The Impact of Covid-19 Vaccines on Sperm Quality

Objective: To determine the impact of Covid-19 vaccines on sperm quality. Study Design: Case control study Place and Duration of Study: Department of Diabetes & Endocrinology, Chandka Medical College Hospital Larkana from 1st July 2022 to 31st December 2022. Methodology: Patients were enrolled as 50 those who had PCR confirmed Covid 19 history and 50 those who never got Covid-19. On this basis those cases who had a Covid-19 history were placed in group A while those who did not had Covid-19 history were placed in Group B. Patients clinical history including anamnesis, marital status, cryptorchidism, operative varicocele, or any chronic ailment were documented. A counting chamber was used for sperm count in a 100 square area. Spermatozoa was measured as either rapid-progressively motile (Type a), or as slow-progressively-motile (Type b), or as situ motile (Type c), and finally as immobile (Type d). The total semen sperm count was gained by multiplication of concentration of sperm with its volume. Result(s): Volume and concentration was significantly different in both study groups. Difference in tail anomaly was also observed. In group A, it was 29.20 +/- 10.26 while 27.59 +/- 12.31 was the value of group B. Almost equal number of participants were married. Azoospermia was only found among Covid patients. Conclusion(s): Azoospermia was only found in Covid patients and no such results were obtained from Covid negative patients.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

A systematic review of the effect of COVID-19 on semen parameters.

Background and objectives: Since the outbreak of COVID-19, more and more studies have proved that it has an impact on the male reproductive system. The purpose of this article is to investigate the effects of COVID-19 on male semen parameters, further analyze the incidence and risk factors of diseases related to semen parameters, and put forward to corresponding preventive measures. Methods: Retrieved from PubMed, Embase, The Cochrane Library, Web of Science, Clinicaltrails, CNKI, CBM, Wanfang Database and VIP to collect research on the effects of COVID-19 on the male reproductive system. The literature search was conducted until January 2022. In strict accordance with the inclusion and exclusion criteria, two researchers independently screened the literature and comprehensively analyzed five cohort studies on the impact of COVID-19 on male reproductive system. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included cohort studies, and Revman 5.4.1 was applied for statistical analysis. Results: Semen volume (RR = -0.10; 95% CI: 0.45, 0.26; P = 0.60), there was no significant difference between the test group and the control group; Sperm count (RR = -45.28; 95% CI: 66.38, 24.19; P = 0.0001), the sperm count of the COVID-19 test group was lower than that of the control group, and the difference was statistically significant; Sperm concentration (RR = -15.65 × 106; 95%CI: 31.52 × 106, 0.21 × 106; P = 0.05), there was no significant difference between the test group and the control group; progressive sperm motility (RR = 4.31; 95% CI: 4.62, 13.24; P = 0.34), there was no effect on progressive sperm motility in the COVID-19 test group compared with the control group. Conclusions: COVID-19 can reduce semen quality and affect male fertility. However, due to the limitations of this study, this conclusion needs to be further verified by large-sample, high-quality prospective cohort studies on the long-term effects of COVID-19 on male reproductive function.

Mild Androgen Insensitivity Syndrome presenting in male with infertility and sexual difficulties

Androgen insensitivity syndrome has a wide spectrum of presentations. It results from a mutation in androgen receptor (AR) gene. It ranges from mild androgen insensitivity syndrome (MAIS) which is the mildest form to complete androgen insensitivity syndrome (CAIS). In case of MAIS, the abnormality that can be observed appears to be male infertility and sexual difficulties including premature ejaculation and erectile dysfunction. In this case report, we discuss a case of MAIS in a 37-year-old male who presented with infertility, premature ejaculation, and secondary erectile dysfunction.Copyright © 2023, Ibn Sina Trust. All rights reserved.

