COVID-19 and its treatments: lights and shadows on testicular function

Abstract

Purpose The SARS-CoV-2 pandemic has rapidly spread worldwide and, among the others, the male gender was quickly recognized as an independent risk factor for both the disease and its consequences. Since the possibility of long-term hormonal axis changes and male gamete impairment have been hypothesized but a relatively low levels of evidence has been reached, we focused this narrative mini-review on summarizing key state-of-the-art knowledge on male reproductive effects of COVID-19 as a quick reference for reproductive health specialists. Methods A comprehensive Medline/PubMed and Embase search was performed selecting all relevant, peer-reviewed papers in English published from 2020. Other relevant papers were selected from the reference lists. Results Available evidence indicates that the likelihood of direct testicular damage from SARS-CoV-2 is somewhat low, but there are many indirect ways (fever, cytokine imbalance, and drugs) through which the pituitary-gonadal axis and spermatogenesis may be disrupted. These alterations are probably transient, but as available evidence is low quality, it cannot be excluded that previous pathologies or comorbidities might modulate the risk of their persistence. On the other hand, available evidence shows high safety regarding andrological health for available vaccines, although studies are mainly focused on mRNA vaccines. Conclusion A careful andrological evaluation of men recovering from COVID-19 is highly recommended. Since available evidence is relatively scarce, a careful andrological follow-up and counseling of these patients are mandatory.

Semen parameters and male reproductive potential are not adversely affected after three or more months of recovery from COVID-19 disease

“…This may be the main reason for the inconsistency between the results, and confirm that male reproductive function may be impaired in a short period of time, while in the long term it may return to normal (15,27,28). In addition, recent data remarked that COVID-19 does not appear to cause direct damage to testicular function, while indirect damage appears to be transient (37,38). Overall this can lead to the conclusion that temporary variations in semen quality can be attributed to acute febrile disease, since hyperthermia is known to have this effect.…”

Exploring spermatogenesis post-SARS-CoV-2: a comprehensive review of male reproductive health

“…The article by Pallotti et al [12] offers a thorough examination of all the important aspects of how SARS-CoV-2 affects male reproductive health. It starts by explaining how the SARS-CoV-2 receptor, angiotensin-converting enzyme 2 (ACE2), is widely expressed in testicular cells.…”

“…Furthermore, the paper summarizes research results from multiple investigations about the effects of COVID-19 on sperm quality, including changes in parameters like concentration, motility, morphology and DNA fragmentation in sick and recovered individuals. Lastly, the analysis looks at possible negative effects on spermatogenesis and testicular function caused by medications that are frequently used to treat COVID-19, such as tocilizumab, lopinavir/ritonavir, remdesivir and hydroxychloroquine [12].…”

COVID-19 and Male Infertility: Is There a Role for Antioxidants?

“…COVID-19 may cause acute-stage hypogonadism [ 150 ] in male patients during the inflammatory phase, which may be responsible for exaggerated inflammatory responses and overproduction of cytokines [ 23 , 147 ]. T is essential as an immunosuppressor and cytokine regulator during inflammation [ 24 ].…”