A recent study published in the open-access journal PLOS ONE investigated whether SARS-CoV-2 infection affected the semen quality of infertile men in Tunisia. The spike protein of the virus that causes COVID-19 attaches to the angiotensin converting enzyme 2 (ACE2) receptor of the host to establish the infection. The ACE2 receptor is prominently expressed in several cell types in the testes, which suggests that the virus could impair the semen quality of infected individuals, particularly among infertile men.
The study aimed to assess the impact of the COVID-19 pandemic on the sperm quality of infertile Tunisian patients. The COVID-19 pandemic impacted all 24 governorates of Tunisia. The Laboratory of Cytogenetics and Reproductive Biology of Monastir conducted the study. A total of 90 patients with a mean age of 38 years were recruited for the study. The participants were recommended for sperm analysis during the first and second pandemic waves in Tunisia. All participants had a spermogram conducted before the pandemic period. The study considered two-time points: before the COVID-19 pandemic (T1) and during the COVID-19 pandemic (T2).
Participants under antivirals, antibiotics, anti-inflammatories, and antioxidants between the two compared spermograms were excluded from the cohort along with participants with a history of urogenital surgery during the study period. Semen samples were obtained from the participants after 3-5 days of sexual abstinence. Both macroscopic and microscopic examinations of the semen were carried out. The study found an impairment in sperm quality during the pandemic. Two of the key sperm parameters, i.e., sperm mortality and morphology, were found to be altered during the study period.
The authors claim this to be the first Tunisian study to evaluate semen quality variations during the COVID-19 pandemic. Obesity, tobacco consumption, and professional exposure to a toxic environment were found to have an adverse impact on semen quality. A significant reduction in sperm motility and abnormal spermatozoa were observed among infertile Tunisian patients during the pandemic, even without biological proof of SARS-COV-2 infection.
Previous studies have shown that viral infections, such as Human Herpes Virus (HHV), Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Zika, and Ebola, affect sperm count, semen volume, motility, and morphology. More research is required to uncover the full impact of SARS-CoV-2 on semen parameters. Mechanistically, COVID-19 can impact male reproductive health through two pathways: (a) viral invasion into the reproductive cells, and (b) induction of an inflammatory response in the reproductive tract due to COVID-19.
A high level of ACE2 mRNA was found in patients in their thirties, while the lowest was found in sixty-year-old males. This suggests that younger patients are at higher risk of testicular damage than older age groups. SARS-CoV-2 infection induces a cytokine storm associated with dysregulation of pro-inflammatory cytokines. Cytokine storm has been associated with higher production of alpha tumor necrosis factor and interleukin-6 by macrophages, leukocytes, and T cells. These proapoptotic factors were also found during the inflammatory process in the testis.
According to the World Health Organization (WHO), individuals who are not able to conceive after 12 months of unprotected sexual intercourse can be classified as infertile. Infertility is a significant issue that affects millions of people worldwide. Infertile individuals undergo significant social pressure that lowers their self-esteem. No scientific evidence is available regarding the sexual transmission of the SARS-CoV-2 virus or its impact on infertile couples. There is a possibility that the SARS-CoV-2 infection could impact infertile couples by affecting the quality of gametes.
In conclusion, the study highlights the potential impact of COVID-19 on semen quality, particularly among infertile men. The findings of the study suggest that the COVID-19 pandemic has an adverse effect on sperm quality during the pandemic. The study concludes that further research is required to understand the full impact of SARS-CoV-2 on semen parameters. Infertile patients should take necessary precautions to prevent infection to avoid further complications.
