SARS-CoV-2 effect on male infertility and its possible pathophysiological mechanisms

Abstract

First case of COVID-19 was reported in Wuhan, China in December 2019. As of now, May 2021, a total of 164,189,004 people were infected, and 3,401,990 deaths have occurred caused by SARS-CoV-2. As SARS-CoV-2 virus cell entry mainly depends on the ACE2 and TMPRSS2 proteins, the presence of high expression levels of both ACE2 and TMPRSS2 in testes highlights the possible vulnerability of men to the virus. Other RNA viruses frequently induce orchitis and result in male infertility. This review evaluates the decline in male fertility and a total of 48 original articles were included for the analysis. We investigated the effects of COVID-19 on male reproductive health and male fertility. There is a strong association between the high number of ACE2 receptors in the testes and the COVID-19 viral loads. SARS-CoV-2 infection negatively affects the male reproductive tract. Human biological tissues, including body fluids and excretions, tissues, and organs showed positive results tests for SARS-CoV-2. A disruption in the balance of male reproductive system hormones is also observed. Male gonads may be potentially vulnerable to SARS-CoV-2 infection, suggesting caution to follow-up and evaluate infected men that have plans to conceive. Further studies are required to determine if this impairment is temporary or permanent, elucidate SARS-CoV-2’s entrance strategies into the testis and how it can affect the semen quality and quantity. We recommend a post-infection follow-up, especially in male patients of reproductive age already having fertility issues.

Impact of COVID-19 on fertility and assisted reproductive technology (ART): a systematic review

“…The possible impairment of the male reproductive system is because ACE2 receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. This highest concentration may reduce the process of spermatogenesis, the division of male gametes and their transformations during fertilization [ 19 , 20 ]. It has also been concluded in numerous published articles that the ACE2 expression is much stronger among young men aged 30–40 years [ 17 ].…”

Mast Cell Activation Syndrome in COVID-19 and Female Reproductive Function: Theoretical Background vs. Accumulating Clinical Evidence

“…Despite the fact that fertility (including low sperm count, low sperm quality, and reduced sperm mobility) and sexual function may be disrupted in a portion of male patients as a result of SARS-CoV-2 infection [ 191 , 192 ], there is no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females may negatively affect normal female fertility or affect embryo laboratory outcomes or clinical outcomes in assisted reproductive technology (ART) treatments [ 168 , 172 , 193 , 194 ]. Moreover, to date, cohort studies of SARS-CoV-2-positive mothers, including both asymptomatic mothers and those with mild symptoms, did not reveal adverse effects on the mothers or neonates regardless of the timing of the infection (i.e., first, second, or third trimester) [ 194 – 196 ].…”

Relação entre infecção pelo SARS-CoV-2 e fertilidade masculina: o que é conhecido?

“…Portanto, não se trata de um vírus exclusivamente respiratório. O testículo e o trato urogenital expressam grande quantidade desses receptores (Agolli et al, 2021;Anifandis et al, 2020), e então, questionou-se se a infecção pelo SARS-CoV-2 poderia afetar negativamente o aparelho reprodutor masculino (Anifandis et al, 2020).…”