We know that COVID-19 has caused some very serious medical conditions, including neurological issues, blood clots and damage to the heart, lungs and kidneys. I know it’s the last thing you want to hear, but we are also seeing that COVID-19 may have negative effects on male reproductive health as well. As a urologist, I haven’t been on the front lines of this global health crisis, but I suspect I will have a front-row seat to the ensuing waves of complications that are yet to come. 

Although it seems like the pandemic has lasted forever, in the grand scheme of things, we’re still in the beginning phases when it comes to understanding long-term side effects that patients might experience. According to the studies that have been conducted so far, it does appear that a COVID-19 infection has the potential to negatively affect male fertility.

A recent study involving 120 Belgian men, ages 18 to 69 years, who had recovered from documented COVID-19 infections, illustrates some of the dangers that SARS-CoV-2 poses to male fertility in general and sperm motility and sperm count specifically. For this study, blood and semen were collected between one week and about 53 days after the participants had recovered from the coronavirus. Here’s what they found.

Sperm Motility

When we talk about sperm motility, what we’re talking about is a sperm cell’s ability to swim. The Belgian study found that 60% of the study participants had reduced sperm motility when measured during the first month after their coronavirus infection. When sperm motility was tested between one to two months after infection, 37% of participants had reduced sperm motility, and 28% showed reduced sperm motility after two months. 

The technical term for poor sperm motility is asthenozoospermia. When a sperm cell moves in a straight line or travels in large circles, it’s labeled as progressive motility. If a sperm does not travel along a straight line or if it swims in tight little circles, it’s considered non-progressive motility. Progressive sperm motility is an important factor when it comes to fertility. If your little swimmers are floundering, they’re less likely to fertilize an egg because they’re less likely to even reach the egg. 

According to this study, it’s likely that men will experience some degree of decreased fertility due to poor sperm motility after a COVID-19 infection although sperm motility seems to improve with time. The severity of the infection did not appear to affect the outcomes. Men who had recovered from mild cases and men who had recovered from severe cases had similar results.

Sperm Count

The other major factor at play when it comes to male fertility is sperm count. The more sperm you have, the more likely at least one is going to cross the finish line and fertilize the egg. The technical term for a low sperm count is oligospermia, and it refers to the amount of sperm that’s present in your ejaculate. A sperm count is considered low when it’s measured at fewer than 15 million sperm per milliliter of semen.

Like sperm motility, the Belgian study showed that sperm count also suffers in the wake of a COVID-19 infection. During the first month post-infection, 37% of study participants had a reduced sperm count. When measured at one to two months post-infection, this percentage decreased to 29% and then continued to decrease to 6% when measured after two months of recovery. There’s definitely cause for hope here. It appears that sperm counts dramatically increased with time. 

A Perfect Target

It’s suspected that men are at higher risk for fertility complications with COVID-19 because there is a high expression of the ACE2 receptor in the testicles. (The ACE2 receptor is what the coronavirus binds on to in order to enter our cells.) The high-quantity of ACE2 and the ability of SARS-CoV-2 to cross the blood-testis barrier may mean that testicular involvement occurs early in a COVID-19 infection. 

In one study, testicular tissue that was examined from men who died from COVID-19 revealed a reduction in testosterone-producing cells high in ACE2 along with inflammation and swelling (Yang). Because there is an abundance of ACE2 in the cells that produce sperm, one might also assume that there could be similar negative effects on reproductive function. Sperm cells themselves have an ACE2 receptor, which could explain why COVID-19 has been found in semen (Li). 

Fact vs. Fiction

While you may not have heard about the scientific studies being done on how COVID-19 affects fertility, you no doubt have heard someone talking about COVID-19 vaccines causing infertility, impotence or some other negative sexual side effect. Let me be very clear – COVID-19 vaccines do NOT cause infertility. Whether you heard it from Nicki Minaj or your Uncle Steve, it’s just not true. 

A study by the National Institutes of Health (NIH) followed more than 2,000 couples to find out if vaccination in the male, female or both affected the chances of conceiving a child. They found that there was no difference in the vaccinated couples as opposed to the unvaccinated couples. What they did find was a slightly lower chance of conception in couples where the man had a COVID-19 infection within 60 days before the female’s menstrual cycle. 

The moral of the story – get vaccinated! If you’re a man, you’re less likely to experience fertility problems if you avoid a SARS-CoV-2 infection altogether.

In the Future

We still don’t know what COVID-19’s impact on fertility will be in the long term. We simply haven’t had enough time pass. However, the research emerging shows that while there’s room for continued caution, there’s also room for hope as we move into a post-pandemic future. 

For some other coronavirus side effects, genetic and physiological predispositions are being identified. We may very well find the same connections to reproductive side effects as well. That could help us identify men who are at an increased risk for sexual side effects from COVID-19. Either way, we are seeing that the instance of these side effects does seem to lessen with time, and that’s a good thing. 

If you have concerns about COVID-19 as it relates to fertility, semen quality, sperm count, sperm motility, sexual function or reproductive health, make sure you talk to your doctor. Sexual function is vital to a person’s quality of life. As sexual health experts, my colleagues and I may not be frontline healthcare workers, but we’ll definitely be there in the aftermath of COVID-19 to support patients as we navigate these new challenges together.

References:

https://www.sciencedirect.com/science/article/pii/S0015028221021567

https://www.forbes.com/sites/brucelee/2021/12/24/study-reduced-sperm-count-motility-over-2-months-after-covid-19-coronavirus-infection/?sh=4a4cf3ec41fd

https://www.medicalnewstoday.com/articles/320160#:~:text=How%20does%20sperm%20motility%20affect%20fertility%3F&text=Sperm%20motility%20is%20the%20ability,cause%20of%20male%20factor%20infertility.

https://www.mayoclinic.org/diseases-conditions/low-sperm-count/symptoms-causes/syc-20374585

https://astroglide.com/blog/erections-in-the-time-of-covid?utm_source=Doctors&utm_campaign=0ebc160597-DOCTOR+EMAIL+JAN+2021&utm_medium=email&utm_term=0_34d519331f-0ebc160597-189073534&mc_cid=0ebc160597&mc_eid=45b2496cd2

https://www.nih.gov/news-events/news-releases/covid-19-vaccination-does-not-reduce-chances-conception-study-suggests

Yang M, Chen S, Huang B, Zhong JM, Su H, Chen YJ, et al. Pathological findings in the testes of COVID-19 patients: clinical implications. Eur Urol Focus. 2020 doi: 10.1016/j.euf.2020.05.009.

Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical Characteristics and Results of Semen Tests Among Men With Coronavirus Disease 2019. JAMA Netw Open. 2020;3(5):e208292. doi:10.1001/jamanetworkopen.2020.8292