Misinformation on Tiktok About the Effect of Covid-19 Infections and Vaccinations on Male Fertility

INTRODUCTION AND OBJECTIVE: The effect of the SARSCoV- 2 infection and vaccine on male fertility has been a cause of controversy. Studies have found that while COVID-19 disease can be associated with decreased sperm counts and quality, the vaccine is not. Despite evidence about the lack of association between the COVID-19 vaccine and male fertility, social media platforms, including TikTok, continue to spread misleading information. Objective(s): To identify how TikTok contributes to misinformation regarding the COVID-19 virus, vaccination, and male infertility. METHOD(S): After excluding unrelated videos, 58 videos using the terms #covidvaccine and #malefertility were identified on Tiktok from January 1 to December 31, 2021. Videos were reviewed by five independent researchers. Information collected included video publication date, length, views, likes, comments, presence of US certified medical professional, demographic details, scientific article cited, belief held on COVID-19 vaccine, infection and infertility, modified DISCERN score and Patient Materials Assessment Tool (PEMAT). The PEMAT score evaluated 17 items regarding understandability and actionability. The modified DISCERN based reliability score ranked quality from 1=poor, to 5=excellent. Data was analyzed using SPSS statistics software v24. RESULT(S): The average video was 51 seconds long, received 34,678 views, 3,301 likes, and 160 comments. A majority of videos featured a medical professional (67.2%). Most videos were of the opinion that the COVID-19 infection causes infertility in men (48.3%) but not the vaccine (37.9%). Few videos believed that the vaccine was responsible for male infertility (6.9%). The average DISCERN score for the 58 videos was 2.93, PEMAT Understandability score was 76.1%, and PEMAT Actionability score was 25.7%. With the presence of a certified US Medical Professional in the TikTok video, the average DISCERN score (2.00 vs. 3.38, p=.001), PEMAT Understandability Score (67.68 vs. 80.26, p=.015), and PEMAT Actionability Score (13.16 vs. 31.82, p=.024) increased significantly. Videos with medical professionals present had a lower average number of views (31,996 vs. 40179, p=.691), fewer likes (1,902 vs. 6,173, p=.290), and fewer comments (150 vs. 182, p=.737), but none of these differences were statistically significant. CONCLUSION(S): This study demonstrates that TikTok videos endorsing misinformation are popularly viewed. Among all the misinformation in social media, it is reassuring to see that there are medical professionals interested in promoting medically accurate information.

Semen Quality in Males Suffering From COVID-19

Background: It is well knowledge that various viral illnesses may interfere with a man's ability to father children. Through the angiotensin-converting enzyme-2 receptor, which is highly concentrated in testicular tissue, the corona virus illness known as COVID-19 may cause harm to several organs. On the other hand, there is a paucity of data about the transmission of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) in sperm, as well as the virus's influence on spermatogenesis and the capacity for fertility. We intended to look into whether or not COVID-19 guys' sperm contained SARS-CoV-2 as well as examine how COVID-19 affected the overall quality of the sperm and the degree to which it's DNA was fragmented. Material(s) and Method(s): The survey was conducted between May 2022 to October 2022, with the participation of 40 male COVID-19 patients who were between the ages of 19 and 45 and enrolled at the RSDKS, Government Medical College, Ambikapur, Chhattisgarh. We tested each sample of sperm with a real-time reverse transcriptase and found no abnormalities. At the time of the initial sample, which took place during COVID-19, a comprehensive examination of the sperm was carried out. This analysis included the calculation of the sperm DNA Fragmentation Index. After 74 days had passed since the first sample, we were able to get the second specimen and carried out the aforementioned tests once again. Result(s): All of the sperm samples that were examined using real-time reverse transcription-polymerase chain reaction (RT-PCR) came back negative for SARS-CoV-2. These samples were taken during the first and second sampling. The initial sample had considerably lower levels of fructose, semen volume, vitality, total motility, sperm concentration, total sperm count, percentage of normal morphology, and cytoplasmic droplet percentage than the subsequent samples. On the other hand, the agglutination of the semen, the percentage of head defects, the DNA Fragmentation Index, the liquefaction time, the viscosity of the semen, and the number of leukocytes all rose. At the second sample, these results were inverted, but not to the level that would be considered optimal. These results all had a p-value less than 0.05, meaning they were statistically significant. As a result, COVID-19 has a detrimental impact on the characteristics of the sperm, including the sperm DNA fragmentation index. Conclusion(s): The quality of the semen remained low up until the second time it was sampled, despite the fact that we were unable to discover SARS-CoV-2 in the sample. It is recommended that assisted reproductive technology (ART) clinics and sperm banking facilities evaluate the quality of the sperm produced by males infected with COVID-19 and exclude men who have a history of being infected with SARS-CoV-2 until the men's sperm quality recovers to normal.Copyright © 2023 Ubiquity Press. All rights reserved.

