“Hajizadeh Malekiand Tartibian conducted a prospective, longitudinal cohort study of 84 men with laboratory-confirmed COVID-19 and 105 men without the disease in Iran. The researchers analyzed changes in angiotensin-converting enzyme 2 (ACE2) activity, markers of inflammation and oxidative stress, apoptotic variables and semen quality, all of which were evaluated at 10-day intervals for up to 60 days.
Most of the men in the study were in their 30s and “differed substantially” in body weight, body fat percent and BMI, according to the researchers. Among those with COVID-19, all but one had either a moderate, severe or critical form of the disease. A urology expert confirmed that all the men were fertile in the study. Men with COVID-19 were treated with corticosteroids and/or antiviral therapies.
The researchers reported that at baseline and during subsequent follow-ups, the COVID-19 group showed significantly higher levels of seminal plasma ACE2 enzyme, as well as higher levels of both pro- and anti-inflammatory cytokines in sperm — including interleukin (IL) 1-beta, IL-6, IL8, IL-10, transforming growth factor (TGF)-beta, tumor necrosis factor-alpha, and interferons alpha and gamma. They also had higher levels of reactive oxygen species and lower superoxide dismutase activity compared with healthy controls.
The markers of inflammation and oxidative stress in sperm cells of men with COVID-19 were increased by more than 100% compared with controls, according to the researchers. Sperm concentration was reduced by 516%, mobility by 209% and sperm cell shape was altered by 400%.
Although these effects tended to improve over time — representing “a transient state of male subfertility like those with oligoasthenoteratozoospermia” — the researchers wrote they remained “significantly and abnormally higher in the COVID-19 patients, and the magnitude of these changes were also related to disease severity.”
In an interview with Healio Primary Care, Hajizadeh Maleki recommended that couples who want to have children should proceed with caution.
“Female partners of men recovering from the disease should decide not to conceive until a specialist carefully examines and certifies their fertility status,” he said.”