ABSTRACT
Contradictory results have been reported regarding effects of the SARS-CoV-2 upon human semen. A timely and up-to-date systematic review with meta-analysis appears necessary. This study aimed to deliver pooled prevalence (PP) of SARS-CoV-2 in semen and pooled semen parameters as compared with the uninfected. The relevant databases were scanned by two authors for observational studies reporting analysis of semen in COVID-19 patients. The SARS-CoV-2-infected were assigned to group A (exposed arm), whereas the uninfected to group B (unexposed arm). Newcastle-Ottawa Scale was used to address the risk of bias. PRISMA guidelines were adopted. In case of homogenous studies, fixed-effects model was followed, whereas for heterogenous studies random-effects model was used. Of 990 studies, 24 were eligible involving 1589 subjects (947 in group A and 642 in group B). The "comparability" domain was biased the most. SARS-CoV-2 RNA was detected in three studies among 8 individuals producing the PP of 1.76% (95% CI 0.72-3.21). Sperm concentration was reduced significantly (WMD = -16.23 [95% CI -25.56 to -6.89], as well as total sperm in ejaculate (WMD = -34.84 [95% CI - 43.51 to -26.17]) and sperm volume (WMD = - 0.48 [95% CI - 0.59 to - 0.36] in group A as compared with controls. There was a non-significant effect upon progressive motility and leukocyte presence in semen. SARS-CoV-2 RNA in semen among the infected individuals is detected infrequently. By this token, sexual transmission through semen is of low probability and little concern for public health. However, significant decrease in sperm volume, sperm concentration, and total sperm in ejaculate has been noted. The current data, though, are limited, and more studies with longer follow-up are needed to evaluate the further impact.
Subject(s)
COVID-19 , Semen , Humans , Male , SARS-CoV-2 , RNA, Viral , SpermatozoaABSTRACT
Background: The purpose of the current study was to assess pooled prevalence (PP) of SARS-CoV-2 in semen and pooled estimates including weighted mean difference (WMD) and risk ratio (RR) of semen characteristics in infected cases as compared with healthy controls. Methods: Major databases were searched by two authors. SARS-CoV-2-positive cases were assigned to the exposed arm (group A), whereas the controls to the unex-posed (group B). Risk of bias was assessed with Newcastle-Ottawa Scale and PRISMA guidelines were followed. Random-effects model was employed for analyzing the heterogeneity and fixed-effects model for homogeneity of studies. Results: Of 170 studies, 14 studies were eligible involving 507 subjects (316 in group A, 191 in group B). The risk of bias was the highest for "comparability" domain. SARS-CoV-2 RNA was found in only two studies among 7 subjects (PP= 2.10%, 95%CI 0.58-4.42). There was a significant decrease in sperm concentration (WMD= -15.29, 95%CI -24.70 - -5.88) and total sperm in ejaculate (WMD= -47.58, 95%CI -86.40 - -8.75) in group A. The effect of COVID-19 upon progressive motility, ejaculate volume, and leukocyte presence in semen was not significant. Conclusion: Prevalence of SARS-CoV-2 in semen among the infected cases is low. Sexual transmission through semen is improbable and of little concern for public health. Sperm concentration and total sperm in ejaculate are significantly reduced as compared with controls. Due to limited information of the current research, longer follow-up is needed to identify delayed or progressive impact.