Abstract
Coronavirus disease 2019 (COVID-19) has emerged as a new public health crisis, threatening almost all aspects of human life. Originating in bats, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted to humans through unknown intermediate hosts, where it is primarily known to cause pneumonia-like complications in the respiratory system. Organ-to-organ transmission has not been ruled out, thereby raising the possibility of the impact of SARS-CoV-2 infection on multiple organ systems. The male reproductive system has been hypothesized to be a potential target of SARS-CoV-2 infection, which is supported by some preliminary evidence. This may pose a global threat to male fertility potential, as men are more prone to SARS-CoV-2 infection than women, especially those of reproductive age. Preliminary reports have also indicated the possibility of sexual transmission of SARS-CoV-2. It may cause severe complications in infected couples. This review focuses on the pathophysiology of potential SARS-CoV-2 infection in the reproductive organs of males along with their invasion mechanisms. The risks of COVID-19 on male fertility as well as the differences in vulnerability to SARS-CoV-2 infection compared with females have also been highlighted.
Highlights
In early December 2019, several pneumonia cases of unknown aetiology were reported in Wuhan, China
SARS-CoV-2-infected men should be provided with psychological consultation in time to avoid irrational fear and excessive stress, as these may indirectly affect their reproductive health and well-being [77]
The presence of SARS-CoV-2 nuclei has been confirmed in the testicular tissue of infected men using RT-qPCR technique, which is indicative of the direct viral invasion on the male reproductive system [101]
Summary
In early December 2019, several pneumonia cases of unknown aetiology were reported in Wuhan, China. SARS-CoV and SARSCoV-2 are similar in that both viruses invade host cells through the ACE2 surface receptor present in the host cell, and it is worth mentioning that ACE2 exists in respiratory tissues and in reproductive tissues, including spermatozoa, seminiferous tubules, Leydig cells and Sertoli cells [29] This evidence fuelled the possibility of SARSCoV-2 infection in the male reproductive tract and potential damage to male fertility [30].The expression of ACE2 was reported in the proximal regions of the heart, kidney, lung, ileum and bladder [31]. The binding of SARSCoV-2 with the ACE2 receptor (ACE2-R) allows its entry into cells and completes its replication [6] This may, in turn, activate direct viral invasion and cause tubular epithelial and podocyte damage, resulting in acute cardiac and lung injury. IgG levels are increased, and there is a higher titre of total antibodies [38]
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