{"id":466,"date":"2020-11-23T12:30:04","date_gmt":"2020-11-23T12:30:04","guid":{"rendered":"http:\/\/legacy.varunme.com\/resources\/will-covid-19-affect-male-fertility\/"},"modified":"2023-06-14T14:54:10","modified_gmt":"2023-06-14T14:54:10","slug":"covid-19-male-fertility","status":"publish","type":"post","link":"https:\/\/www.givelegacy.com\/resources\/covid-19-male-fertility\/","title":{"rendered":"Will COVID-19 affect male fertility?"},"content":{"rendered":"
<\/h6>\n
Table of contents:<\/h6>\n
    \n
  1. COVID-19 fever<\/a><\/li>\n
  2. ACE2 receptors and male fertility<\/a><\/li>\n
  3. Short-term impact of COVID-19 on male fertility<\/a><\/li>\n
  4. Long-term impact of COVID-19 on male fertility<\/a><\/li>\n
  5. Can coronavirus infect the testicles?<\/a><\/li>\n
  6. COVID-19 and orchitis<\/a><\/li>\n
  7. Can coronavirus be found in semen?<\/a><\/li>\n
  8. Can coronavirus be sexually transmitted?<\/a><\/li>\n
  9. COVID-19 and pregnancy<\/a><\/li>\n
  10. Planning a pregnancy or fertility treatment<\/a><\/li>\n
  11. Sperm freezing during COVID-19<\/a><\/li>\n
  12. References<\/a><\/li>\n<\/ol>\n
    UPDATED WITH NEW RESEARCH: NOVEMBER 23, 2020<\/strong><\/h6>\n

    Each day, we learn more about the novel coronavirus and COVID-19. Here, we speak with some of Legacy\u2019s male fertility experts and examine up-to-date research on COVID-19 and male fertility, pregnancy, and family planning.<\/span><\/p>\n

    For those who are concerned about fertility after COVID-19, any impact on sperm health can be evaluated with <\/span><\/i>sperm testing<\/span><\/i><\/a>.<\/span><\/i><\/p>\n

    COVID-19 fever and male fertility<\/h4>\n

    One of the primary short-term concerns around COVID-19 and male fertility stems from the known impact of the flu, and its associated fever, on fertility. While COVID-19 is new, \u201cwe know quite a lot about viruses, flus, and male infertility,\u201d explains Legacy advisor and reproductive urologist Dr. Paul Turek<\/a>. \u201cSeasonal flus are known to reduce male fertility\u2026 We think that it\u2019s due to the fever associated with the illness, which overheats the testicles.\u201d<\/span><\/p>\n

    \"\"<\/p>\n

    This effect is demonstrated in several case studies of fertile men experiencing fevers. In <\/span>one<\/span><\/a>, a patient recovering from influenza produced abnormal sperm for 45 days post-fever. In <\/span>another<\/span><\/a>, sperm count, motility, and genetic health was decreased for over 2 months after the patient\u2019s fever resolved. Considering that one of the primary symptoms of COVID-19 is a high fever, it\u2019s reasonable to assume that men with COVID-19 will also experience reduced fertility.<\/span><\/p>\n

    However, it\u2019s currently believed that the impact of COVID-19 on male fertility will be, like the seasonal flu, temporary. \u201cThe effect is similar to that of hot baths or tubs, and is fully reversible,\u201d Dr. Turek explains.<\/span><\/p>\n

    ACE2 receptors in the male reproductive system<\/h4>\n

    Some researchers have <\/span>raised<\/span><\/a> concerns<\/span><\/a> around what\u2019s known as ACE2, the protein enzyme to which the novel coronavirus binds; ACE2 provides a sort of \u201centryway\u201d for the virus to infect cells. ACE2 is on the surface of many cells in the lungs, heart, blood vessels, kidneys, liver, gastrointestinal tract, and reproductive organs. According to <\/span>researchers<\/span><\/a>, \u201cthe testis is one of the organs with high levels of\u2026 expression of ACE2,\u201d which means the testes are a <\/span>probable \u201ctarget\u201d<\/span><\/a> of the novel coronavirus, and reproductive function could potentially be affected by COVID-19.<\/span><\/p>\n

    \"\"<\/p>\n

    <\/h4>\n

    <\/h4>\n

    <\/h4>\n

    COVID-19 does seem to affect male fertility in the short-term<\/h4>\n

    Studies demonstrate COVID-19 may at least have a temporary impact on fertility hormones. Preliminary <\/span>research<\/span><\/a> revealed that men with novel coronavirus infections had elevated levels of luteinizing hormone (LH) and decreased ratios of testosterone and follicle-stimulating hormone (FSH), compared to healthy men. In another <\/span>study<\/span><\/a>, nearly 70% of men admitted to a German ICU with COVID-19 had clinically low testosterone levels. In both cases, whether the hormone imbalances were caused by the COVID-19 infection or were a pre-existing factor in the severity of their illness is unknown.<\/span><\/p>\n

