There have been repeated suggestions on social media and in newspaper reports that COVID-19 might damage male fertility.

 

The concerns have in part arisen because the testes are known to produce the protein that the novel coronavirus is thought to use to get into cells (called ACE2). So theoretically the testes could be affected by the virus.

 

There is also some evidence that illness and high temperature caused by some infections including flu, can temporarily lower sperm count and increase the production of abnormal sperm, but this effect is short lived.

 

One study in 181 men from China found that men with COVID-19 seem to have changes in levels of some of their reproductive hormones compared to men without the virus but found no difference in testosterone levels. Two studies from China found no evidence of the virus in the semen of men who had recovered from COVID-19.

 

No studies so far have looked at important issues such as sperm count or quality, so there isn’t convincing evidence that COVID-19 impacts men’s fertility.

 

Where did the story come from?

In March the Mail Online reported that a Professor in reproductive medicine from Wuhan suggested that coronavirus could affect the testes and that men who have had it should have fertility tests after recovery. The South China Morning Post reported that a similar report was published on the Hubei government website and widely shared on social media, before being removed.

 

 

What is the basis for the claim?

The basis for the Professor’s claim was that the protein thought to be used by the novel coronavirus to enter cells (called ACE2) is found in the testes (among other places). So, cells in the testes could theoretically be infected by the virus, and this might affect sperm production. He stated that SARS, which was also caused by a coronavirus, had led to damage to the testes in some cases.

He acknowledged though that at that point there was no research to confirm an impact of coronavirus on male fertility.

We are starting to see a few early studies being published on this issue. These studies are generally small and often have not yet been through review by other experts to check that they are of good quality.

 

A recent study coming out of Wuhan compared the levels of reproduction-related hormones in 81 men who had COVID-19 and 100 men who did not have the infection (controls).

The study found that the men with COVID-19 did show differences in the levels of some of their reproduction-related hormones, but not in testosterone levels. The research did not look at the men’s sperm counts or sperm quality, so we don’t know if these differed. Professor Paolo Madeddu from the University of Bristol commenting on the study noted that “Hormonal changes could be due to general inflammation affecting also the gonad function”.

Two studies in a small number of men (12 men and 34 men respectively) in China who had COVID-19 did not find any evidence of coronavirus being present in their semen after they recovered. The findings of one of these studies also suggested that testicular cells with the ACE2 protein lacked a second protein needed for the virus to enter the cells.

Overall, there isn’t currently convincing evidence that coronavirus has an impact on male fertility.

What do trusted sources say?

As of the 23rd April, specific advice on coronavirus and male fertility had not been issued by sources such as the UK’s Human Fertilisation & Embryology Authority, the British Fertility Society, or the American Society for Reproductive Medicine.

Analysis by EIU Healthcare, supported by Reckitt Benckiser

Citation

  1. Daily Mail online. Doctors claim new coronavirus ‘may cause damage to a man’s testicles’ and urge male patients to take fertility tests upon recovery. 12 March 2020. Available at:  https://www.dailymail.co.uk/news/article-8104477/Doctors-claim-new-coronavirus-cause-damage-mans-TESTICLES.html (Accessed 23 April 2020)
  2. Ling et al. Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study. medRxiv website. Posted 30 March 2020. https://doi.org/10.1101/2020.03.21.20037267 (Accessed 23 April 2020)
  3. Pan et al. No evidence of SARS-CoV-2 in semen of males recovering from COVID-19. Fertility and Sterility. In press, available online 17 April 2020. Available at: https://www.sciencedirect.com/science/article/pii/S0015028220303848 (Accessed 23 April 2020)
  4. Song et al. Detection of 2019 novel coronavirus in semen and testicular biopsy specimen of COVID-19 patients. medRxiv website. Posted 10 April 2020. Available at: https://www.medrxiv.org/content/10.1101/2020.03.31.20042333v2.full.pdf+html (Accessed 23 April 2020)

Reading list

  1. American Society for Reproductive Medicine. COVID-19 Resources for Patients. Available at: https://www.reproductivefacts.org/news-and-publications/covid-19-resources-for-patients/?_ga=2.85838297.1124890166.1587642257-1781960207.1587642257 (Accessed 23 April 2020)
  2. British Fertility Society website. Available at: https://www.britishfertilitysociety.org.uk/ (Accessed 23 April 2020)
  3. Human Fertilisation & Embryology Authority. Coronavirus (COVID-19) and fertility treatment. Publication date 16 April 2020. Available at: https://www.hfea.gov.uk/treatments/covid-19-and-fertility-treatment/ (Accessed 23 April 2020)
  4. Sergerie M. Mieusset R. Croute F. High risk of temporary alteration of semen parameters after recent acute febrile illness. 2007; 88(4): p.970