COVID-19 is the infectious disease caused by the most recently discovered Coronavirus in China in 2019. It belongs to a large family of viruses which, in humans, are known to cause infections (mainly respiratory, such as coughs, colds and fevers). Coronaviruses are also the cause for other severe diseases such as MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome).

One issue which we would like to touch upon is Fertility – whether people who have tested positive with COVID-19, have had any problems with fertility.

According to well known reproductive urologist, Dr. Paul Turek, “Seasonal flus are known to reduce male fertility. We think that it’s due to the fever associated with the illness, which overheats the testicles.” One of the primary symptoms of COVID-19 is high fever and, currently, it is believed that since the symptoms are similar to a common seasonal flu virus, the impact on male fertility may also be the same, with reduced fertility. However, this impact will probably be temporary and is reversible. COVID-19 also causes inflammation of tissues, including the testes, which could lead to problems with sperm. It has been found that high fever or influenza affects the DFI (DNA fragmentation index) and sperm count. Samples of fertile men recovering from influenza have shown abnormal sperm for about 45 days after the fever resolved, whereas others have shown a decrease in sperm count, motility and genetic health for over 2 months post-fever. However, there has been no difference in testosterone levels. In females, it is known that the immune system is altered during pregnancy, a result of which is risk of infections, like flu which could be more severe. Related infections such as SARS can result in miscarriage, premature delivery and other adverse pregnancy outcomes. Hence, it is advised that pregnant women take all necessary precautions, follow proper personal hygiene/sanitisation practices and avoid unnecessary external visits or contact with others to minimise risk of exposure.

In China, a study showed that 9 pregnant women who contracted Coronavirus subsequently had healthy, live babies, showing that the illness was not more severe than it was among non-pregnant women. However, there have been 2 reports of newborns with COVID-19 infection showing that a possible ‘vertical transmission’ of the virus from mother to baby can also not be excluded.

So, although there is no medical reason to change plans of trying to conceive, it is highly advisable to contact your Fertility specialist and make an informed decision on pursuing your fertility treatment cycles.

While the novel Coronavirus is not related to Zika (mosquito-borne disease) which has had bad effects on pregnancy and fetal health, there are certain viral infections – eg, Mumps, that can cause orchitis (inflammation of the testes) and damage to male fertility, especially if it infects boys at puberty, when the testicles are actively growing.

Viruses infect their host cells by attaching or binding to certain receptors present on the susceptible host cell. In the case of COVID-19, the novel Coronavirus is thought to recognise and attach to the ACE2 (angiotension-converting enzyme 2) receptor in humans that is produced by the testes and invade cells, causing tissue damage, which could affect fertility, but this is just a theory at present and there is no conclusive evidence or data currently.

Researchers in Wuhan recently felt that since the SARS virus (a similar infection known to cause orchitis and damage to the testicles) and the novel Coronavirus are genetically similar, it is possible, in theory, that COVID-19 could have similar results. However, no cases of testicular infections have been documented during the COVID-19 pandemic. In fact, the researchers’ statement was later retracted.

For those who are concerned about any possible connection between male infertility and COVID-19, it is recommended that you speak to your doctor. Patients recovered from COVID-19 would be advised to undergo a semen analysis and/or sperm DFI test, which will show any impact on fertility and sperm health. If the patient has reported symptoms of fever/cough/cold in the previous 2 weeks, a Covid 19 test should first be carried out, before any further fertility treatments are attempted.

In conclusion, although it is felt that COVID-19 may affect fertility, at the present time, there is no proven evidence that it does.

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