Reactivation of Surgical Campaigns after the Covid Pandemic: Surgeons in Action with Hernia International Foundations in 2022

Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.

Plausible Impacts of SARS-CoV-2 on Human Reproductive System

SARS-CoV-2, a member of the family Coronaviridae, is a positive-stranded RNA virus with the spike glycoproteins present on its envelope. ACE2 serves as the entry mediator of SARS-CoV-2 as it attacks mainly the organs of the respiratory, cardiovascular, digestive, and urinary system showing high expression of ACE2 or TMPRSS2. ACE2 is found to have significant differential expression in all the reproductive tissues, thus posing the reproductive system vulnerable to the adverse effects of SARS-CoV-2 infection. Previous coronavirus attacks (SARSCoV and MERS) have also been known to impose adverse effects on the reproductive system. Therefore, there is a dire need to safeguard the reproductive system against COVID-19 as it not only bothers the present generation but may also affect the well-being of future progeny. Since the inception of pandemic, several scientific studies have been carried out to assess its impact;yet there are research lacunas to claim reproductive system as a potential target of this deadly virus. To avoid the detrimental effects of the current pandemic on reproductive sustainability, well-planned large-scale and multicentric cohort follow-up studies are mandatory for accurate evaluation of the enduring effects of SARS-CoV-2 infection on human fertility and pregnancy outcomes. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.

Fetal impact of cystic fibrosis transmembrane conductance regulator modulator use during assisted and natural reproduction and partner pregnancy in men with cystic fibrosis

Background: Increasing availability of highly effective cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator therapy (HEMT) has improved the quality of life and long-term prognosis for many people with CF. Thus, more people with CF are considering parenthood. Almost all menwith CF (MwCF) are infertile because of congenital bilateral absence of the vas deferens (CBAVD). Based on CF animal models, CBAVD occurs early in gestation and is unlikely to be reversible using HEMT, but assisted reproductive techniques (ARTs) can enable MwCF to father children using the sperm in their testes. Animal reproductive models suggest no HEMT teratogenicity, and the amount of exposure of the fetus to HEMT via absorption of seminal fluid through the vaginal wall is predicted to be negligible, although to ensure no sperm exposure to HEMT, the life span of sperm would require MwCF to discontinue CFTR modulators for approximately 3 months before ART. Because abrupt discontinuation of CFTR modulators may result in health decline, MwCF and their providers must consider all potential risks. There are no published data in MwCF regarding use of HEMT during conception and partner pregnancy. Method(s): Beginning in August 2021, CF center staff in the United States, United Kingdom, and Australia completed a two-page anonymous questionnaire regarding MwCF who used CFTR modulators during ART (sperm retrieval and in vitro fertilization) or natural conception with subsequent partner pregnancy. Result(s): Providers have submitted 34 surveys for MwCF on CFTR modulators whose partner became pregnant after use of ART (n = 32) or natural conception (n = 2). The median age of the samplewas 32 (range 24- 43). Fifteen were homozygous for F508del, median percentage predicted forced expiratory volume in 1 second was 76% (range (22-111%), and median body mass index was 24 kg/m2 (range 18.5-32.1). Twenty-three were taking elexacaftor/tezacaftor/ivacaftor. The median time that MwCF were taking CFTR modulators before partner conception was 18 months (range 0-82). One newly diagnosed man initiated HEMT after sperm retrieval. Four MwCF stopped CFTR modulators before sperm retrieval, one of whom experienced pulmonary decline. None of the 19 MwCF whose condom use during pregnancy was known used condoms. Fetal complications in partners of MwCF included three first-trimester miscarriages, two* COVID, two breech presentation, two* vaginal bleeding, and one vasa previa. None of the complications were deemed definitively related to use of CFTR modulators. One MwCF experienced testicular infection after sperm retrieval#. Postpartum complications included three# infants with hypoxemia requiring neonatal intensive care unit stay, three maternal blood loss, one forceps delivery, and one caesarean section. No congenital anomalies were reported for any infant. (*/# overlap). Conclusion(s): Use of CFTR modulator therapy during partner conception and pregnancy in 34 MwCF has not resulted in higher-than-expected miscarriage rates or congenital anomalies. Providers should consider the risk to the health of MwCF combined with the lack of teratogenicity in animal reproductive models and limited safety data in the human fetus before discontinuing CFTR modulators before ART or natural partner conception. Survey collection is ongoing;results will be updated for presentationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Application of single-cell RNA sequencing on human testicular samples: a comprehensive review.

