Will COVID-19 affect male fertility?

In the short term: it can be temporarily affected. The long-term outcome is a little less clear.

There may not be a lot of information about the novel coronavirus and fertility, specifically, but “we know quite a lot about viruses, flus, and male infertility,” explains Legacy advisor and reproductive urologist Dr. Paul Turek. “Seasonal flus are known to reduce male fertility… We think that it’s due to the fever associated with the illness, which overheats the testicles.”

This effect is demonstrated in several case studies of fertile men experiencing fevers. In one, a patient recovering from influenza produced abnormal sperm for 45 days post-fever. In another, sperm count, motility, and genetic health was decreased for over 2 months after the patient’s fever resolved.

Considering that one of the primary symptoms of COVID-19 is a high fever, it’s reasonable to assume that men infected with coronavirus will also experience reduced fertility. “Currently, it is believed that the [novel coronavirus] is similar to a common seasonal flu virus regarding its impact on male fertility,” explains Dr. Turek. However, as he reassures, that impact should be temporary: “The effect is similar to that of hot baths or tubs, and is fully reversible.”



Will there be any permanent effects of the novel coronavirus on male fertility?

First, a note of reassurance: The novel coronavirus is not related to zika, the mosquito-borne illness with devastating effects on pregnancy and fetal health.

There are certain viral infections — namely, mumps — that can cause permanent damage to male fertility. In some cases, mumps can cause a painful condition called orchitis, or inflammation in the testes that has a small chance of long-term damage. “It has to infect boys at puberty, when the testicles are actively growing, to harm future fertility,” explains Dr. Turek.

In a recent statement, researchers in Wuhan raised concerns about the novel coronavirus’ potential to impact male fertility based on the fact that SARS—a similar infection—has also been known to cause orchitis and damage to the testicles. Since SARS and the novel coronavirus are genetically similar, it’s possible, in theory, that today’s coronavirus could have similar results.

However, no documented cases of testicular infections have been noted during the COVID-19 pandemic, and in fact the researchers’ statement was quickly retracted. Allan Pacey, PhD, male fertility expert and Legacy advisor, explained to Newsweek that the statement was highly theoretical. “At present it is somewhat premature to conclude [that] COVID-19 will definitely affect male fertility,” Dr. Pacey explains. “But it is useful that the authors have raised this concern.”

For those who are concerned about COVID-19, any impact on fertility or sperm health can be evaluated with a semen analysis.

Can coronavirus be found in semen?

A recent study published on May 7, 2020 suggests that “SARS-CoV-2 can be present in the semen of patients with COVID-19, and SARS-CoV-2 may still be detected in the semen of recovering patients.” While this may be alarming, it is not necessarily surprising. Many viruses have been known to live in the male reproductive tract, even after recovery. It is important to note, that there is currently no evidence that suggests the virus can be transmitted sexually. However, to ensure safe sex condoms would decrease likelihood of transmission.

According to Allen Pacey, professor of andrology at Sheffield University, these studies should not be seen as conclusive because testing semen for viruses has its own set of technical challenges. More research is currently needed.


Is it safe to be pregnant during the coronavirus COVID-19 pandemic?

During any pandemic or crisis, we expect essential services like maternity wings and neonatal centers to continue to operate. However, outpatient services at major hospitals and clinics, including their fertility centers, are likely to have have their services curtailed or suspended. This time is no different.

Right now, there’s very little data on how COVID-19 might affect pregnant people. We do know that pregnancy alters the immune system in such a way that increases the risk of infections, such as influenza, and could make illness more severe. And we know that related infections such as MERS and SARS can cause adverse pregnancy outcomes, such as miscarriage, premature delivery, intrauterine growth restriction, and maternal death.

Based on this information, American College of Obstetricians and Gynecologists (ACOG) has advised that pregnant women who get COVID-19 may have a higher risk for some complications.

A study of 9 pregnant women in China who contracted coronavirus—and their 9 subsequent healthy live births—demonstrated that their illness wasn’t more severe than it was among non-pregnant women, and that they did not pass the virus along to their babies in utero or via breast milk. However, there have been two (1, 2) reports of newborns with COVID-19 infections shortly after birth, so the possibility of “vertical transmission” of the virus from mother to baby cannot be excluded.

If you already have COVID-19, the Society for Assisted Reproductive Technology (SART) recommends “avoiding getting pregnant for now and waiting until you fully recover before attempting conception (either naturally or via assisted reproductive technology).” Because COVID-19 patients can be asymptomatic, it’s best to get tested to make an informed decision about any potential pregnancies. 

April 8th update: The European Society of Human Reproduction and Embryology has written, “ESHRE continues to recommend a precautionary approach to assisted reproduction, which is consistent with the position of other scientific societies in reproductive medicine.” 



What if I’m already planning a pregnancy or fertility treatment?

Reproductive health organizations are recommending, out of caution and concern for lack of data, that couples planning pregnancies consider holding off for now. The European Society of Human Reproduction and Embryology states that “all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid becoming pregnant at this time.”

Similarly, the American Society for Reproductive Medicine has recommended that fertility clinics postpone new fertility treatments until more is known about the virus, due in part to “the known and unknown impact of coronavirus on fertility, pregnancy, and transmission patterns.”

April 7th update: The latest ASRM update notes, “If you don’t have COVID-19, there is no medical reason to change your plans regarding trying to conceive. However, there may be logistical, psychological, and emotional reasons to modify your plans…Out of an abundance of caution, you may consider postponing pregnancy.” 

Coronavirus and sperm freezing: protecting your fertility during the COVID-19 pandemic

Considering the lack of data about male fertility and the recommendation that couples consider waiting to get pregnant, sperm freezing may be beneficial—both biologically and emotionally—during the coronavirus pandemic.

 

In addition to the potential impact of coronavirus on fertility (either short-term or long), we also know that time (age) affects male fertility, especially for men over 35. Sperm acquire a new genetic mutation—which is passed onto offspring—every 8 months. If the COVID-19 pandemic is pushing off your family plans, sperm freezing may be a good option for you.

Social distancing recommendations are still in place, so visiting a doctor’s office or hospital to discuss sperm freezing is not recommended, or perhaps possible, at the moment. Mail-in sperm testing and freezing options, like the Legacy kit, are a valuable option to preserve your fertility from the safety and comfort of your own home.

Learn more about the Legacy kit.

This article was last updated on 14 May 2020.