Professor Institute for Urology and Reproductive Health, Sechenov University, Moscow
Introduction: COVID-19 infection is hypothesized to have a potentially negative effect on male fertility through direct damage to the testes. The current trial is aimed at investigating the effect of SARS-CoV-2 on fertility and determining if viral bodies directly damage testicular function.
Methods: This prospective study included controls comprising healthy participants and cases of patients suffering from pneumonia based on chest CT and a positive of SARS-CoV-2 throat swab exhibited only moderate symptoms in accordance with the WHO classification. Extensive epidemiological, clinical, laboratory (hormonal levels, etc.) and ultrasound data (color doppler ultrasound of the scrotum) were collected. A sperm examination was performed in cases during their COVID-19 related hospital stay and 3 months after the discharge home. We also assessed the testicles of COVID-19 patients who died of their disease (n=20) obtained during autopsies.
Results: A total of 88 participants were included (44 controls and 44 cases). Blood testosterone levels were below normal (local reference values, 5-50 nmol/ml) in 27.3% of the cases (12/44). The mean level (7.3±2.7 nmol/ml) was lower than that in the healthy controls (13.5±5.2 nmol/ml, p<0.001). At 3 months after discharge, the level returned to normal (13.7±4.5 nmol/ml) and was no different from that of the controls. An increase in LH and FSH was also detected compared to the healthy controls (p=0.047 and p=0.002). The spermogram revealed decreased motility in COVID-19 patients (p=0.001), and higher number of immobile sperm (during COVID-19 – 58.8% and at 3 months 47.4%, p=0.005). All these parameters returned to normal at 3 months after discharge. As for pathology findings, in the majority of autopsies (18/20) structural disorders of the testicular tissue, with signs of damage to germ cells were observed.
Conclusions: COVID-19 and its treatment significantly affect hormone levels and sperm quality during the disease. Postmortem examination confirms inflammation and viral infiltration of the testicles. However, in those who had moderate to severe disease, decline in hormone levels and sperm quality was transient with values returning to baseline at 3 months.
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