So far there has been no comprehensive review using systematic literature search strategies to show the application of single-cell RNA sequencing (scRNA-seq) in the human testis of the whole life cycle (from embryos to aging males). Here, we summarized the application of scRNA-seq analyses on various human testicular biological samples. A systematic search was conducted in PubMed and Gene Expression Omnibus (GEO), focusing on English researches published after 2009. Articles related to GEO data-series were also retrieved in PubMed or BioRxiv. 81 full-length studies were finally included in the review. ScRNA-seq has been widely used on different human testicular samples with various library strategies, and new cell subtypes such as State 0 spermatogonial stem cells (SSC) and stage_a/b/c Sertoli cells (SC) were identified. For the development of normal testes, scRNA-seq-based evidence showed dynamic transcriptional changes of both germ cells and somatic cells from embryos to adults. And dysregulated metabolic signaling or hedgehog signaling were revealed by scRNA-seq in aged SC or Leydig cells (LC), respectively. For infertile males, scRNA-seq studies revealed profound changes of testes, such as the increased proportion of immature SC/LC of Klinefelter syndrome, the somatic immaturity and altered germline autophagy of patients with non-obstructive azoospermia, and the repressed differentiation of SSC in trans-females receiving testosterone inhibition therapy. Besides, the re-analyzing of public scRNA-seq data made further discoveries such as the potential vulnerability of testicular SARS-CoV-2 infection, and both evolutionary conservatism and divergence among species. ScRNA-seq analyses would unveil mechanisms of testes' development and changes so as to help developing novel treatments for male infertility.

Evaluation of testicles by sonoelastography in men recovering after Covid-19 disease.

INTRODUCTION: Testicular cells, seminiferous tubule cells, spermatogonia, Leydig and Sertoli cells showing angiotensin-converting enzyme 2 expression have the potential to be targets and to be damaged by the coronavirus. We aimed to use Two-Dimensional Shear Wave Elastography (2D-SWE) as an effective technique to identify parenchymal damage in the testicles of patients recovering from COVID-19 infection. METHODS: 35 Male patients (group 1) who recovered after COVID-19 infection between 4 and 12 weeks were included in this prospective study. Before 2D-SWE, these male patients were confirmed with control Rt-PCR test negativity. In addition, the first Rt-PCR test positivity of these patients was confirmed. A control group was formed of 31 healthy subjects (group 2). These two groups were compared in terms of age, volume of each testis, and SWE values. Ultrasound including SWE was applied to all the testes. A total of 9 measurements were taken as 3 SWE measurements from each third of the testis (superior, mid, inferior) and the average of these was calculated. Data obtained in the study were analyzed statistically. A value of p < 0.05 was accepted as statistically significant. RESULTS: The mean SWE values for the right testis and the left testis were determined to be statistically significantly higher in Group 1 than in Group 2, respectively (p < 0.001, p < 0.001). CONCLUSION: There is an increase in testicular stiffness in males who have recovered from COVID-19 infection. The underlying cause of testicular damage is changes at the cellular level. The 2D-SWE technique can predict potential testicular parenchymal damage in male patients recovering from COVID-19 infection. IMPLICATIONS FOR PRACTICE: Two-Dimensional Shear Wave Elastography (2D-SWE) seems to be a promising imaging technique in the evaluation of testis parenchyma.

