Does COVID-19 influence male fertility?

This review looked at the effect of COVID-19 infection on male fertility. It found that COVID-19 may alter ale hormone levels and reduce sperm quality and that some men have the virus in their semen. It also found that pregnant women with COVID-19 may undergo preterm delivery.

The COVID-19 virus emerged in late 2019. It causes flu-like symptoms, can affect breathing and can cause abnormal blood clotting. COVID-19 infection has a 2 to 3% mortality, although this varies by country. However, some people infected with COVID-19 do not have symptoms. COVID-19 has rapidly spread across the globe, affecting millions of people.

COVID-19 belongs to the coronavirus family and is related to the SARS virus. SARS can affect the testicles, causing inflammation. It is not clear whether COVID-19 also affects male fertility. Additionally, it is not clear whether COVID-19 infection affects the outcomes of in vitro fertilization (IVF) and other infertility techniques.

This review used 24 studies of COVID-19 and fertility. Specific outcomes included the effect on semen, reproductive hormones, or pregnancy.

Six studies of 120 patients looked at the effect on semen. 6 patients (5%) had the virus in their semen based on a test for viral RNA (genetic material). 4 of these patients were still acutely ill, and 2 patients were recovering. One study looked at the effect of COVID-19 on sperm quality, using 20 patients and 14 healthy volunteers. Patients who required hospitalization had significantly worse sperm concentration than those with milder infection (16.2 vs 95.9 million per mL). Other measures of sperm quality, such as how many moved in a straight line, were also significantly worse for patients who were treated in the hospital. Patients with milder infection had similar sperm quality to uninfected volunteers.

Three studies looked at the effect of COVID-19 on hormones in male patients. Levels of luteinizing hormone (LH) were significantly higher for COVID-19 patients. In men, LH directs cells in the testes to create testosterone. High levels of LH can indicate the testes are not functioning as well as usual. Two studies found that men with COVID-19 had lower testosterone, particularly those with more severe infection.

Fifteen studies looked at the outcomes of 598 pregnant women with confirmed COVID-19. Women with positive COVID-19 tests had similar outcomes to women with symptoms of COVID-19 but no tests. 88% of women delivered by cesarean section. 33.2% of women had a preterm delivery. 30% of infants required intensive care.

This study found that COVID-19 infection can affect male sperm quality and hormone levels.

The study concluded that assisted reproduction should continue during the ongoing COVID-19 pandemic using infection precautions such as telemedicine and masks.