African Journal for Infertility and Assisted Conception

: 2021  |  Volume : 6  |  Issue : 1  |  Page : 20--21

SARS-CoV-2 and male infertility

Rashmi Baid 
 Department of Reproductive Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Rashmi Baid
Department of Reproductive Medicine, Lilavati Hospital and Research Centre, Mumbai 400050, Maharashtra

How to cite this article:
Baid R. SARS-CoV-2 and male infertility.Afr J Infertil Assist Concept 2021;6:20-21

How to cite this URL:
Baid R. SARS-CoV-2 and male infertility. Afr J Infertil Assist Concept [serial online] 2021 [cited 2022 Dec 8 ];6:20-21
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Full Text

The SARS-CoV-2 pandemic has taken the world by storm with over 160 million reported COVID-19 cases worldwide and more than 3.8 million deaths.[1]

Viruses including hepatitis B and C, mumps, Zika, Ebola, and HIV can dysregulate the male reproductive processes by reducing sperm count and motility, altering sex hormone levels, and negatively influencing spermatogenesis. Preliminary data suggest that the male gonads may be vulnerable to SARS-CoV-2 infection with downstream effects. We discuss how the virus may perpetuate an epidemic of male infertility [Figure 1].{Figure 1}

Nearly 80% of the adult COVID-19 patients report fever with as many as 14.7% having high-grade fever.[2] High temperature can cause partial-to-complete spermatogenic arrest, generation of morphologically abnormal sperms, and reduced motility. Animal models have previously reported altered expression of functional sperm proteins including testicular isoform of Na-K-ATPase.[2],[3] Hyperthermia is known to impair the blood–testis barrier, leading to passage of macromolecular substances into the male reproductive organs.[3]

The SARS-CoV-2 virus enters the cell after binding to ACE2 receptors.[1] Cells with different levels of expression of ACE2 may be differently affected by the virus. Once within the cell, it initiates its replication cycle and induces cytotoxicity. All testicular cells, including Leydig cells, Sertoli cells, and spermatogonia, are known to have high expression of ACE2, making them a potential viral target leading to infection and direct cell injury.[4]

Indeed, autopsies of testicular and epididymal samples of patients with COVID-19 disease have shown significantly increased apoptosis, with interstitial edema, red cell exudation, and exaggerated CD3+ and CD68+ response in the testis.[4],[5] This is accompanied by increased inflammatory levels of IL-6, TNF-alpha, and monocyte chemoattractant protein-1. As many as 39% of the patients were found to have oligospermia in one study. IL-6 is known to affect tight junction permeability in Sertoli cells, inhibit meiotic DNA synthesis phases of spermatogenesis, impair motility of sperms, and affect inhibin and transferrin secretion by Sertoli cells.[5]

Substantially reduced sex hormone levels have been reported in COVID-19 patients including total testosterone and free testosterone, especially LH levels have been reported to be markedly higher and have been linked to acute male hypogonadism in COVID-19 subjects.[4],[6] Direct invasion and impairment of the hypothalamo-pituitary dysfunction and the cytokine storm known to accompany the disease could augment this dysfunction. Whether this leads to a persistent sex hormone shift is unknown.[6]

Drug-related injury to the testis could lead to male infertility. A number of drugs used to treat COVID-19 infections have been implicated, including glucocorticoids, antidepressants, and antiviral agents. Corticosteroids are known to cause male infertility through reduced expression of steroidogenic enzymes, apoptosis of Leydig cells, oxidative stress in the testes, and impaired gonadotropin responsiveness.[1] Antidepressants like tricyclic antidepressants and reuptake inhibitors used to treat accompanying depression with COVID-19 disease have been reported to hamper sperm motility and DNA fragmentation.[7] Lopinavir/ritonavir and chloroquine phosphate are known to affect spermatogenesis by inducing oxidative damage to the testis.[8]

In retrospect, the COVID-19 pandemic can hitherto herald an underdiagnosed epidemic of male infertility and as clinicians, it is paramount that we be aware of the consequences.

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Conflicts of interest

There are no conflicts of interest.


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