Do the Covid-19 vaccines affect the reproductive parameters of men?-A Northern Saudi experience.

Background: The COVID-19 vaccine acceptance is a psychological behavior influenced by many factors, including fear of an adverse effect on the reproductive system. Aims: The aim of this study is to assess the COVID-19 vaccines effect on reproductive parameters among the male population of northern Saudi Arabia. Patients and Methods: We conducted a prospective cohort study among 100 volunteers who received two doses of COVID-19 vaccines. A pre- and post-vaccination blood sample was collected and analyzed for testosterone, prolactin, and follicle-stimulating hormone (FSH). Semen samples were also collected and analyzed. The Wilcoxon signed-rank test was used to compare the values between pre- and post-vaccination. Results: Of the 100 samples analyzed, there was a significant increase in progressive sperm motility after the second dose of vaccination, but the increase was within the physiological limits (pre-55.03 [42.00-61.75] vs. post-57.50 [42.25-63.00], P = 0.008). Similarly, a significant increase in serum testosterone level after the second vaccination dose was observed (pre-380.65 [301.60-485.73] vs. post-410 [318.18-505.35], P = 0.016). Conclusion: These preliminary results show that the COVID-19 vaccines do not have any adverse effect on the reproductive parameters of men. A prospective long-term follow-up study will be necessary on all WHO -approved COVID vaccines to determine their long-term effect on men's reproductive health. The future follow-up study could strengthen our findings and encourage the men who have vaccine hesitancy to take due to fear of its effect on reproductive parameters.

Investigating impacts of CoronaVac vaccination in males on in vitro fertilization: A propensity score matched cohort study

Study question: Does a history of SARS-CoV-2 vaccination (CoronaVac) in males influence male fertility, gamete and embryo development, and in vitro fertilization (IVF) outcomes? Summary answer: CoronaVac vaccination in males may not have an adverse effect on patient's performance or the gamete and embryonic development potential during ART treatments. What is known already: Vaccines against COVID-19 have been approved for emergency use in several countries and regions, while concerns about the potential negative effect of vaccines on fertility contributed to vaccine hesitancy. It is urgent to explore the effect of CoronaVac on human fertility to help to overcome vaccine hesitancy about possible fertility impairment. Study design, size, duration: A retrospective cohort study enrolled couples undergoing IVF cycles between June and August 2021 at Reproductive Medicine Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. According to the history of SARS-CoV-2 vaccination in males, the participants were divided into the vaccination group and the non-vaccination group. Participants/materials, setting, methods: A self-controlled study of semen analyses for males before and after CoronaVac vaccination was conducted. Baseline characteristics were matched using propensity score matching. Participants were categorized into the unexposed group (non-vaccination) and exposed group (vaccination), and the population was 271 for each. Semen parameters and IVF outcomes were the main outcomes. Main results and the role of chance: Generally, no statistically significant differences were exhibited between the matched cohorts regarding embryo developmental parameters, including fertilization rate, cleavage rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst rate, as well as clinical outcomes, such as implantation rate, biochemical pregnancy rate, and clinical pregnancy rate. Moreover, males after vaccination seemed to have fluctuated semen parameters including increased semen volume, lower motility, and decreased normal forms of sperms, while the motile sperm counts were similar. In addition, all semen parameters were above the lower reference limits. Limitations, reasons for caution: It was a single-center retrospective cohort study with a small sample size, and the men enrolled were suffering from infertility, which limited the generalizability of the conclusions. In addition, the endpoint of the current is a confirmation of clinical pregnancy, a study with a longer period of follow-up was urgent. Wider implications of the findings: Our findings suggested that CoronaVac vaccinations in males may not have adverse effects on patient's performance or the gamete and embryonic development potential during ART treatments. Larger studies among a wider population with longer followup in the future are required to support and validate our observations.

