Studies show COVID-19 impacts male fertility

Although cases of post-Covid complications have declined to a large extent, a study carried out by the doctors in Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) in Lucknow shows that the disease impacts male fertility as ACE 2 receptors are also found in testicles.

“In future, if couples face any problem related to conception and the male partner had previously had a Covid history then it is a possibility that Covid could be the reason for this problem. The person should go for a sperm count investigation,” Dr SP Ambesh from SGPGI.

For SARS-CoV-2 to gain entry into a human body and begin to replicate, it needs to bind to something called an ACE2 receptor, a protein found on the surface of cells in the mouth, lungs, heart, and other areas throughout the body. Among all the tissues in the body, the male testis shows nearly the highest level of ACE2 mRNA expression, causing researchers to worry that it could be a target for viral invasion and damage.

Dr Ambesh said that ACE 2 receptors are found at four places in the human body, including the lungs from which the virus mainly enters the body. Lungs have the maximum ace 2 receptors which are also found in the intestinal mucosa through which the virus can also enter the body.

Ace 2 receptors are also found in kidneys which could lead to chronic renal disease. Testes also have ace 2 receptors but the virus does not get a direct entry through them.

“The focus always remains on the respiratory distress as far as the projection of Covid is concerned and this is important also because the damage in lungs can lead to death. Also, it has been seen that when the disease impacts the intestine, several problems related to absorption of food occur which leads to malnutrition, leading to weight loss and the patient is unable to gain weight after Covid,” he pointed out.

Dr Ambesh said ace receptors in the testes attack the sperm-producing cells which leads to low sperm count. “The result is something which we will not see now but in few years the problem of male infertility will emerge. There are many reports on the issue,” he said.

He added that this kind of impact is not seen in the ovaries. “Women will not face any such problems because ACE2 receptors are not found in ovaries,” he said.

However, Dr Ambesh said it is not necessary that everyone who had Covid would face the issue of infertility.

He said these are scientifically proven facts and will emerge as the main concern for people aged 20-40 years who are keen on having children

Similar research has been carried out the world over. There is evidence that fertility and sexual function may be disrupted in a portion of male patients, especially those who had a severe case and wound up hospitalized from the disease. Here's a quick roundup of what research studies have reported about patients recovering from COVID-19:

• 19% of patients in one study presented with scrotal discomfort suggestive of virus-induced inflammation around the time of their diagnosis.

• 39% of patients had clinically low sperm count in a Chinese study of men who'd all previously fathered at least one child without any reproductive assistance. Sperm function was compromised in 61%.

• 33% of the semen samples in one study showed low sperm quality and lesser ability to swim. 25% also reported low libido, and one patient reported the failure to achieve an erection. The patients also had significant hormone changes, which can be indicators of fertility disturbances.

• An Iranian study analyzing semen samples from patients every 10 days for 60 days found imbalances of free radicals and antioxidants, signs of inflammation, and the activation of pathways that facilitate sperm cell death. Sperm concentration was reduced by 516% and its ability to swim by 209%.

• An Italian study that asked online survey respondents to self-report COVID diagnosis and erectile dysfunction symptoms found that the disease increases the risk nearly six-fold.