Does COVID-19 impair male fertility?

A number of studies presented at ESHRE 2022 revealed conflicting findings regarding the effect of COVID-9 on male fertility. While some studies say it does, other data appear to state otherwise.

 

Among COVID-19-negative: yes

A study from Tunisia looked at 90 men who were being followed for hypofertility. Each participant had a spermogram before and during the first two COVID-19 waves to allow for comparisons of semen parameters. [ESHRE 2022, abstract P-741]

“[In our study,] sperm motility, as well as sperm morphology, were impaired during the COVID-19 pandemic,” said the investigators.

Both total and progressive sperm motility were reduced significantly during the pandemic (p<0.0001 and p=0.001, respectively). “The observed decrease 30 minutes after ejaculation was maintained [up to] 4 hours after ejaculation,” they said.

There was an uptick in the percentage of morphologically abnormal spermatozoa from the pre-COVID-19 samples to those obtained during the pandemic (from 91 percent to 94 percent; p<0.0001). There was also a slight drop in sperm count from the samples obtained during the pandemic (p=0.079).

Despite the absence of COVID-19 symptoms on the day of sperm collection, nor proof that could substantiate this absence, the observed impairments in semen quality may have been induced by a latent infection, the researchers pointed out. “[These] could not be only a consequence of psychological stress.”

Hence, the impairments in semen parameters imply that COVID-19 does have an influence on male fertility.

 

Among those who recovered from COVID-19: yes … and no?

Two separate studies from Italy showed conflicting findings.

One study evaluated 43 sexually active men who have recovered from SARS-CoV-2 infection. Biological fluid samples (ie, saliva, pre-ejaculation urine, semen, and post-ejaculation urine) were collected after recovery from COVID-19 (ie, at 1 month and 3 months after a second negative nasopharyngeal swab). [ESHRE 2022, abstract O-001]

A quarter of men were oligo-crypto-azoospermic at the 1-month follow-up mark. By month 3, semen parameters in most of these men improved: two of the four crypto-azoospermic men became oligozoospermic and one became normozoospermic; only one remained azoospermic. Two out of the three oligozoospermic men turned normozoospermic.

Oligo-crypto-azoospermia was significantly associated with COVID-19 severity (p<0.001).

“Despite the [small sample size] and the fact that the previous semen quality of these men was unknown, our results indicate that males of reproductive age recovering from COVID-19 deserve accurate follow-up for their fertility status,” said the researchers.

Another study however digressed from the above findings, as “COVID-19 did not impact semen parameters and reproductive potential in infertile men when semen was collected at least 3 months after recovery,” the investigators said.

Despite the substantial jump in median sperm concentration from pre-COVID-19 diagnosis to post-COVID-19 recovery (from 26.0 vs 68.0 million/mL; p=0.003), median semen volume was no different between the two timepoints (2.9 vs 2.5 mL; p=0.766), as was progressive motility (38 percent vs 40 percent; p=0.782). The investigators attributed the improvement in sperm concentration to intra-individual and treatment centre variabilities (ie, higher ejaculatory frequency, oral antioxidant treatments, other therapies). [ESHRE 2022, abstract P-091]

This study looked at 20 men with COVID-19. A majority had mild-to-moderate disease (n=15), while four were asymptomatic; only one had severe infection. Sperm parameters were evaluated from semen samples collected before being diagnosed with COVID-19 and at least 3 months after recovery.

While the findings appear reassuring, these may have been limited by the small sample size, the researchers noted. Generalizability may have also been limited by the lack of data on fertile men.

Whether COVID-19 does affect male fertility remains to be confirmed in larger, more robust trials.