SARS-CoV-2 Enters Human Leydig Cells and Affects Testosterone Production In Vitro.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a SARS-like coronavirus, continues to produce mounting infections and fatalities all over the world. Recent data point to SARS-CoV-2 viral infections in the human testis. As low testosterone levels are associated with SARS-CoV-2 viral infections in males and human Leydig cells are the main source of testosterone, we hypothesized that SARS-CoV-2 could infect human Leydig cells and impair their function. We successfully detected SARS-CoV-2 nucleocapsid in testicular Leydig cells of SARS-CoV-2-infected hamsters, providing evidence that Leydig cells can be infected with SARS-CoV-2. We then employed human Leydig-like cells (hLLCs) to show that the SARS-CoV-2 receptor angiotensin-converting enzyme 2 is highly expressed in hLLCs. Using a cell binding assay and a SARS-CoV-2 spike-pseudotyped viral vector (SARS-CoV-2 spike pseudovector), we showed that SARS-CoV-2 could enter hLLCs and increase testosterone production by hLLCs. We further combined the SARS-CoV-2 spike pseudovector system with pseudovector-based inhibition assays to show that SARS-CoV-2 enters hLLCs through pathways distinct from those of monkey kidney Vero E6 cells, a typical model used to study SARS-CoV-2 entry mechanisms. We finally revealed that neuropilin-1 and cathepsin B/L are expressed in hLLCs and human testes, raising the possibility that SARS-CoV-2 may enter hLLCs through these receptors or proteases. In conclusion, our study shows that SARS-CoV-2 can enter hLLCs through a distinct pathway and alter testosterone production.

Spatial Distribution of SARS-CoV-2 Receptors and Proteases in Testicular Cells.

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). SARS-CoV-2 RNA has been found in the human testis on occasion, but subgenomic SARS-CoV-2 and infectious SARS-CoV-2 virions have not been found. There is no direct evidence of SARS-CoV-2 infection of testicular cells. To better understand this, it is necessary to determine whether SARS-CoV-2 receptors and proteases are present in testicular cells. To overcome this limitation, we focused on elucidating with immunohistochemistry the spatial distribution of the SARS-CoV-2 receptors angiotensin-converting enzyme 2 (ACE2) and cluster of differentiation 147 (CD147), as well as their viral spike protein priming proteases, transmembrane protease serine 2 (TMPRSS2) and cathepsin L (CTSL), required for viral fusion with host cells. At the protein level, human testicular tissue expressed both receptors and proteases studied. Both ACE2 and TMPRSS2 were found in interstitial cells (endothelium, Leydig, and myoid peritubular cells) and in the seminiferous epithelium (Sertoli cells, spermatogonia, spermatocytes, and spermatids). The presence of CD147 was observed in all cell types except endothelium and peritubular cells, while CTSL was exclusively observed in Leydig, peritubular, and Sertoli cells. These findings show that the ACE2 receptor and its protease TMPRSS2 are coexpressed in all testicular cells, as well as the CD147 receptor and its protease CTSL in Leydig and Sertoli cells, indicating that testicular SARS-CoV-2 infection cannot be ruled out without further investigation.

Phytomedicines for Covid-19: Opportunities and Obstacles

COVID-19 is a disease caused by SARS-CoV-2 that can trigger respiratory tract infection. Due to its tendency to affect the upper respiratory tract (sinuses, nose and throat) or lower respiratory tract (windpipe and lungs), this disease is life-threatening and affects a large number of populations. This virus's unique and complex nature enhances the scope to look into the direction of herbal plants and their constituents for its prevention and treatment. The herbal remedies can have preventive as well as therapeutic actions. This review focuses on various aspects of using herbal medicines for COVID-19, as herbal constituents may also have adverse effects. Various studies revealed that some medicinal plants show life-threatening adverse effects, so selecting plants, and their related studies should be appropriate and strategic. This article includes various factors that should be considered before herbal drug use in COVID-19 patients. These are clinical trials, safety, molecular mechanism, and self-medication, which have been elaborated. This article also discusses the targets of covid-19 and different coronavirus strains. As before, treatment diagnosis of the disease is very important. Various patents have been filed and granted for its proper diagnosis so that its treatment can be easy.Copyright © 2022 Society of Pharmaceutical Sciences and Research. All rights reserved.