    In a small <\/span>study<\/span><\/a> of men recovering from mild and moderate cases of COVID-19 (Holtmann et al), patients with a moderate case had a \u201cstatistically significant impairment of <\/span>sperm quality<\/span><\/a>\u201d and sperm concentration compared to men without infection, even after up to 54 days post-infection. Two of the moderate cases exhibited azoospermia, a condition in which no sperm at all can be found in the semen sample.<\/span><\/p>\n

    Additionally, brand new (and still unpublished) <\/span>research<\/span><\/a> from as Israeli medical center reports that patients with moderate COVID-19 symptoms have a 50% reduction in semen volume, sperm concentration, and sperm motility 30 days post-diagnosis.<\/span><\/p>\n

    \"\"<\/p>\n

    The long-term impact of COVID-19 on male fertility is less clear<\/h4>\n

    While these studies may indicate that COVID-19 impacts male fertility, there have yet to be any follow-up studies to determine if the effect is reversible (as it is with influenza). As Allan Pacey, PhD, male fertility expert and Legacy advisor, <\/span>explained<\/span><\/a>, \u201cPeople who get coronavirus are probably quite unwell. Even influenza will cause a decline in sperm count temporarily\u2026 The question is whether it is permanent.\u201d<\/span><\/p>\n

    Holtmann et al, the above-mentioned study of semen parameters in moderate and mild COVID-19 cases, examined men at up to 54 days post-infection, but a follow-up study would be necessary to understand if these changes can be seen long-term. And again, these changes could be due to the fever associated with COVID-19, as opposed to infection of the reproductive system.<\/span><\/p>\n

    And finally, as experts <\/span>writing in <\/span>Fertility & Sterility<\/span><\/i><\/a> underscore, understanding the impact of COVID-19 on fertility may be confounded by the medications used to treat COVID-19, particularly antivirals and hydroxychloroquine, which are known to be <\/span>toxic to sperm<\/span><\/a>. For example, in Holtmann et al, three out of the four patients with moderate symptoms of COVID-19 were treated with these medications.<\/span><\/p>\n

    Can the coronavirus infect the testicles?<\/h4>\n

    A <\/span>recent study<\/span><\/a> points to yes. Researchers collected tissue samples from the testicles of six men who died of COVID-19 and one live patient. Tissue analysis demonstrated that SARS-CoV-2 was found in the testis of one autopsy patient as well as the live patient. This study also found that, in 50% of the patients who had died, spermatogenesis was impaired in direct association with ACE-2 levels.<\/span><\/p>\n

    This study was small, and the disease experienced by the subjects was obviously quite severe. While it doesn\u2019t give us any clear answers about whether COVID-19 has the ability to infiltrate the testis in all cases, it does demonstrate that testicular infection is possible, and lends more support to the idea that fertility is at least temporarily impacted.<\/span><\/p>\n

    COVID-19 and orchitis<\/h4>\n

    There are certain viruses that can cause a painful condition called viral orchitis, inflammation in the testes. While this condition is most closely associated with mumps, SARS\u2014a related infection to COVID-19\u2014has been <\/span>known<\/span><\/a> to cause orchitis and damage to the testicles.<\/span><\/p>\n

    We have enough information now to conclude that orchitis seems to be a rare, but possible, side effect of COVID-19 infection. While in <\/span>one study<\/span><\/a> of 253 COVID-19 patients, doctors did not observe any signs of orchitis, in Holtmann et al, one of four patients with a moderate case of COVID-19 experienced testicular discomfort, a symptom of orchitis. Similarly, in a <\/span>study<\/span><\/a> of 34 male COVID-19 patients, six reported \u201cscrotal discomfort suggestive of viral orchitis.\u201d<\/span><\/p>\n

    At least one diagnosed case of orchitis in a COVID-19 patient has been <\/span>documented<\/span><\/a>. As doctors note, \u201cspermatocyte function may be compromised secondary to this infection…  We characterize the potential complications and importance of fertility follow up.\u201d<\/span><\/p>\n

    While it may take up to a few weeks for the pain of orchitis to subside, there\u2019s a small chance that it will permanently impact male fertility, especially if it only affects one testicle. In cases of mumps, the most common cause of viral orchitis, the condition rarely leads to complete sterility, but may contribute to subfertility; impairment of fertility is <\/span>estimated<\/span><\/a> to occur in about 13% of patients with unilateral (one-sided) orchitis. The virus typically \u201chas to infect boys at puberty, when the testicles are actively growing, to harm future fertility,\u201d explains Dr. Turek.<\/span><\/p>\n

