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Review
. 2021 Apr;115(4):813-823.
doi: 10.1016/j.fertnstert.2020.12.033. Epub 2021 Jan 1.

The impact of SARS-CoV-2 and COVID-19 on male reproduction and men's health

Darshan P Patel  1 , Nahid Punjani  2 , Jingtao Guo  1 , Joseph P Alukal  3 , Philip S Li  2 , James M Hotaling  4
Affiliations
Review

The impact of SARS-CoV-2 and COVID-19 on male reproduction and men's health

Darshan P Patel et al. Fertil Steril. 2021 Apr.

Abstract

Many couples initially deferred attempts at pregnancy or delayed fertility care due to concerns about coronavirus disease 2019 (COVID-19). One significant fear during the COVID-19 pandemic was the possibility of sexual transmission. Many couples have since resumed fertility care while accepting the various uncertainties associated with severe acute respiratory syndrome coronavirus 2, including the evolving knowledge related to male reproductive health. Significant research has been conducted exploring viral shedding, tropism, sexual transmission, the impact of male reproductive hormones, and possible implications to semen quality. However, to date, limited definitive evidence exists regarding many of these aspects, creating a challenging landscape for both patients and physicians to obtain and provide the best clinical care. This review provides a comprehensive assessment of the evolving literature concerning COVID-19 and male sexual and reproductive health, and guidance for patient counseling.

Keywords: COVID-19; angiotensin-converting enzyme 2; coronavirus; infertility; male; semen.

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Figures

Figure 1
Figure 1
Viruses found in the male reproductive tract. CMV = cytomegalovirus; EBV = Epstein-Barr virus; HBV = hepatitis B virus; HCV = hepatitis C virus; HHV = human herpesvirus; HIV = human immunodeficiency virus; HPV = human papillomavirus; HSV = herpes simplex virus; HTLV = human T-lymphotropic virus; VZV = varicella zoster virus; ZIKV = Zika virus.
Figure 2
Figure 2
SARS-CoV-2 viral entry in host cell. ACE2 = angiotensin-converting enzyme 2; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; TMPRSS2 = transmembrane protease serine 2.
Figure 3
Figure 3
Pathologic changes of the testes associated with severe acute respiratory syndrome coronavirus 2 infection. (A) Seminiferous tubule injury including chromatin condensation, acidophilic alteration of the cytoplasm of spermatocytes, and swelling of the Sertoli cells (hematoxylin and eosin stain [H&E], ×400 magnification). (B) Accumulation of sperm and immature spermatocytes in the epididymis (H&E, ×400 magnification). (C) Multifocal platelet aggregation and microthrombi (H&E, ×200 magnification). (D) CD61 immunostain highlights platelet clusters within testicular vessels (×200 magnification). (E) Mononuclear inflammatory infiltrate in the testicular interstitium and atrophic seminiferous tubules consistent with orchitis (H&E, ×200 magnification). (F) Immunohistochemical studies reveal a predominant CD8-positive T-cell infiltrate (CD8, ×200 magnification). Reproduced from Flaifel et al. (60).
See this image and copyright information in PMC

Comment in

  • The COVID-19 pandemic and reproductive health.
    Legro RS. Legro RS. Fertil Steril. 2021 Apr;115(4):811-812. doi: 10.1016/j.fertnstert.2021.02.003. Epub 2021 Feb 6. Fertil Steril. 2021. PMID: 33832740 Free PMC article.
  • #ESHREjc report: does SARS-CoV-2 affect male fertility?
    Mincheva MN, Massarotti C, Ali ZE, Serdarogullari M, Hotaling J, Best J, Ramasamy R, Uraji J. Mincheva MN, et al. Hum Reprod. 2021 May 17;36(6):1730-1731. doi: 10.1093/humrep/deab120. Hum Reprod. 2021. PMID: 34002212 Free PMC article. No abstract available.
  • Male Infertility.
    Niederberger C. Niederberger C. J Urol. 2021 Dec;206(6):1499-1501. doi: 10.1097/JU.0000000000002220. Epub 2021 Sep 8. J Urol. 2021. PMID: 34494457 No abstract available.

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