Detection of SARS-CoV-2 RNA in the Seminal Fluid and its Impact on Male Fertility: A Systematic Review

Background: As there is an increase of infections in the male population, concerns have emerged about the potential impact of COVID-19 on male fertility. This study aimed to investigate systematically the presence of SARS-CoV-2 RNA in the semen and determine the contagiousness of sperm and its influence on male fertility after COVID-19 infection. Method(s): Electronic searches were performed in PubMed/ MEDLINE, SCOPUS, and Web of Science up to December 2021 regarding the existence of SARS-CoV-2 RNA in seminal fluid, testis, and the effects of COVID-19 on male reproduction. A total of 24 original articles were included in the study. Result(s): The presence of a virus in a semen sample is still a topic of discussion and research due to the small number of studies. Only two studies identified viral mRNA in the semen of infected men;others stated semen is not infectious with SARS-CoV-2 at one week or more after COVID-19 infection. However, couples with a desire for pregnancy should be warned that sperm quality after COVID-19 infection can be suboptimal. According to the existing clinical data, this virus could infect the testis and the male genital tract and cause damage to male fertility. It shows a negative impact on male reproductive health, inducing spermatogenic failure. However, the mechanism for testicular involvement remains doubtful. Conclusion(s): SARS-CoV-2 RNA was undetectable in all semen samples, but it may cause testicular involvement and impact the male reproductive system inducing spermatogenic failure.

Bilateral facial nerve palsy after COVID 19 vaccination

Background: There has been lot of speculation around the possible side effects associated with COVID vaccination and incidence of facial palsy is one of them. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral facial nerve palsy and warrants further investigations to find any secondary cause. COVID 19 infection and the vaccinations for the same are also included in the unique list of differentials. Case report: We report an interesting case of bilateral rapidly sequential facial nerve palsy following the administration of COVID vaccination that showed subsequent improvement. We provide literature review to report the current incidence of same, secondary to the vaccination as well the infection itself Case presentation: Following the introduction of COVID 19 vaccine, there have been reports of various cranial nerve involvement including lower motor neuron type facial paresis. Bilateral facial palsy is less likely to be idiopathic as compared to unilateral palsy(23% vs 70%) and requires further work up to determine the etiology before determining to be idiopathic. Unilateral facial palsy(FP) has been reported in the Phase I and II trials for Pfizer and Moderna vaccine, with a total of 7 cases reported in these initial trials. To date, there is no direct evidence that these vaccines have increased the incidence of facial palsy as compared to adverse events reported with other vaccines or compared to COVID 19 infection itself. We report a unique case of bilateral lower motor neuron type facial palsy noted in a young male within hours of receiving the vaccine that later improved with treatment. Reports of simultaneous bilateral facial palsy after vaccine are rare with only few cases reported to date in literature. Conclusion(s): In conclusion from current available literature, we would like to postulate that though there is a risk of facial nerve palsy following the vaccination, it is comparable to the risks associated with any other vaccinations and not been higher than the non-vaccinated population. The overall risk is higher with the actual COVID 19 infection itself as compared to the vaccine.Copyright © 2022

Morphological changes in testicles of patients with idiopathic infertility after novel coronavirus infection (COVID-19)

Introduction. SARS-CoV-2 causes several negative processes in the body and complicates the course of chronic somatic diseases, causing dysfunction and having a negative effect on many organs and systems of the body, including organs of the reproductive system. Objective. To study morphological changes in testicles of patients who have undergone a new coronavirus infection. Materials and methods. Objects of morphological research were testicular tissues obtained by intraoperative biopsy under intravenous anesthesia served. Material sampling was carried out in 12 patients aged 25–29 years with idiopathic infertility who underwent COVID-19. Patients showed ultrasound signs of fibrosis in the testicles, which were absent before infection with SARS-CoV-2. The biopsy was performed 12 months after COVID-19. Results. In all observations, changes were observed that are characteristic of the inflammatory process, nonbacterial autoimmune genesis. Histio-lymphocytic infiltration of testicular tissue with destruction of single tubules and parenchyma atrophy, combined with varying degrees of sclerosis, was verified. Conclusion. In testicular biopsy specimens from patients who have undergone COVID-19, an autoimmune inflammatory process is recorded, manifested by lymphocytic infiltration of testicular tissue, which was combined with varying degrees of sclerosis. © Vestnik Urologii 2022.