ANDROLOGY IN THE ERA OF COVID

OBJECTIVE: The last year has represented a challenging time for andrology laboratories due to the COVID-19 pandemic. Public health guidelines and government regulations intended to reduce the spread of COVID-19 caused a shift in patient practices across healthcare. They impacted the infertility laboratory by changing where and how semen samples are collected. The current study compared the quality of semen being collected for routine semen analysis (SA), and therapeutic IUI cycles, comparing the first year of the pandemic with the previous twelve-month period in a regional fertility center. MATERIALS AND METHODS: Institutional rules, public health guidelines, and government regulations required the majority (> 98%) of semen samples collected at a regional fertility center to be collected off-site starting March 18th, 2020. The center serves a catchment basin of approximately 300 miles in diameter, meaning some patients might travel for 1-2 hrs to deliver samples collected at home or have to make other arrangements for a collection location closer to the laboratory. To determine what impact the delay in processing and other factors, such as stress, might be having on semen quality, the center conducted a study comparing the standard semen parameters in two arms. The COVID-19 arm were patients seen from March 18th, 2020 to March 17th, 2021, and they were compared to the Pre-COVID-19 arm, who were seen from March 18th, 2019 to March 17th, 2020. Semen Analysis parameters analyzed for all samples included volume, concentration/mL, motility, morphology, total concentration, and total motile concentration. IUI samples were also analyzed for post-wash total concentration and total motile concentration. Resulting Data were compared using student's T-test. RESULTS: A total of 423 SA and 378 IUI records were compared. As expected, off-site collection significantly increased the time from collection to completion of the procedure (P < 0.001). Numerous semen parameters of the standard semen analysis were 10-20% lower in the pandemic year when collecting off-site than the same parameter in the 12 months before the pandemic when on-site collection was used. Focusing on IUI data, the average processing time from collection to finish increased 26 to 48 mins (p < 0.006). Average Total motile sperm has decreased from 49 to 42 million (14%;P < 0.05) between groups. Pregnancy data is pending. CONCLUSIONS: The pandemic has presented challenges to all reproductive centers. The challenges appear to have had a negative effect on the overall semen quality of patients. While it is unclear how much of an impact delays in processing are having, the data is highly suggestive they are impacting patient treatment. IMPACT STATEMENT: While delivery of reproductive health care continued during the pandemic, changes in public health guidelines and governmental regulations have impacted patient care thereby causing a reduction in semen quality. Public health officials and practices may need to reevaluate how semen samples are collected for diagnostics and treatment to mitigate this reduction in quality while maintaining the overall health of patients and staff.

EFFECT OF COVID-19 mRNA VACCINES ON SPERM QUALITY

OBJECTIVE: Fertility related safety data was neither reported in the clinical trials nor evaluated in animal models prior to emergency use authorization (EUA) for two novel mRNA vaccines, BNT162b2 and mRNA-127.1,2 Despite excellent safety profiles for both vaccines, 44% of Americans are hesitant in receiving the vaccine. Although the specific reasons for COVID-19 vaccine hesitancy are unknown, concerns over fertility has previously decreased other vaccine uptake. As COVID-19 vaccination in the United States opens to children and adolescents, evaluating any potential impact of the vaccine on male reproduction is imperative for public reassurance. We hypothesized that since both vaccines only contain mRNA encoding the SARS-CoV-2 spike protein without biologic ability to replicate live virus, the vaccines would not decrease semen parameters. MATERIALS AND METHODS: We conducted a single-center prospective cohort study after IRB approval from the University of Miami (#20201451). Healthy men aged 18-50 scheduled for mRNA COVID-19 vaccination in Miami, Florida were recruited.Participants provided a semen sample after 2-7 days of abstinence, prior to receiving the first dose of either vaccine and about 72 days after the second dose. Specimens were self-collected into a wide-mouth sterile container and semen analysis (SA) performed by HCLD trained andrology clinicians examined semen volume, concentration, motility, and total motile sperm count (TMSC). RESULTS: 45 men provided a semen sample. Neither median sperm concentration nor total motile sperm count (TMSC) declined post vaccination (Figure 1). There was no clinically significant change in TMSC. Only 12 (26.6%) men had a marginal decrease in TMSC. In fact, the remaining 33 (73.3%) men demonstrated normal sperm parameters. Importantly, 8 (17%) men with oligospermia prior to vaccination did not experience a decrease in spermatogenesis. Only one subject had an abnormal TMSC (TMSC ≤ 9) after vaccination. CONCLUSIONS: After receiving the two doses of the vaccines, we did not observe a clinically significant sperm parameter decline within the cohort, suggesting the vaccines do not negatively impact male fertility potential. IMPACT STATEMENT: This is the first male fertility evaluation of the COVID-19 mRNA vaccines, in which we found that the vaccines do not negatively impact semen parameters. (Table Presented).

