ABSTRACT
INTRODUCTION AND OBJECTIVE: Current evidence has proven the systemic nature of COVID19, including its involvement in the male reproductive tract. We aimed to investigate seminal parameters of moderate-to-severe COVID-19 men during the convalescence phase. METHODS: This cross-sectional study included 18 to 50-yearold men with confirmed moderate-to-severe COVID-19. Patients were enrolled 15 to 45 days after the diagnosis. After a urologist's initial clinical evaluation, semen samples were obtained by masturbation and processed within one hour. Semen analysis was performed using the World Health Organization (WHO) manual (6th edition). Sperm function tests were conducted in an andrology laboratory, including Reactive oxygen species (ROS), DNA fragmentation, lipid peroxidation, and Creatine Kinase (CK) analysis. An essential endocrine evaluation was performed. Patients with a history of disorders that could impair testicular function were excluded. A group of pre-vasectomy baseline samples was used as a control group. Statistical analysis was performed using R version 4.0.5. One-tailed and paired T-tests were used for comparisons between groups. RESULTS: The sample size was 26 men (mean 34.3±6.5 years;range: 21-50 years). Sperm concentration (mean 38.74±32, P <0.01) and total motile count (mean 55.3±66.8, P <0.01) were significantly reduced in the COVID-19 group. The DNA fragmentation (mean 41.1±29.2) and ROS (mean 4.84±8.7) were significantly higher in post-infection patients. Other parameters such as WHO/ Kruger morphology and progressive motility were also reduced in the disease group, albeit not statistically significant. Total testosterone (mean 409.2±201.2) was lower in the convalescent men. All semen samples were negative for SARS-CoV-2 using the PCR analysis. CONCLUSIONS: Our findings indicate that male reproductive injury can be a relevant component of SARS-CoV-2 systemic infection. High DNA fragmentation and ROS, hallmarks of tissue injury, might signal a direct testicular involvement. The morphological and functional damage could represent significant impairment of the male reproductive health if persistent after convalescence.
ABSTRACT
OBJECTIVE: Severe acute respiratory syndrome corona virus 2 (SARS-COV-2) enter different body tissues via the angiotensin-converting enzyme 2 (ACE2) receptor. This enzyme is highly expressed in testicular tissue making testicular hormone function & spermatogenesis vulnerable to such infection. This study aims to evaluate the effect of SARS COV-2 infection on the testicular function in proven fertile males on short & long term basis MATERIALS AND METHODS: This prospective cohort study enrolled patients infected with SARS COV-2 virus. Patients with normal semen analysis or evidence of fertility in the past 2 years were included. Patients with history of infertility or those receiving treatment & had abnormal semen parameters prior to infection were excluded. Patients were divided into asymptomatic & symptomatic group requiring hospitalization. Medical history & physical exam were performed during the initial visit and blood hormones were withdrawn. Patients underwent conventional semen analysis, advanced sperm function tests & hormone tests at 3 & 6 months following infection. Variables were reported as mean ± SE & compared using Kruskal Wallis Test. Spearman correlation was performed to assess relationship between Ct PCR value & numerical variables RESULTS: A total of 60 patients infected with SARS COV-2 virus were included & 48 patients completed the study. The mean age was 35.1±5.6 years. The mean Ct value was 23.38±5.2. There was no significant correlation between the Ct value, the hormonal profile & patient age at time of recruitment. The semen parameters & hormonal profile at 3 & 6 months follow up were in normal range (Table 1). There was significant difference in the testosterone levels between asymptomatic group (mean 11.35 ± 4.8) & symptomatic hospitalized group (mean 7.48 ± 3.49) upon initial enrollment (P value=0.005). Decreased testosterone levels during infection turned back to normal on 6 months follow up (mean 12.78±4.98) CONCLUSIONS: SARS COV-2 infection does not affect semen parameters nor hormonal profile for previously fertile patients on short & long term basis. Testosterone levels in symptomatic hospitalized patients is significantly decreased compared to asymptomatic non-hospitalized group at the time of SARS COV-2 infection IMPACT STATEMENT: Long term reproductive health of men is not affected by SARS COV-2 infection. (Table Presented).