SARS-CoV-2 and male infertility: from short- to long-term impacts.

PURPOSE: The coronavirus 2019 (COVID-19) pandemic-caused by a new type of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-has posed severe impacts on public health worldwide and has resulted in a total of > 6 million deaths. Notably, male patients developed more complications and had mortality rates ~ 77% higher than those of female patients. The extensive expression of the SARS-CoV-2 receptor and related proteins in the male reproductive tract and the association of serum testosterone levels with viral entry and infection have brought attention to COVID-19's effects on male fertility. METHODS: The peer-reviewed articles and reviews were obtained by searching for the keywords SARS-CoV-2, COVID-19, endocrine, spermatogenesis, epididymis, prostate, and vaccine in the databases of PubMed, Web of Science and Google Scholar from 2020-2022. RESULTS: This review summarizes the effects of COVID-19 on the male reproductive system and investigates the impact of various types of SARS-CoV-2 vaccines on male reproductive health. We also present the underlying mechanisms by which SARS-CoV-2 affects male reproduction and discuss the potentially harmful effects of asymptomatic infections, as well as the long-term impact of COVID-19 on male reproductive health. CONCLUSION: COVID-19 disrupted the HPG axis, which had negative impacts on spermatogenesis and the epididymis, albeit further investigations need to be performed. The development of vaccines against various SARS-CoV-2 variations is important to lower infection rates and long-term COVID risks.

COVID-19 and Male Reproduction: A Thorny Problem.

With the global epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the increasing number of infections, little is known about how SARS-CoV-2 affects the male reproductive system during infection or after recovery. Based on the existing research data, we reviewed the effects of SARS-CoV-2 on the male reproductive system and discussed its possible mechanism of action. SARS-CoV-2 enters host cells through the angiotensin-converting enzyme 2 (ACE2)/transmembrane serine protease 2 (TMPRSS2) pathway, and males are more susceptible than females. After infection, immunopathological damage is noticed in the testicles, and the semen index is significantly reduced. Second, abnormalities of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (T) levels were also observed, suggesting that there may be dysfunction of the hypothalamic-pituitary-gonadal (HPG) axis. Even after recovery, the effect of SARS-CoV-2 on the male reproductive system can last for at least a period. There are still many unresolved questions about the effect of SARS-CoV-2 infection on the male reproductive tract. Other receptors involved during the invasion of human cells by SARS-CoV-2 remain to be identified. Will the mutation of SARS-CoV-2 increase the diversity of receptors? How does SARS-CoV-2 affect the HPG axis? The long-term effects of SARS-CoV-2 on the male reproductive system remain to be evaluated. SARS-CoV-2 infection can affect male reproductive function. Standard treatment strategies should be developed in time to protect the fertility of infected patients. For recovered patients with fertility requirements, fertility assessments should be performed and professional fertility guidance should be provided at the same time.

AUTOPSY STUDY OF TESTICLES IN COVID-19: UPREGULATION OF IMMUNE-RELATED GENES AND DOWNREGULATION OF TESTIS-SPECIFIC GENES.