SIXTEEN YEAR LONGITUDINAL STUDY OF U.S. SPERM DONORS CONTINUES TO DEMONSTRATE DECLINING SPERM COUNT AND MOTILITY

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.

The impact of COVID-19 vaccine on sperm quality.

OBJECTIVE: To examine the effect of the BNT162b, mRNA, SARS-CoV-2 virus vaccine on sperm quality. METHODS: This was a prospective cohort study conducted on sperm donors at the sperm bank of a tertiary, university affiliated medical center. All sperm donors donated sperm repeatedly and the average sperm parameters of all available samples were compared before and after receiving the SARS-CoV-2 vaccine. Each donor served as his own control. For all participants, at-least one sperm sample was received 72 days after completing the second vaccine. Main outcome measures included total sperm count, total motile count and percent of motile sperm. RESULTS: A total of 898 sperm samples from 33 sperm donors that were vaccinated with the Pfizer BNT162b, mRNA, SARS-CoV-2 virus vaccine were analyzed, 425 samples were received before the vaccine, while 473 samples were received after vaccination. Total sperm count and total motile count increased after the second vaccine compared to samples before vaccination. Percent of motile sperm did not change after vaccine. CONCLUSION: The Pfizer BNT162b, SARS-CoV-2 vaccine has no deleterious effect on sperm quality. Patients and physicians should be counseled accordingly.

QUALITY OF EJACULATE OF MALE PATIENTS WITH TYPE 2 DIABETES MELLITUS (DM), VACCINATED WITH GAMCOVIDVAC (SPUTNIK V)

BACKGROUND: New coronavirus infection (Covid-19) in patients with diabetes type 2 mellitus (DM) often has severe clinical course and manifestation. This comorbidity is a reasonable indication for vaccination. Male patients are often concerned about the vaccination impact on their fertility, so the current research of this issue seems to be essential and relevant. AIMS: To evaluate the quality of ejaculate in type 2 diabetes mellitus (DM) patients, vaccinated by GamCovidVac (Sputnik V). MATERIALS AND METHODS: The pilot observational prospective study included 30 males with type 2 diabetes mellitus (DM). The study continued from February 2021 till June 2021. The research design involved medical history analysis, glycated hemoglobin (HbA1c) tests, total testosterone level in blood measurement, semen analysis (sperm count test). Group comparison was performed by Wilcoxon Signed Ranks Test. The differences were considered statistically significant at p<0.05. RESULTS: After vaccination 19 patients (63%) demonstrated a temperature rise which lasted for 2 days;26 patients (87%) complained of tenderness in the injections site which lasted up to 5 days. Though a few patients reported general somatic side effects after the vaccination, there have been no statistically significant deviations in sperm count, viability, function and morphology. The levels of glycated hemoglobin and total testosterone remained unchanged. CONCLUSION: The study revealed no negative impact of GamCovidVac on ejaculate quality, total testosterone level and compensation of carbohydrate metabolism.