    Can the novel coronavirus be found in semen?<\/h4>\n

    Conclusions about the presence of the coronavirus in the semen of infected men are conflicting. According to Dr. Pacey, testing semen for viruses has its own set of technical challenges, and more research is currently needed. In Holtmann et al, the coronavirus was not found in the semen of any of the recovered or acutely infected male patients. This finding is consistent with <\/span>several<\/span><\/a> recent<\/span><\/a> reports<\/span><\/a> in which the coronavirus was not detected in semen.<\/span><\/p>\n

    However, another <\/span>recent study<\/span><\/a> of 38 men recovering from or infected with COVID-19 concluded that the novel coronavirus was present in the semen samples of 6 subjects. While this may be alarming, it is not necessarily surprising, nor does it indicate a long-term impact of COVID-19 on male fertility. Many viruses have been known to live in the male reproductive tract, even after recovery from the illness they cause.<\/span><\/p>\n

    It\u2019s not <\/span>currently believed<\/span><\/a> that sperm (or eggs) can carry coronavirus, due to the lack of ACE2 receptors in these cells.<\/span><\/p>\n

    Can COVID-19 be sexually transmitted?<\/h4>\n

    There is currently <\/span>no evidence<\/span><\/a> to suggest that coronavirus can be transmitted sexually. According to researchers, contact tracing does not indicate that COVID-19 is an STD, and again, conclusions are conflicting as to whether the coronavirus can actually be found in semen (or vaginal fluid). However, the use of condoms would decrease the likelihood of transmission.<\/span><\/p>\n

    COVID-19 and pregnancy<\/h4>\n

    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 their services curtailed or suspended. This time is no different.<\/span><\/p>\n

    Right now, there\u2019s not much data on <\/span>how COVID-19 might affect pregnant people<\/span><\/a>. We do know that pregnancy alters the immune system in such a way that increases the risk of infections, such as <\/span>influenza<\/span><\/a>, and could make illness more severe. And <\/span>we know<\/span><\/a> that related infections such as MERS and SARS can cause adverse pregnancy outcomes, such as miscarriage, premature delivery, intrauterine growth restriction, and maternal death.<\/span><\/p>\n

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

    If you already have COVID-19, the Society for Assisted Reproductive Technology (SART) <\/span>recommends<\/span><\/a> \u201cavoiding getting pregnant for now and waiting until you fully recover before attempting conception (either naturally or via assisted reproductive technology).\u201d Because COVID-19 patients can be <\/span>asymptomatic<\/span><\/a>, it\u2019s best to get tested to make an informed decision about any potential pregnancies.<\/span><\/p>\n

    Planning a pregnancy or fertility treatment during COVID-19<\/h4>\n

    Reproductive health organizations have advised a cautious approach to conceiving and fertility treatments<\/a> during the COVID-19 pandemic. As of April 7, the American Society for Reproductive Medicine (ASRM) <\/span>notes<\/span><\/a> that \u201cif you don\u2019t have COVID-19, there is no medical reason to change your plans regarding trying to conceive<\/a>. However, there may be logistical, psychological, and emotional reasons to modify your plans\u2026 Out of an abundance of caution, you may consider postponing pregnancy.\u201d<\/span><\/p>\n

    Their counterparts abroad, the European Society of Human Reproduction and Embryology (ESHRE) has <\/span>written<\/span><\/a> that \u201call 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.\u201d As of April 23, ESHRE has <\/span>advocated<\/span><\/a> for recommencing fertility treatments, with caution.<\/span><\/p>\n

    Sperm freezing during the COVID-19 pandemic<\/h4>\n

    Considering data about COVID-19 and male fertility, and the recommendation that couples consider waiting to get pregnant, <\/span>sperm freezing<\/span><\/a> may be beneficial\u2014both biologically and emotionally\u2014during the coronavirus pandemic.<\/span><\/p>\n

    In addition to the potential impact of COVID-19 on fertility (either short-term or long), we also know that time (age) affects <\/span>sperm quality<\/span><\/a>, especially for men over 35. Sperm<\/a> acquire a new genetic mutation\u2014which is passed onto offspring\u2014<\/span>every 8 months<\/span><\/a>. If the COVID-19 pandemic is pushing off your family plans, <\/span>sperm freezing<\/span><\/a> may be a good option for you.<\/span><\/p>\n

    \"\"<\/p>\n

    Social distancing recommendations are still in place, so visiting a doctor\u2019s office or hospital to discuss sperm freezing<\/a> may not be recommended, or perhaps possible, at the moment. <\/span>Mail-in sperm testing<\/span><\/a> and <\/span>freezing<\/span><\/a> options, like the <\/span>Legacy kit<\/span><\/a>, are a valuable option to preserve your fertility from the safety and comfort of your own home.<\/span><\/p>\n