CONTEXT: Infection by SARS-CoV-2 may be associated with testicular dysfunction that could affect male fertility. OBJECTIVE: Testicles of fatal COVID-19 cases were investigated to detect virus in tissue and to evaluate histopathological and transcriptomic changes. METHODS: Three groups were compared: a. uninfected controls (subjects dying of trauma or sudden cardiac death; n = 10); b. subjects dying of COVID-19 (virus-negative in testes; n = 15); c. subjects dying of COVID-19 (virus-positive in testes; n = 9). SARS-CoV-2 genome and nucleocapsid antigen were probed using RT-PCR, in situ hybridization, immunohistochemistry (IHC). Infiltrating leukocytes were typed by IHC. mRNA transcripts of immune-related and testis-specific genes were quantified using the nCounter method. RESULTS: SARS-CoV-2 was detected in testis tissue of 9/24 (37%) COVID-19 cases accompanied by scattered T-cell and macrophage infiltrates. Size of testicles and counts of spermatogenic cells were not significantly different among groups. Analysis of mRNA transcripts showed that in virus-positive testes immune processes were activated (interferon-alpha and -gamma pathways). By contrast, transcription of 12 testis-specific genes was downregulated, independently of virus positivity in tissue. By IHC, expression of the luteinizing hormone/choriogonadotropin receptor was enhanced in virus-positive compared to virus-negative testicles, while expression of receptors for androgens and the follicle-stimulating hormone were not significantly different among groups. CONCLUSION: In lethal COVID-19 cases, infection of testicular cells is not uncommon. Viral infection associates with activation of interferon pathways and downregulation of testis-specific genes involved in spermatogenesis. Due to the exceedingly high numbers of infected people in the pandemic, the impact of virus on fertility should be further investigated.

Infection of SARS-CoV-2 causes severe pathological changes in mouse testis.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected more than 600 million people worldwide. Several organs including lung, intestine, and brain are infected by SARS-CoV-2. It has been reported that SARS-CoV-2 receptor angiotensin-converting enzyme-2 (ACE2) is expressed in human testis. However, whether testis is also affected by SARS-CoV-2 is still unclear. In this study, we generate a human ACE2 (hACE2) transgenic mouse model in which the expression of hACE2 gene is regulated by hACE2 promoter. Sertoli and Leydig cells from hACE2 transgenic mice can be infected by SARS-CoV-2 pseudovirus in vitro, and severe pathological changes are observed after injecting the SARS-CoV-2 pseudovirus into the seminiferous tubules. Further studies reveal that Sertoli and Leydig cells from hACE2 transgenic mice are also infected by authentic SARS-CoV-2 virus in vitro. After testis interstitium injection, authentic SARS-CoV-2 viruses are first disseminated to the interstitial cells, and then detected inside the seminiferous tubules which in turn cause germ cell loss and disruption of seminiferous tubules. Our study demonstrates that testis is most likely a target of SARS-CoV-2 virus. Attention should be paid to the reproductive function in SARS-CoV-2 patients.

An Assessment of Men Semen Alterations in SARS-CoV-2: Is Fever the Principal Concern?

The SARS-CoV-2 virus (COVID-19) was identified as a pandemic in March 2020 by the World Health Organization. The virus spreads primarily through saliva droplets or nasal discharges, in addition to coughing or sneezing from an infected person. The most common symptom at the onset of illness is fever, which may appear within 2-14 days after exposure. The high fever (above 38 °C) can persist from one to 4 days. The febrile illness usually has a variable negative impact on sperm characteristics such as sperm output, motility, morphology, and DNA fragmentation. These defects proliferated due to an increase in testicular temperature, and disturbance in the thermoregulatory systems that are responsible for the testicular heat loss. Coronavirus studies suggest that fever from SARS-CoV-2 virus infection induces a reversible negative effect on the sperm parameters until one cycle (74 days) of spermatogenesis. We believe that SARS-CoV-2 can have long-term adverse effects on testicles via immune or inflammatory reactions after the patient has fully recovered. This evidence could be added to the list of the long-term post-COVID-19 syndromes. Long-term follow-up and evaluation of the sperm parameters are necessary for all recovered male patients, especially the young ones.

