Possible differences in sperm quality of infertile patients during the COVID-19 pandemic


Several studies have shown that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily targets the respiratory tract and subsequently affects multiple organs. mechanically Spike protein The virus binds to the host’s angiotensin-converting enzyme 2 (ACE2) receptor to form infection.

Study: The Adverse Impact of the COVID-19 Pandemic: Male Fertility Wasn't Out of the Bag.  Image credit: Christoph Burgstedt / Shutterstock.com
Stady: The detrimental impact of the COVID-19 pandemic: Male fertility was not out of the bag. Image credit: Christoph Burgstedt / Shutterstock.com

Because the ACE2 receptor is prominently expressed on several types of cells in the testes, scientists are considering whether the virus impairs the semen quality of people infected with SARS-CoV-2, especially among those who are infertile.


According to the World Health Organization (WHO), individuals who are unable to conceive after 12 months of unprotected intercourse can be classified as infertile. Infertile individuals are subject to significant family and social pressure that lowers their self-esteem. There is no scientific evidence available regarding sexual transmission of SARS-CoV-2 or its effect on infertile couples. There is a possibility that SARS-CoV-2 infection could affect infertile couples by affecting the quality of gametes.

about studying

newly Plus one The study looked at the aforementioned research gap and investigated how SARS-CoV-2 infection affected the semen quality of infertile men in Tunisia.

The coronavirus pandemic 2019 (COVID-19) has affected all 24 governorates of Tunisia. The current study was carried out in the Laboratory of Cytogenetics and Reproductive Biology in Monastir. Male patients who were recommended for semen analysis during the first and second epidemic waves in Tunisia were considered in this study. All recruited participants had a spermogram prior to the epidemic period.

Two time points, i.e., T1 (before the COVID-19 pandemic) and T2 (during the COVID-19 pandemic), were taken in this study. Participants under antivirals, antibiotics, anti-inflammatories and antioxidants, between the two compared spermogram groups, were excluded from the group. In addition, participants who had a history of genitourinary surgery during the study period were excluded. Semen samples were obtained from the participants 3-5 days after they had sex refrain. Microscopic and microscopic examinations of semen were performed.


A total of 90 patients with an average age of 38 years were recruited into this study. Most of the participants lived in urban areas, between the ages of 30 and 39. Notably, this study found poor sperm quality during the pandemic. Two of the main sperm parameters, i.e. sperm mortality and morphology, were found to change over the study period.

About 48% of the participants were working in an occupation that could put fertility at risk. In addition, more than half of the study group consumed tobacco and were obese. Male infertility factors were identified in approximately 66% of the participants. Alterations were found in several semen parameters even during pre-pandemic sample analysis. These findings were consistent with previous studies that revealed associations of sociodemographic and lifestyle factors with male reproductive health.

About 78% of the participants showed a change in sperm morphology and 89% showed a multiple abnormality index (MAI) change, that is, the numbers were well below the WHO threshold. The two major factors modifying male reproduction during the COVID-19 pandemic were sperm motility and morphology. The decrease in these factors was explained by two hypotheses, namely: (a) patients were infected with the virus during a second sperm examination; and (b) the COVID-19 pandemic increased stressors that affected the spermatogenesis pathway.

Previous studies have shown that viral infections, such as human herpes virus (HHV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), Zika, and Ebola, affect sperm count, semen volume, motility, and morphology. More research is required to reveal the full impact of SARS-CoV-2 on semen parameters. Mechanistically, COVID-19 can affect male reproductive health through two pathways, (a) viral invasion of reproductive cells; and (b) induction of an inflammatory response in the reproductive tract due to COVID-19.

An elevated level of ACE2 mRNA was found in patients in their 30s, while the lowest level was found in males at the age of 60. This result indicates that younger patients are more likely to develop testicular damage than older age groups. SARS-CoV-2 infection induces a Cellular storm associated with dysregulation of pro-inflammatory cytokines. Cytokine storm has been associated with increased production of tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), IL-7, and IL-8 by macrophages, leukocytes, and T cells. These proactive factors are also found during the inflammatory process in the testis.


The authors claim that this is the first Tunisian study to assess differences in semen quality during the COVID-19 pandemic. Obesity, tobacco consumption, and occupational exposure to a reproductively toxic environment have been found to have a negative impact on semen quality. Significant decreased sperm motility and sperm abnormalities were observed among infertile Tunisian patients during the epidemic, even without biological proof of SARS-CoV-2 infection.


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