Men who have recovered from COVID-19 may be at risk of developing low sperm count, at least in the short term, suggests a small new study.
The study researchers at the University of Florence in Italy analyzed semen samples from 43 men between the ages of 30 and 65, about a month after they recovered from COVID-19. They found that 25% of men had low sperm count and almost 20% had azoospermia, or the total absence of sperm in the semen. This is much higher than the prevalence of azoospermia in the general population worldwide, which is around 1%, according to Johns Hopkins School of Medicine.
In addition, participants with severe COVID-19 infections – those who were hospitalized or admitted to the intensive care unit (IUC) – were more likely to have azoospermia after infection, compared with those who faced less severe infections, according to with the study published February 1 in the newspaper Human Reproduction.
However, the researchers emphasize that their study does not prove that SARS-CoV-2, the virus that causes COVID-19, harms sperm. The researchers do not know what the sperm count of men was before their infections, so the authors cannot say with certainty whether the count decreased after infection; but all men with azoospermia have had children, meaning that they have had at least some viable sperm in the past, the report said. In addition, it is possible that some of the drugs administered to treat COVID-19, such as antivirals, antibiotics and corticosteroids, may affect sperm count.
Being sick in general can affect semen. “The sicker you are, the more effect it can have,” said Dr. Ajay Nangia, professor and vice president of urology at the University of Kansas Health System, who was not involved in the study.
Dr. Boback Berookhim, director of Male Fertility and Microsurgery at Lenox Hill Hospital in New York, agrees. “This may not be a specific phenomenon of COVID and may (and is probably likely!) Be due to the fact that these patients have a more serious illness [and requiring] intensive care, “Berookhim told Live Science by email.
Nangia added that these men need to be followed for at least 90 days after the disease to see if the effect is lasting, because the sperm takes several months to fully mature. “You would have to repeat the study with these people at the 90 day mark,” to see if the effect is prolonged, he said.
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COVID-19 and fertility
There is reason to think that SARS-CoV-2 can affect sperm production. Testicular cells have high levels of the ACE2 receptor, which allows SARS-CoV-2 to enter cells, the authors said.
However, only a few studies have examined SARS-CoV-2 in the semen of men who tested positive for the virus; these studies found coronavirus in the semen of some, but not all, men during infection or recovery.
At least one other study from China, published in October 2020 in the journal EClinicalMedicine, found lower sperm counts in men who had COVID-19, but this small study included only 23 patients.
For the new study, the researchers collected saliva, urine and semen samples from participants about 30 days after they recovered from COVID-19, which was defined as having two consecutive negative COVID-19 tests.
Of the 43 patients, 12 were treated at home, 26 were hospitalized and five were admitted to the ICU.
Overall, eight men had azoospermia and three had oligospermia, or low sperm count, defined in the study as less than 2 million sperm per milliliter of semen. (Men are generally considered to have a low sperm count if they have less than 15 million sperm per milliliter of semen, according to the Mayo clinic.) The risk of azoospermia was related to the severity of the men’s disease: azoospermia was found in four out of five of the ICU patients, three of the 26 hospitalized patients and only one of the outpatients.
Only one participant had SARS-CoV-2 detected in their semen, suggesting that “the occurrence of viruses in semen is a rare event”, after recovery, the authors wrote.
The researchers also found that three quarters of participants in general and 100% of participants admitted to the ICU had high levels of interleukin 8 (IL-8), a Imune system molecule and inflammation marker in your semen.
“Patients with COVID-19 of reproductive age must undergo careful monitoring of reproductive function and semen parameters,” concluded the authors.
Temporary effect?
Nangia said that, based on the current study and other previous research, there appears to be at least a temporary effect of the disease on the testes and sperm. “In the short term, it looks real,” Nangia told Live Science. However, the big question is whether men’s sperm count will increase over time. “Is it a persistent and irreversible effect? … We don’t know.”
Berookhim said he is not convinced that patients who have been infected with COVID-19 necessarily require prolonged follow-up to analyze their sperm. But “we clearly need more data and experience in dealing with the consequences of COVID, and therefore more follow-up will help to better define which patients are most at risk of negative reproductive effects due to COVID 19,” he said.
Certain viral diseases are known to have a lasting effect on fertility. In particular, mumps it can lead to inflammation of the testicles, known as orchitis, which can result in infertility in some cases. Nangia noted that there have been some reports of men with COVID-19 experiencing testicular pain similar to that seen in mumps.
Although the new study is one of the largest to date to assess semen quality after COVID-19, it is still relatively small, the authors said, so larger studies are also needed to confirm the findings.
Originally published on Live Science.