SARS-CoV-2 and Its Implications for the Human Reproductive System: A Review Article

Context: The SARS-CoV-2 virus causes dysfunction of vital organs in the body. Concerns about the destructive effect of SARS-CoV-2 on human reproductive tissues and fertility have increased. Evaluation of the possible mechanisms by which SARS-CoV-2 causes infertility is essential for effective prevention and treatment. This review aims to assess the studies that have been conducted on SARS-CoV-2 impacts on the human reproductive system. Evidence Acquisition: This review study investigated articles indexed in PubMed, Science-Direct, Scopus, and google scholar databases from 2019 to 2021. The Keywords SARS-CoV-2, COVID-19, human reproductive system, testis, and ovary were searched in the mentioned databases. Result(s): The present study assessed the expression of SARS-CoV-2-specific receptors, the presence of the virus in the human reproductive system, and the mechanisms by which this virus can affect human fertility. Conclusion(s): SARS-CoV-2, like other viruses, may indirectly influence the male reproductive system through cytokine storms, inflammation-causing oxidative stress, and its possible complications. The direct effects of SARS-CoV-2 on the male reproductive system are also reported. The testis may be a potential target for the SARS-CoV-2 virus. The impact of the SARS-CoV-2 virus on women's reproductive performance is unknown and requires further investigation. Copyright © 2022, Author(s).

Semen quality changes during infection and recovery phases of mild-to-moderate COVID-19 in reproductive-aged patients: a prospective case series.

BACKGROUND: Despite the documented effects of the coronavirus disease 2019 (COVID-19) on spermatogenesis, the reversibility of these effects is uncertain. We aimed to assess the changes of sperm quality between the infection and recovery phases of COVID-19 in reproductive-aged men. The semen quality of men with mild-to-moderated COVID-19 (defined by the degrees of symptoms and chest involvement on computed tomography) was studied during October, 2020-May, 2021 at our hospital. Two semen samples were analyzed at timings estimated to represent spermatogenic cycles during the infection and recovery phases of COVID-19. RESULTS: A total of 100 patients were included with mean ± SD (range) age of 24.6 ± 3.3 (21-35) years. During infection, 33% of patients had abnormal semen quality. However, a significant reduction was found in this abnormality from 33 to 11% (P < 0.001) after recovery from infection. In a comparison of the two semen analyses, there were significant improvements in the mean values of sperm progressive motility (P =0.043) and normal morphology (P < 0.001). However, the mean sperm concentration showed a statistically insignificant increase (P = 0.844). CONCLUSIONS: In reproductive-aged patients with mild-to-moderate COVID-19, the effects on seminal quality were recoverable, represented by significant improvements in the means of progressive sperm motility and normal morphology between the infection and recovery phases of COVID-19. TRIAL REGISTRATION: ClinicalTrials, NCT04595240 .

RéSUMé: CONTEXTE: Malgré les effets documentés de la maladie à coronavirus 2019 (COVID-19) sur la spermatogenèse, la réversibilité de ces effets reste incertaine. Notre objectif était d'évaluer les changements de la qualité du sperme entre les phases d'infection et de récupération de la COVID-19 chez des hommes en âge de procréer. La qualité du sperme d'hommes atteints d'une forme de COVID-19 de légère à modérée (définie par les degrés de symptômes et l'atteinte thoracique lors de la tomodensitométrie) a été étudiée entre octobre 2020 et mai 2021 dans notre hôpital. Deux échantillons de sperme ont été analysés à des moments estimés représenter les cycles de spermatogénèse pendant les phases d'infection et de rétablissement de la COVID-19. RéSULTATS: Au total, 100 patients ont été inclus avec un âge moyen ± ET (intervalle) de 24,6 ± 3,3 ans (21-35). Au cours de l'infection, 33% des patients avaient une qualité anormale de sperme. Une réduction significative de cette anomalie de 33 à 11% (p < 0,001) a toutefois été observée après la guérison de l'infection. La comparaison des deux analyses de sperme montre des améliorations significatives des valeurs moyennes de la motilité progressive (p = 0,043) et de la morphologie normale (p< 0,001) des spermatozoïdes. Cependant, la concentration moyenne de spermatozoïdes a montré une augmentation statistiquement non significative (p = 0,844). CONCLUSIONS: Chez les patients en âge de procréer atteints d'une forme de COVID-19 légère à modérée, les effets sur la qualité spermatique étaient récupérables, avec des améliorations significatives des valeurs moyennes de la motilité progressive et de la morphologie normale des spermatozoïdes entre les phases d'infection et de récupération de la COVID-19.