Male infertility – post Covid infection

Most of us have accepted that we will have to learn to live with Covid hovering around us. The side effects will linger. One of the many questions raised has been, “Is male fertility affected by men who have had Covid and recovered?”

A recent study and research was conducted on 120 Belgian men, between the ages of 18 and 70 years, who had recovered from positive Covid19 infection. The assessment of semen quality was conducted using the WHO (World Health Organisation) criteria. The spermMar test kit was used to detect antisperm antibodies (ASA) in semen. The SCSA (sperm chromatin structure assay) test was used, which measures the percentage of spermatozoa with DFI (DNA fragmented index) as well as the percentage with HDS (high DNA stainability).

The DFI is a measure of the integrity and the damage present in the genetic material of the sperm (DNA), and the SCSA test is used to detect any sperm DNA damage in the semen sample. It plays a very important part in evaluation of semen quality and is an important indicator of fertility potential. HDS measures the amount of sperm in a semen sample having an increased amount of retained histones (basic proteins that associate with DNA in the nucleus) due to lack of full protamination (conversion of histones to protamines which helps in chromatin condensation). In combination, these DFI and HDS values give an insight into the quality of the genetic material in the sperm.

In the recent study, the number of symptoms each patient had was taken into account (no symptoms to a maximum of 15 symptoms), creating a symptom score. Among the symptoms were fever, cough, shortness of breath, fatigue, nasal congestion, headache, gastrointestinal symptoms (nausea, vomiting, diarrhea), chest pain, muscle pain, eye pain, throat pain, cerebral symptoms (dizziness, hallucinations, concentration problems), shaking (without fever) and flu-like feelings.

The following were the results:

• Men tested less than 1 month after infection: Mean progressive motility (sperm swimming in a mostly straight line or in very large circles) was reduced in 60% of the men and sperm count was also reduced in 37%.
• Men tested 1 – 2 months after infection: Mean progressive motility was reduced in 37% of the men and sperm count was reduced in 29%.
• Men tested more than 2 months after infection: Mean progressive motility was reduced in 28% of the men and sperm count was reduced in 6%.
• DFI (DNA damage) was higher within the first month of infection and less with the longer term lapse.
• Mean HDS was greater in the short term lapse and less in men tested after 1 month from the date of infection.

Although the severity of the infection (those hospitalised) in some cases had an impact on lower motility and morphology, fever and the total symptom score had no effect on the sperm quality.

This study also aimed to validate the SpermCOVID Test by analysing semen samples for the presence of viral RNA. Semen is not infectious with Covid one week or more after the infection. The Covid RNA virus was detected in testicular cells of 2 men who died from Covid. However, according to data, the Covid RNA disappears soon from the testes after recovery from Covid infection in all men. SpermCOVID tests were negative as late as 181 days and as early as 6 days after Covid positive diagnosis in patients. This is an important finding as it was unclear whether SARS-CoV-2 could be transmitted sexually after convalescence from Covid-19 infection. Hence, it is possible that the Covid virus can cross the barrier between the blood vessels and the tubules of the tests during the intense phase of the disease but not after the convalescence period of 21 days.

However, there were correlations between sperm abnormalities and the Covid antibody levels in serum. Sperm quality can be suboptimal after recovery from Covid. The estimated recovery time is 3 months but studies are still going on to confirm this. The research found evidence of a negative impact on sperm quality after convalescence. These decreased parameters included sperm concentration, motility, DFI and HDS.

Conclusion:

Research evidence has proved that the Covid virus cannot be transmitted through sperm after convalescence from Covid. However, sperm quality parameters were affected. These damages were highest during the first month after contracting the Covid infection; they were lower during the 1 -2 month period after the infection and were almost normal after 2 months from the infection.

This research was conducted by studies on DNA collected from an international cohort of 185 infertile men and their parents. 145 rare protein-altering mutations were identified which are likely to have a negative impact on male fertility. 29 of the mutations affect genes directly involved in spermatogenesis – sperm cell development – or other cell procedures relating to reproduction.

This major breakthrough gives new knowledge to understand causes for male infertility. It also results in hope for couples who have so far not been able to conceive. With this additional knowledge, perhaps more options can be given for the best treatment to deal with infertility.