Assessing the impact of COVID 19 on male fertility: A systematic review

Abstract

Coronavirus disease 2019 (COVID-19) infection is presently a global pandemic; it is mainly an acute respiratory infection. It can affect various organs of the body, primarily the lung, GI tract, and CVS and can even affect the urinary system and male reproductive system. A systematic search using PubMed, EMBASE, and Scopus was performed using the keywords and Boolean operators. There were 55 studies, which were found to be relevant to the search conducted in the above-mentioned databases. Out of the 55 studies, 32 were identified to be fitting the inclusion and exclusion criteria of the review. Recent studies have conflicting results on the presence of COVID-19 in the semen of patients who were reverse transcription polymerase chain reaction (RT-PCR) positive for COVID-19. Majority studies negate COVID-19 infection in semen as per RT-PCR, but semen parameters are adversely affected especially in moderate cases. One study states that RT-PCR is positive in few semen samples of severe cases. Testes have high angiotensin-converting enzyme 2 (ACE2) expression and transmembrane serine protease 2 is essential for priming of the spike (S) protein in COVID-19 virus and it is concentrated in spermatogonia and spermatids, which means if spermatogonia is infected with COVID-19 and it hampers the spermatogenesis, it can lead to dysfunction of the male reproductive system. There is evidence of high ACE2 expression in renal tubules, which means there can be renal tubular damage because of COVID-19 infection and there is a possibility of shedding of virus in urine. The COVID-19 detected in the semen could also be because of shedding of virus from the urinary tract in men. The authors thus conclude that there is a need larger study to answer the questions like whether the COVID-19 infection just present in the semen or it is attached to the spermatozoa or its present inside the cells because of interaction of COVID-19 S protein and ACE2 receptor on the spermatogonia. If COVID-19 infection is detected in the semen, then whether it can be removed from the semen by the sperm washing techniques and is it safe to use in ART procedures or any other fertility treatment.