A Covid-19 infection could negatively impact semen quality in men, according to a new joint study by All India Institute of Medical Sciences (AIIMS) in Mangalagiri, Andhra Pradesh, AIIMS Patna, and AIIMS Delhi.
The study, published in the Cureus Journal of Medical Science, investigated the presence of SARS-CoV-2 in the semen of Covid-19 affected males.
Semen, also known as seminal fluid, is the fluid that is emitted from the male reproductive tract and contains sperm cells, which are capable of fertilising a female’s egg.
It is made up of a number of different substances, including sperm cells, enzymes, and hormones, which contribute to its characteristic appearance and function.
The normal sperm count for a healthy male is about 15 million per ml of semen. The normal count of sperm is called normospermia, and if the count is less, the condition is called oligospermia.
The AIIMS researchers noted that Covid-19 can lead to multiorgan damage through the angiotensin-converting enzyme-2 receptor (ACE2), which is abundant in testicular tissue.
ACE2 acts as the receptor for the SARS-CoV-2 spike protein, through which the virus gains entry into the host cells.
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No need to worry
The good news, however, is that while viral infections do affect semen quality and count, the count returns to normal after recovery, Dr V Surya Prakash, consultant urologist, and laparoscopic, robotic and transplant surgeon at the Yashoda Hospitals in Hyderabad, told South First.
The recovery also depends on the kind of viral infection a person has suffered.
“Usually it takes three months to return to normal; but when there is chronic illness, it sometimes takes even six months. When any person’s body temperature goes up, the semen count goes down,” said Dr Surya Prakash.
Also, researchers involved in the new study said that there is little information available regarding the shedding of SARS-CoV-2 in semen, and its impact on sperm formation and fertility potential.
“As such, we have not observed Covid-19 patients coming with infertility,” Dr Surya Prakash added.
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What the study found
The researchers analysed the effect of the disease on semen quality and what is called the “sperm DNA fragmentation index”, which reflects the integrity of and the damage to the DNA, thereby detecting potential sperm damage.
Thirty male Covid-19 patients aged 19-45 registered with AIIMS Patna hospital and participated in the study between October 2020 and April 2021.
“We conducted a real-time reverse transcriptase test on all the semen samples. Detailed semen analysis, including the sperm DNA fragmentation index, was done at first sampling that is during COVID-19,” the authors of the study said.
“After 74 days of the first sampling, we obtained the second sampling and repeated all the tests,” they said.
The study found that all semen samples collected in the first and second sampling tested with real-time reverse transcription-polymerase chain reaction (RT-PCR) were negative for SARS-CoV-2.
Impact on Semen by Covid19
However, in the first sampling, semen volume, vitality, total motility, sperm concentration, and total sperm count were significantly lower, the researchers found.
In contrast, semen agglutination, or formation of sperm heaps, head defect, DNA fragmentation index, liquefaction time, semen viscosity, and leukocytes or white blood cells, were high.
Liquefaction time is a measure of the time it takes for the semen to turn into a liquid while viscosity is the thickness of the seminal fluid.
These results were reversed at the second sampling — but not to the optimum level, according to the researchers.
The findings were statistically significant, suggesting the “Covid-19 negatively affects semen parameters, including sperm DNA fragmentation index”, the authors noted.
No need for medication
“We don’t have to be in a hurry to start medication; we wait till they get recover. We tell them not to worry and that, in fact, they can wait for as long as six months — after which most of the parameter return to normal,” said Dr Surya Prakash.
If after six months — during which period the patients are advused to eat healthy, especially fresh fruits — things do not get back to normal, patients are advised to take medications, “which also mostly consist of antioxidants twice daily for three months”, he added.
“We do a semen analysis after three months, and, if the semen quality still hasn’t improved, we do chromosome analysis, DNA fragmentation index analysis, check for abnormalities in chromatin, and even a genetics analysis,” Dr Surya Prakash said.
While some viral disease — mumps, for instance — can “irreversibly affect the testes”, most brief viral infections, including Covid-19 and pneumonia, “do not have a long-lasting affect”, he said.
“SARS-CoV-2 is not secreted in the semen during Covid-19, and hence there is risk of sexual transmission,” the doctor said.
This study suggests that assisted reproductive technology (ART) clinics and sperm banking facilities should consider assessing detailed semen analysis of males with a history of Covid-19.
ART includes all fertility treatments in which either eggs or embryos are handled.
These clinics should exclude men with a positive history of SARS-CoV-2 until their semen quality returns to normal, the researchers added.