-19 infections on male fertility. In this relatively small group of 84 infected men, all semen parameters, including concentration, motility, and shape, were impaired as compared to a control group. In addition, markers of inflammation and oxidative stress - which are known to harm sperm function – were increased.
While the study’s conclusions certainly give reason for further investigation, it is important to use caution when interpreting such findings. The study demonstrates an association and not a causation as perhaps originally thought. However, this association was influenced by the severity of the COVID infection whereby the worse cases had the more damaged results. It is not clear if the debilitation of the disease and associated febrile period is the main driver of the impact or the virus itself has a direct added influence.
It is not unusual for a virus to impact men’s reproductive tract. In fact, the effects of a broad range of viruses on the male reproductive tract have previously been documented. Some viruses, such as mumps and HIV, can even cause severe damage leading to male infertility. However, the severity to which the coronavirus affects the male reproductive tract is still unknown. It is becoming increasingly apparent that the prerequisite receptors to the virus are present in testicular tissue which may highlight COVID-19’s affinity for the testes. Angiotensin-converting enzyme-2 (ACE-2) receptors, the same receptors found in the tissues of the lungs, are highly concentrated in the testes. This protein provides the entry point for coronavirus to enter, infect human cells, and, potentially, cause infertility. More research to evaluate how testis tissue responds to the virus and how that impacts male fertility and sexual transmission must be undertaken before any conclusions are made. In the interim, men, especially those considering conceiving, would be mindful to consult with an urologist and get their testosterone levels and other parameters evaluated with a semen analysis.
In the context of an overall decline in global sperm concentration, the added insult of the COVID pandemic warrants concern and attention. Additional research on the impact of COVID-19 on the male reproductive tract and fertility is needed to determine whether this disease poses a serious threat to male fertility. Individuals concerned or interested in having their fertility evaluated should speak with their primary care physician and call 212-756-5777.