O-019 Covid 19 and male infertility-how long should fertility treatment be deferred to overcome the postcovid changes in semen parameters and to restore male fertility?

Abstract

Study questionMale recovered from covid19 showed negative impact on sperm quality- are these changes reversible and are antioxidant therapy beneficial to overcome sperm quality changes?Summary answerOxidative stress created by the proinflammatory cytokine storm by covid19 virion might interect with spermatozoa to cause changes in spermiogram and antioxidant is the treatmentWhat is known alreadyCovid19 virion might interect with human spermatozoa and disrupt male fertility. Suppression of semen volume, progressive motility, morphology, sperm number and DNA integrity as a result of covid19 infection were correlated with markers of oxidative stress and inflammation. Sperm DNA damage is the key feature of the disease but the effect on semen quality seem to subside with the passage of time although further studies are needed to substantiate this point. My study is to determine whether the proposed antioxidant treatment to restore the negative impact of covid19 on sperm vitality is beneficial or not.Study design, size, durationThe study included 20 male aged 20-45yrs among those couples who were undergoing infertility treatment at Shristi Healthcare between April/2020 to October/2020 with a positive covid19 test and has recovered from the disease atleast 3-5months earlier and who had undergone spermiogram test before the onset of the disease. Semen samples were taken3-5months after recovery from covid19 and after 3 months treatment with antioxidant(CoenzQ10/300mg).Participants/materials, setting, methodsInclusion criteria: precovid normal spermiogram, with mild to moderate covid symptoms without hospitalisation. Exclusion criteria: those with precovid oligospermia or azooospermia, h/o steroid therapy for covid, h/o hormonal drug use that could affect spermiogenesis, with severe covid symptoms requiring ICU treatment. Time between last negative nasal swab test to semen analysis was 120-150days. Antioxidant(CoenzQ10/300mg)given as once daily dose for 3months after recovery from covid and semen test reviewed after treatment and compared with precovid data.Main results and the role of chanceThe mean age of participants were 30.4±4.8yrs and smoking status, BMI, medical history, presence of varicocele were recorded. Semen samples were processed according to WHO guidelines(2010, 5th edition). Statistical analysis was done by paired t test for paired samples and p value <0.05 was considered statistically significant. When semen samples before and after covid19 were evaluated, it showed marked decline in sperm volume/ml(precovid 3(2.5-3.5) to postcovid 1.5(1-2), p < 0.005); total sperm count x10^6per ejaculate(precovid 42(25-65) to postcovid 5(1-10), p < 0.005); progressive motility% (precovid 55.1±21.7 to postcovid 15.1±5.7, p < 0.001); sperm morphology%(precovid 45(30-60)to postcovid10(5-25), p < 0.001).After 3months CoenzQ10/300mg treatment semen showed significant improvement in all 3 parameters eg sperm count (3.15±3.38-20.9±2.11, p < 0.001), sperm motility(5.25±3.25- 42.85±3.30, p < 0.001) sperm morphology(7.81±2.26- 25.89±7.05, p < 0.001). All previous studies about postcovid semen changes used normal male as reference but strength of my study was precovid semen profile of same participant was available as a reference point. It was seen that fertility of male restores between3-6months postcovid with antioxidant treatment and can resume planning pregnancy.Limitations, reasons for cautionSmall sample size, interpatient variation in the severity of covid19, inadequate study design and retrospective nature. All patient examined had mild to moderate symptoms and none suffered from severe covid19 symptoms or needed ICU treatment so no data available to comment on severe postcovid19 case semen changes.Wider implications of the findingsMany couples initially deferred fertility care due to concern about covid19 disease. Globally many fertility centre has resumed delivering care. Men and their partners must be appropriately counselled regarding what is known and remains unknown about covid19 and male reproductive health.Trial registration numbernot applicable