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Review
. 2021 Jul;38(7):1691-1708.
doi: 10.1007/s10815-021-02097-1. Epub 2021 May 11.

The probable destructive mechanisms behind COVID-19 on male reproduction system and fertility

Mojgan Moshrefi  1   2   3 , Saeed Ghasemi-Esmailabad  2 , Jaffar Ali  4 , Necati Findikli  5   6 , Esmat Mangoli  1   2 , Mohammad Ali Khalili  7   8
Affiliations
Review

The probable destructive mechanisms behind COVID-19 on male reproduction system and fertility

Mojgan Moshrefi et al. J Assist Reprod Genet. 2021 Jul.

Abstract

Purpose: The present study aims to summarize the current understanding of probable mechanisms and claims of adverse effects of SARS-CoV-2 on male fertility potential.

Methods: Our search was including original articles, reviews, guidelines, letters to the editor, comments on guidelines, and editorials, regarding the male reproductive system. We used the words SARS-CoV-2, coronavirus, severe acute respiratory syndrome coronavirus 2, "2019 ncov," testis, sperm, male factor infertility, fertility treatment, semen, assisted reproductive technology (ART), sexual transmission, and ACE2.

Results: Data showed coronavirus affects men more than women because of more expression of 2019 nCoV receptors (ACE2 and TMPRSS2) in testicular cells. Also, "Bioinformatics Analysis" suggests that sperm production may be damaged, since "Pseudo Time Analysis" has shown disruption in spermatogenesis. "Gene Ontology" (GO) showed an increase in viral reproduction and a decrease in sperm production-related terms. Recently, SARS-COV-2 mRNA and protein were detected in the semen of patients that had recovered from SARS-CoV-2 infection. Therefore, the probable disruption of blood-testis barrier (BTB) in febrile diseases is suspected in the acute phase of the disease enabling viral entry into the testes. Not only is spermatogenesis disturbed, but also disturbs gonadotropin, androgens, and testosterone secretion during SARS-CoV-2 infection. No sexual transmission has been reported yet; however, detection of the virus in semen still makes the sexual transmission an open question.

Conclusion: There is a concern that male fertility may be disturbed after the SARS-CoV-2 infection. Therefore, follow-up of the reproductive functions and male fertility may be necessary in recovered cases, especially in aged men.

Keywords: COVID-19; Male reproduction; SARS-CoV-2; Sperm; Testis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The mechanisms of virus entry to cells
Fig. 2
Fig. 2
The mechanisms of orchitis in COVID-19
See this image and copyright information in PMC

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