ABSTRACT
OBJECTIVE: The effects of SARS-CoV-2 were initially studied in the respiratory system, but research has now shown manifestations in multiple organ systems. SARS-CoV-2 is known to enter target cells through the ACE- 2 receptor, which is expressed in the testes. Due to this, the testes has been purported to be a potential target for SARS-CoV-2 infection. To date, studies have suggested that there is only a minor risk for shedding of SARS-CoV-2 into the semen.1 The objective of this study is to compare semen analysis parameters in a subset of healthy sperm donors prior to, during, and after testing positive for COVID-19. MATERIALSAND METHODS: The study included semen analyses (SA) from qualified sperm donors aged 19-38, with 2-5 days of abstinence who donated sperm prior to COVID infection, during active COVID infection, and post COVID infection. Semen was collected in the course of sperm bank operation and samples were collected concurrent with incidental positive test results obtained through COVID screening. Primary outcomes included ejaculate volume (mL), average concentration (M/mL), and percent motility (%). The standard operating procedure for sperm donation dictated that morphology is performed when they are first accepted into the program, thus was not recorded for these samples. Data were compared and analyzed by ANOVA. RESULTS: A total of five qualified sperm donors met inclusion criteria for this study. When comparing semen analyses across the three time points, there was not a significant difference in concentration (p=0.7460), percent motility (p=0.9135), or ejaculate volume (p=0.9241) [Table 1]. CONCLUSIONS: Sperm quality measures as evidenced in qualified, healthy sperm donors are not significantly different when comparing sperm samples prior to COVID infection, during active COVID infection, and after recovery from COVID infection. Although limited by a small sample size, our findings are reassuring to those with SARS-CoV-2 infection, as there appears to be no adverse association with sperm quality. IMPACT STATEMENT: Sperm quality in healthy, qualified donors is not affected by active SARS-CoV-2 infection.
ABSTRACT
OBJECTIVE: It has been suggested that geographic variations in environmental toxins may impact sperm quality. Previously, we published findings that demonstrated a decline in sperm quality over an eleven year period across six regions of the United States (US).1 The current study investigates whether there was a decrease in sperm quality from a diverse set of US sperm donors across six regions in the US over a sixteen year period. Additionally, this study sought to evaluate changes between semen analysis (SA) parameters in an era of sperm collection during the COVID-19 pandemic. MATERIALS AND METHODS: Semen analyses (SA) from sperm donors aged 19-38, with 2-5 days abstinence, from 9 different geographic regions from January 2005-April 2021 were examined. The sperm donors originated from one of the following regions: Palo Alto, Los Angeles, Westwood, International Nordic Cryo Bank Denmark, Indianapolis, Cambridge, New York, Houston, and Spokane, WA. Donation date, BMI, and geographic region were recorded. Data was analyzed as a whole as well as by individual region. Primary outcomes were ejaculate volume (mL), average concentration (M/mL), motility (%), and total motile count (M). Data was analyzed using a general estimate equation (GEE) model with an exchangeable working correlation structure to account for repeated measures. RESULTS: A total of 176,706 SA specimens (from 3,532 unique donors) were analyzed. Controlling for BMI, there was a significant decline in average concentration (M/mL) (β=-1.89, p<0.0001), sperm motility (%) (β=-0.2892, p<0.0001) and total motile sperm (M) (β=-4.53, p<0.0001) over the 16-year study period. There were significant decreases in SA parameters within all geographic regions (Spokane only had two unique donors and could not be examined). Indianapolis showed a significant decrease in sperm concentration and total motile sperm, but also displayed an increase in sperm motility over the study period. CONCLUSIONS: Time related decline in sperm quality continues to be evident at a national level in young, healthy sperm donors. There was a decline across all geographic regions in all parameters except for ejaculate volume. How this decline in sperm counts impacts fertility has yet to be determined. Our modern environment involves increased exposures to endocrine disruptors and changes to lifestyle (including smoking, diet, and stress) that are postulated to impair male fertility by interfering with spermatogenesis. While a causative link to these risk factors remains to be elucidated further studies are necessary to evaluate whether this temporal decline in sperm count correlates with decreased fecundity. IMPACT STATEMENT: Sperm concentration, motility, and total motile sperm continue to decline across young, healthy sperm donors across the continental United States.
ABSTRACT
OBJECTIVE: Concerns have arisen in the lay press regarding a theoretical impact of the COVID-19 vaccine on fertility and early pregnancy. These concerns originate from speculation regarding homology between the COVID- 19 spike protein targeted by the vaccine and syncitin-1 protein, which mediates cytotrophoblast and syncytiotrophoblast fusion and placental development. 1 While this theory has been deconstructed by immunology experts, robust clinical studies have yet to examine a relationship between the mRNA COVID-19 vaccines and reproductive potential. This study aims to assess whether COVID-19 vaccination status impacts early pregnancy outcomes in patients undergoing IVF. MATERIALS AND METHODS: This study included patients who underwent single euploid frozen-thawed embryo transfer (FET) at a single academic center. Vaccinated patients who received the second dose of the Pfizer or Moderna mRNA vaccine two weeks prior to single euploid FET were compared to non-vaccinated patients who underwent single euploid FET during the same time period. Patients who received vaccine doses less than 14 days prior to FET were excluded. Outcomes included pregnancy rate (HCG R2.5IU/L), clinical pregnancy rate (presence of a gestational sac on ultrasound), ongoing pregnancy rate, and pregnancy loss rate. Statistical analysis was performed using Chi-square, Student's t-test, and multivariable logistic regression to control for confounders. RESULTS: Of the 65 patients who underwent single euploid FET two weeks after their final vaccine dose, 28 patients received the Pfizer vaccine and 37 received the Moderna vaccine. Fully vaccinated patients underwent FET between February-April 2021. During that time period 328 non-vaccinated patients underwent single euploid FET and comprised the control group. Baseline characteristics including age, oocyte age, BMI, AMH, BAFC, and endometrial thickness were similar between the groups. Vaccinated and non-vaccinated patients had similar pregnancy rates (75.6% vs. 73.0%, p=.72) and clinical pregnancy rates (63.4% vs. 56.9%, p=.43). No significant differences were seen in pregnancy loss rates (11.8% vs. 23.2%, p=.13) or ongoing pregnancy rates (66.7% vs. 56.1%, p=.18) between the groups. Controlling for age, BMI, AMH, and endometrial thickness revealed no association between vaccination and early pregnancy outcomes (Pregnancy: aOR 1.15, 95% CI 0.49- 2.75, p=.75;Clinical pregnancy: aOR 1.42, 95% CI 0.65-3.10, p=.38;Ongoing pregnancy: aOR 1.67, 95% CI 0.77-3.61, p=.19;Pregnancy loss: aOR 0.39, 95% CI 0.11-1.37, p=.14). CONCLUSIONS: Administration of COVID-19 mRNAvaccines does not interfere with early pregnancy in patients who undergo transfer of genetically screened embryos. There is no relationship between immune response to the COVID-19 spike protein and placental development. IMPACT STATEMENT: Patients who are planning pregnancy can be reassured that COVID-19 vaccination does not adversely impact early pregnancy outcomes. Our findings serve to debunk circulating myths and substantiate that the risk/benefit ratio supports vaccination in women who are trying to conceive.