How COVID-19 affects male fertility

Male infertility is rapidly increasing. Every sixth man in the world will not become a father, since, according to the World Health Organization, this is the percentage of infertile couples recorded.

The number of men experiencing infertility varies little between countries and does not depend on economic status. A study from the US Centers for Disease Control and Prevention came to similar conclusions, showing that one in five women also cannot conceive. “Male infertility has been growing rapidly in recent years. It is estimated that in half the cases the problems start with men, and the list of reasons is long. It was noticed that their sperm quality deteriorates. Also, more and more people are experiencing abnormalities in the genitourinary system and developing testicular cancer,” notes Dr. Anastasios Livanios, andrologist-urologist.

Most male infertility is caused by environmental factors such as poor diet, weight gain, stress, cannabis use, chronic use of glucocorticoids, exposure to too much estrogen or testosterone, drinking alcohol, smoking or vaping, and exposing the testicles to high temperatures.

Research has also revealed the effects of hormone-disrupting chemicals that men come into contact with in everyday life. Causes include genetic as well as medical conditions such as diabetes, varicocele, erectile dysfunction, cystic fibrosis and Cushing’s syndrome, dysfunction of the hypothalamus or pituitary gland, which produces hormones to maintain normal testicular function. Adrenal hyperplasia and the presence of autoimmune disorders, injuries and infections can also lead to difficulties in obtaining offspring.

And if it is difficult for men at a young age to have children, then for those over 40, the risk increases many times over. Recent studies have shown that COVID-19 infection also affects fertility by reducing sperm count and quality.

The study, carried out between February 2020 and October 2022 by Spanish researchers, was presented at the 39th annual conference of the European Society of Human Reproduction and Embryology (ESHRE). The study involved 45 men, average age 31 years, who were followed at six assisted reproduction clinics. All had confirmed mild cases of COVID-19, and the clinics had data from semen samples taken before the men were infected. Another semen sample was obtained between days 17 and 516 postinfection. The time interval between sample collections before and after COVID-19 averaged 238 days.

The researchers analyzed all samples taken within 100 days of infection, and then many more samples taken 100 days or more after the subjects had recovered from Covid.

A decrease in the volume and concentration of sperm, their number, overall motility, as well as the number of living sperm has been established. Sperm motility and total count were most affected. About 50% of the men had a total sperm count that was 57% lower than before they got sick, the study leader said.

Although the researchers expected that the creation of new sperm (which takes 78 days) would restore sperm quality and concentration, this did not happen. Therefore, larger and longer-term studies are needed to establish, on the one hand, whether the negative effects of the infection can be permanent and whether it affects fertility, and, on the other hand, to find the mechanism by which SARS-CoV-2 affects the testes and sperm .

The study highlights the importance of long-term follow-up of patients after contracting COVID-19, even if it is mild. In addition, men who find that their efforts to have a child after a reasonable period have not been successful should contact their urologist for testing. A spermogram (sperm analysis) evaluates the concentration (quantity), motility and morphology (shape) of sperm, and the results can identify any abnormalities, which include azoospermia, oligospermia, asthenospermia and teratospermia, each of which can be a cause of male infertility. The laboratory where the test is performed also examines the semen for infections.

If at first glance everything is normal, then it will be necessary to do additional tests, for example, blood, scrotal ultrasound, rectal ultrasound, post-ejaculation urine analysis, testicular biopsy and other, more specialized studies.

“Depending on the cause of infertility recommended methods and treatments that can improve fertility levels. These include antibiotics if infertility is caused by infection, hormone therapy, treatment for sexual problems (such as erectile dysfunction), and surgery. When the problem is low sperm count or low sperm motility, ICSI can produce the long-awaited offspring,” concludes Dr. Livanios.

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