Acute COVID Infections Could Impact Male Fertility

Man wearing surgical mask with head in hands.

Evidence points to possible damage to the male reproductive organs by COVID.

Every day, scientists and researchers are discovering more information about the impact that COVID-19 has on the body, both short- and long-term. The University of Georgia has just published a study that examines the possible effects of the virus upon male fertility. (1)

Published in Nature Reviews Urology, the article discusses the potential ways in which SARS-CoV-2 could single-out and infect testicular cells. They also offer a theoretical outline to track how the virus might impact male fertility and testicular function in acute COVID-19 cases.

The paper’s lead author, Clayton Edenfield, is a doctoral student in environmental health science at UGA’s College of Public Health. He stated that in severe instances, the testes don’t do well during COVID infection. Edenfield was supervised by Charles Easley, who was a coauthor of the paper.

To determine how COVID might interact with testicular tissue and function, the authors reviewed all available evidence regarding COVID’s interactions with the body’s cells, patient reports, and previous research into the effects of other SARS viruses on the testes.

SARS Virus Potentially Harmful to Reproductive Organs

Since the beginning stages of the pandemic, researchers have determined that SARS-CoV-2 is able to infect a number of organs throughout the body via two important proteins: ACE2 receptors (angiotensin-converting enzyme 2) and TMPRSS2 (transmembrane protease serine 2). These proteins are an entryway used by the virus to enter cells.

Clinical reports and the authors agree that the testes produce both of these proteins, which makes them vulnerable to virus infection and possible cell damage.

According to Edenfield, autopsy reports have shown that there was some viral entry into the testis, as well as negative effects of the virus. The symptoms of this type of infection would include inflammation (orchitis) and testicular pain, and even a breaking down of the blood-testis barrier. In some cases, the virus may even be in the ejaculate.

Edenfield claims that the same type of damage to major organs observed in long-term COVID patients may occur in the testes as well. This could include impairing the blood-testis barrier which acts as a road-block to prevent unwanted substances such as viruses, toxins, and sometimes even the body’s own immune cells.

Edenfield says that if the body’s immune system is causing damage, and the virus interacts with the blood-testis barrier, you would likely see a significant reduction in fertility. This could manifest as a decrease in sperm count, or sperm quality.

Potential Long-Term Effects of COVID on Fertility

Edenfield states that the worst-case scenario is one in which the virus damages the germline sperm cells, which are responsible for producing new sperm. This could potentially lead to permanent male fertility problems and even birth defects.

He said that although most people of reproductive age are protected against severe cases of the virus, in the 1% of affected men, the virus could do a lot of harm.

Although these results on male fertility have not been confirmed, the authors suggested an outline of potential approaches that could be used to guide future research.

The paper, titled “Implications of testicular ACE2 & the renin–angiotensin systems for SARS–CoV-2 on testis Function” is available online for viewing. (1)

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