Oocyte and Sperm Cryopreservation In Oncological Patients During Covid-19 Pandemic

During the pandemic, most infertility and IVF Units decided to keep fertility preservation active as an urgent procedure. It is well established that chemotherapy is gonadotoxic and impact negatively on quality of life. The American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) recommend to offer fertility preservation before cancer treatment. Oocyte cryopreservation and sperm cryopreservation are the best treatments of the choices to preserve fertility in cancer patients. This is a prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from February 2020 to January 2021. 149 cancer patients underwent gamete cryopreservation to preserve their fertility. All patients tested for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2 48 hours before cryopreservation. The viral RNA detection was provided only in case of positive swab and no treatment was interrupted. 59 women underwent ovarian stimulation with gonadotropins followed by oocyte retrieval. Women’s basal characteristics were: Age (m±sd) 31.0 ± 7.0 years, FSH (m±sd) 14 ±9IU/l, AMH (m±sd) 2.4 ± 1.3 ng±ml, AFC (m±sd) 9 ±5. 90 men underwent spermatozoa rapid cryopreservation. Men’s basal characteristics were: Age (m±sd) 34±7 years;Total Sperm count x 106 (m±sd) 52.3±49.6, Sperm x 106/ml 28.1±25.5, Total motility (m±sd) 48.0±26.7 %, Progressive motility (m±sd) 22.2±20.5 %, normal morphology (m±sd) 22.3±11.1 %. 296 oocyte were cryopreserved: 5.5±4.3 (mean±sd per patient). Vitrification with closed devices (High-Security Vitrification™ - HSV) was used for oocyte cryopreservation to minimize the risk of viral contamination. 403 Sperm samples were frozen with slow freezing: 5.7±2.1 (m±sd) per patient. All patients tested negative for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2. The oncofertility activity must be maintained even in pandemic periods by implementing adequate safety measures to protect the health of patients and healthcare professionals. Funding: Supported by Italian Ministry of Health "Fertility Preservation in gonadotoxic treatments” project code RF-2011-02348826 Conflict of Interest: None to disclose

Semen parameters in men recovered from COVID-19.

The novel coronavirus disease (COVID-19) pandemic is emerging as a global health threat and shows a higher risk for men than women. Thus far, the studies on andrological consequences of COVID-19 are limited. To ascertain the consequences of COVID-19 on sperm parameters after recovery, we recruited 41 reproductive-aged male patients who had recovered from COVID-19, and analyzed their semen parameters and serum sex hormones at a median time of 56 days after hospital discharge. For longitudinal analysis, a second sampling was obtained from 22 of the 41 patients after a median time interval of 29 days from first sampling. Compared with controls who had not suffered from COVID-19, the total sperm count, sperm concentration, and percentages of motile and progressively motile spermatozoa in the patients were significantly lower at first sampling, while sperm vitality and morphology were not affected. The total sperm count, sperm concentration, and number of motile spermatozoa per ejaculate were significantly increased and the percentage of morphologically abnormal sperm was reduced at the second sampling compared with those at first in the 22 patients examined. Though there were higher prolactin and lower progesterone levels in patients at first sampling than those in controls, no significant alterations were detected for any sex hormones examined over time following COVID-19 recovery in the 22 patients. Although it should be interpreted carefully, these findings indicate an adverse but potentially reversible consequence of COVID-19 on sperm quality.

Evaluation of SARS-CoV-2 in Human Semen and Effect on Total Sperm Number: A Prospective Observational Study.

PURPOSE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created a surge of research to help better understand the breadth of possible sequelae. However, little is known regarding the impact on semen parameters and fertility potential. We sought to investigate for presence of viral RNA in semen of men with SARS-CoV-2 infection and to evaluate its effect on semen parameters in ejaculate. MATERIALS AND METHODS: We prospectively recruited thirty men diagnosed with acute SARS-CoV-2 infection using real-time reverse transcriptase polymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or in-person in office setting. Semen analysis and PCR was performed after samples were received. RESULTS: Thirty semen samples from recovered men were obtained 11-64 days after testing positive for SAR-CoV-2 infection. The median duration between positive SAR-CoV-2 test and semen collection was 37 days (interquartile range [IQR]=23). The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=52.1). When compared with age-matched SARS-CoV-2(-) men, TSN was lower among SARS-CoV-2(+) men (p=0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested. CONCLUSIONS: SARS-CoV-2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting. Whether SARS-CoV-2 can affect spermatogenic function long-term remains to be evaluated.