Over a year after the initial outbreak of COVID-19, the disease still follows us. We continue to wear masks, sanitize, quarantine, and isolate. It’s gratifying to know that an end may finally be in sight with the slow distribution of vaccines, yet many questions surrounding COVID-19 remain.
Currently, little is known about the long term effects COVID-19 may have on the body. While many speculate that life long respiratory health may be jeopardized, others claim that it may put male fertility on the decline.
While there are hundreds of research studies being conducted to better understand COVID-19, the disease continues to baffle us and its effect on male fertility is no exception.
Several studies have recently received media attention due to their claim that COVID-19 could potentially cause male infertility in infected patients. One study conducted by researchers at Justus-Liebig-University in Giessen, Germany claims it has established, “the first direct evidence to date that COVID-19 infection impairs semen quality and male reproductive potential.”
The study compared sperm quality and count of 105 fertile men without COVID-19 to 84 fertile men diagnosed with COVID-19. The researchers performed analysis of sperm samples at 10 day intervals for a total of 60 days. Test subjects with COVID-19 were found to have inflamed sperm cells as well as oxidative stress, a condition where there is an imbalance in the regulation of oxygen reaction species. There was also a noted decrease in sperm concentration and mobility as well as sperm exhibiting strange morphology. All of these symptoms can cause a downward trend in male fertility.
Another study performed in China also discovered COVID-19 in the semen of select test subjects. Of 38 fertile male COVID-positive patients, only six were found to have COVID-19 in their semen.
When considering why male fertility may be vulnerable to COVID-19, researchers point to ACE2 aka angiotensin-converting enzyme 2. ACE2 is a protein that exists on the surface of many cells on the body, including the lungs and the testicles. Normally, ACE2 creates smaller proteins and introduces them to the interior cell. But, scientists have found that ACE2 is manipulated by the COVID-19 virus. After hooking onto the ACE2, COVID is then able to enter the cell and begin wreaking havoc on the body.
Despite this explanation, fellow scientists are skeptical about the claims being made by the above study. In both experiments, a very small sample size was used allowing for a higher margin of error so the data is unlikely to provide an accurate representation of the world populace. But the main qualm of the scientific community surrounding these studies is the claim that “direct evidence” has been found. Rather than the finding being any sort of concrete evidence, they only prove an association between COVID-19 and male infertility which is no surprise to immunologists and urologists studying the disease.
COVID-19 is a febrile illness, meaning it causes a fever. It is also a severe acute respiratory syndrome. Both of these elements are known to cause orchitis or inflammation of the testes. Most often orchitis is caused by bacterial infections such as those caused by STDs. Common symptoms of orchitis include:
Chronic orchitis can result in shrinking of the testicles, scrotal abscesses, and infertility caused by blocked sperm in the epididymis or hypogonadism (decreased testosterone levels). All of these conditions equate to lowered male fertility.
In the case of COVID and other SARS viruses, it is believed that orchitis is part of an immune response rather than a direct result of a virus. On the most basic level, this all means that any decrease in fertility when infected with COVID-19 is not a phenomenon unique to this disease nor is there any reason to believe it is irreversible. Allan Pacey, a professor of andrology at The University of Sheffield, believes, “...any measurable effect of coronavirus on male infertility [is] probably only slight and temporary.”
The main takeaway of the previous sections should be that research studies concerning COVID-19 are currently works in progress with more questions than definite answers. While we all have the tendency to read a snappy headline and jump to conclusions, it is important that we take the time to analyze these claims and check their source material.
Still, even if research is still ongoing, there are ways to protect your fertility throughout the pandemic.
The American Society for Reproductive Medicine (ASRM) along with several other organizations that focus of male reproductive health recommend taking precautions to protect your fertility during the pandemic. Although the effects of COVID-19 on a man’s reproductive health are not known for certain, the general consensus is that it’s better to be safe than sorry.
The ASRM is calling for people to remain aware of their reproductive health during this time. This means doing body checks and setting up telehealth appointments with PCPs and specialists. In cases where patients can safely visit a facility, regular physical exams and ultrasounds should be performed.
If you have contracted COVID-19 and worry that it may have decreased your fertility, the ASRM endorses the use of mail-in sperm analysis kits. A sperm analysis is the best way to directly see how your fertility may have been affected by the virus. From the safety of your own home, you can collect a sample, send it to a lab, and receive results in a short period of time. The results will include information about sperm count, quality, mobility, etc. While a fresh semen analysis done at a lab is the best option, it is not always possible in a pandemic environment.
The ASRM mentions that some patients may benefit from freezing their sperm, or cryopreservation, for later use. This includes, “...those undergoing treatments that are potentially sperm toxic, such as for cancer or non-malignant disease,” as well as, “...those undergoing treatment for concerns regarding deterioration of sperm quality over time, gender affirming therapy, deployment, or other occupations with a risk of bodily injury.”
Finally, as vaccines are becoming more accessible, it is essential that every eligible person receives their dose. This act will protect your fertility from the debilitating effects of COVID-19 and help prevent further spread of the disease.
If you have any questions or concerns about your fertility and how COVID-19 may affect it, be sure to contact your doctor and/or a fertility specialist. They will be able to provide advice personalized to your health needs as well as update you on the latest research. And, even as safety precautions begin to lift, remember to stay safe by washing your hands, wearing a mask, and staying six feet apart to continue curbing the spread of COVID-19.