Patient has low sperm count 11 weeks after severe COVID-19

The SARS-CoV-2 virus was detected in the semen of a COVID-19 patient taking part in a longitudinal study into the impact of the virus on male fertility.

The virus which causes COVID-19 is reported to enter cells by ACE2 receptors, present in the lungs, ovaries (see BioNews 1110) as well as the testes. This has led to some speculation it could impact male and female fertility though there is little conclusive evidence to support this. It is widely recognised that COVID-19 can be transmitted by droplets from the nose and mouth, and that other viruses such as Ebola and Zika can be sexually transmitted in semen. Dr Michael Yin's team at Columbia University in New York City enrolled COVID-positive patients and investigated semen samples to determine if the virus is shed in semen and the impact it has on sperm count.

As researchers stated in the paper published in the journal Emerging Infectious Diseases: 'SARS-CoV-2 RNA in semen appears to be an extremely rare event, but oligozoospermia [low sperm count] has been reported more frequently. Risk factors for viral persistence in the male reproductive tract, longitudinal effects on semen quality, and viral transmission remain to be elucidated, but because of the large number of men in the convalescent phase worldwide, potential effects on reproductive health is not negligible.'

Of 107 participants in the longitudinal study of COVID-19 patients in New York, seven participants provided a total of 17 semen samples. In addition, blood samples were taken as well as nasal, saliva and stool swabs and surveys of their COVID-19 experiences. PCR tests measured the presence and concentration of SARS-CoV-2. Semen analysis determined sperm count and motility.

Just one participant was found to have SARS-CoV-2 detectable in his semen 11 weeks after being diagnosed with severe COVID-19. He had previously been hospitalised, placed on a ventilator and subsequently developed kidney failure. The 34-year-old patient who had no other pre-existing conditions other than a history of childhood asthma also had a low sperm count and no sperm motility. After 15 weeks SARS-CoV-2 was no longer detectable in his semen and after nearly six months his sperm count returned to normal.

The virus was not detectable in the semen of the other six participants in the study, however two participants were found to have severely low sperm counts (<5 million/mL) and one showed a mildly low sperm count (<15 million/mL). Normal sperm counts were reported in three out of five subjects after 15 weeks, however not all participants provided follow-up samples.

The study is limited in its size and pre-infection semen samples were not available from patients for evaluation. Furthermore, the first semen samples were collected during the late recovery stage when the virus is in its inactive form and therefore may not be transmissible.