    Learn more about the Legacy kit.<\/a><\/strong><\/p>\n

    References:<\/h5>\n
      \n
    1. D. P. Evenson et al. \u201cCharacteristics of human sperm chromatin structure following an episode of influenza and high fever: a case study.\u201d <\/span>Journal of Andrology<\/span><\/i>, 2000<\/span><\/a>.<\/span><\/li>\n
    2. Martin Sergerie et al. \u201cHigh risk of temporary alteration of semen parameters after recent acute febrile illness.\u201d <\/span>Fertility & Sterility,<\/span><\/i> 2007<\/span><\/a>.<\/span><\/li>\n
    3. Nora Holtmann, MD et al. \u201cAssessment of SARS-CoV-2 in human semen\u2014a cohort study.\u201d <\/span>Fertility & Sterility<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    4. Caibin Fang et al. \u201cACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection.\u201d Preprint article, 2020<\/span><\/a>.<\/span><\/li>\n
    5. Johnny S. Younis et al. \u201cIs there an impact of the COVID-19 pandemic on male fertility? The ACE2 connection.\u201d <\/span>American Journal of Physiology\u2014Endocrinology and Metabolism,<\/span><\/i> 2020<\/span><\/a>.<\/span><\/li>\n
    6. Saguna Verma et al. \u201cACE2 receptor expression in testes: implications in coronavirus disease 2019 pathogenesis.\u201d <\/span>Biology of Reproduction<\/span><\/i>, 2020.<\/span><\/a><\/li>\n
    7. Ling Ma et al. \u201cEffect of SARS-CoV-2 infection upon male gonadal function: A single center-based study.\u201d Preprint article, 2020<\/span><\/a>.<\/span><\/li>\n
    8. Maria Schroeder et al. \u201cThe majority of male patients with COVID-19 present low testosterone levels on admission to Intensive Care in Hamburg, Germany: a retrospective cohort study.\u201d Preprint article, 2020<\/span><\/a>.<\/span><\/li>\n
    9. Dan Aderka et al. \u201cCOVID-19 may harm sperm production.\u201d Unpublished research reported via <\/span>BioNews<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    10. Darshan P. Patel, MD et al. \u201cThe jury is still out: COVID-19 and male reproduction.\u201d <\/span>Fertility & Sterility<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    11. Jing Fan et al. \u201cA preliminary study on the reproductive toxicity of GS-5734 on male mice.\u201d Preprint article, 2020<\/span><\/a>.<\/span><\/li>\n
    12. Justin K. Achua et al. \u201cHistopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testis.\u201d <\/span>World Journal of Men\u2019s Health<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    13. Jian Xu et al. \u201cOrchitis: a complication of severe acute respiratory syndrome (SARS).\u201d <\/span>Biology of Reproduction<\/span><\/i>, 2006<\/span><\/a>.<\/span><\/li>\n
    14. Kharbach Youssef et al. \u201cMale genital damage in COVID-19 patients: Are available data relevant?\u201d <\/span>Asian Journal of Urology<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    15. Hassan Alkhatatbeh et al. \u201cDoes severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) cause orchitis in patients with coronavirus disease 2019 (COVID-19)?\u201d <\/span>Arab Journal of Urology<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    16. Rachel E. Bridwell, MD et al. \u201cA coronavirus disease 2019 (COVID-19) patient with bilateral orchitis: A case report.\u201d <\/span>American Journal of Emergency Medicine<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    17. M Masarani et al. \u201cMumps orchitis.\u201d <\/span>Journal of the Royal Society of Medicine<\/span><\/i>, 2006<\/span><\/a>.<\/span><\/li>\n
    18. D. Paoli et al. \u201cStudy of SARS-CoV-2 in semen and urine samples of a volunteer with positive naso-pharyngeal swab.\u201d <\/span>Journal of Endocrinological Investigation<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    19. Feng Pan et al. \u201cNo evidence of severe acute respiratory syndrome\u2013coronavirus 2 in semen of males recovering from coronavirus disease 2019.\u201d <\/span>Fertility & Sterility<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    20. Ci Song et al. \u201cAbsence of 2019 Novel Coronavirus in Semen and Testes of COVID-19 Patients.\u201d <\/span>Biology of Reproduction<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    21. Diangeng Li, PhD et al. \u201cClinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019.\u201d <\/span>JAMA Network Open<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    22. Tomer Tur-Kaspa et al. \u201cIs COVID-19 a sexually transmitted disease? A systematic review.\u201d <\/span>Fertility & Sterility<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    23. Guillaume Favre et al. \u201cGuidelines for pregnant women with suspected SARS-CoV-2 infection.\u201d <\/span>The Lancet\u2014Infectious Diseases<\/span><\/i>, 2020<\/span><\/a>.<\/span><\/li>\n
    24. H\u00e1kon J\u00f3nsson et al. \u201cParental influence on human germline de novo mutations in 1,548 trios from Iceland.\u201d Nature<\/i>, 2017<\/a>.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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