O-253 Impact of Covid-19 Infection on Male Seminal and Hormonal Parameters
Authors: Luay A , Al-Kawaz U , Mohsin E 
Published: June 2022

Abstract

Study question
To assess possible effects of Covid-19 infection on male reproductive status

Summary answer
Covid-19 negatively affect erectile function, spermatogenesis & improve over time, subclinical hypogonadism suspected due to decrease testosterone & increase LH, no enough evidence orchitis happen.

What is known already
Covid-19 single-stranded enveloped RNA virus has two spike glycoproteins S & M. Molecular studies shows that Covid-19 infection rely on 2 factors; viral spikes binding to ACE2 receptors for entry, spikes binding to serine protease TMPRSS2 for viral protein priming. The key factors that mediate Covid-19 pathogenicity are highly expressed in urogenital organs. major symptoms of the COVID-19 pandemic are very high fever with a sudden surge in body temperature; fever can negatively affect male fertility

Study design, size, duration
prospective cohort study was conducted from August 2020 to May 2021. Fifty males survived COVID-19 infection (aged between 18-50 years) were recruited after approved diagnoses. Male having previous infertility issues, major systemic illness or with history of medication that could affect spermatogenesis or hormones were excluded. The tested variables were assessed sequentially on three occasions post-recovery in one month interval

Participants/materials, setting, methods
full history & medical examination, seminal fluid analysis abstinence (3-5) days samples collected by masturbation into sterile dry plastic dish placed in an incubator at 37C° to liquefy then do macro & microscopic examination according to WHO 5th ed. 5ml blood drown at day of SFA to perform (FSH, LH, Testosterone & Prolactin), scrotal ultrasound supine/standing position. Assessment repeated at 3 occasions with one month interval.

Main results and the role of chance
Seventy-four percent of participants complained a variety degree of erectile dysfunction (mild, moderate and sever)post-COVID-19 infection. Mild and moderate erectile dysfunction was gradually improved after 30 and 60 days (p = 0.008, p = 0.002 respectively), the severity was reported to correlate with age. Seminal fluid parameters (sperm concentration, motility parameters and normal morphology) were at lowest value after one month post-recovery, afterwards improved gradually within time reaching the best value 3months post-recovery. Even though, progressive motility remained below normal value in all subjects, testosterone was lowest one month post-recovery; subsequently elevated progressively reaching the highest level after 3 months(p &lt; 0.001). Whereas, LH was in highest level one month post-recovery, then declined during the second and third months (p &lt; 0.001). Males (98%) had normal level of FSH during the study period. Highest level of prolactin was observed during the first and second months post-recovery; then all participants returned to normal levels 30 days post-recovery. Ultrasound examination revealed no testis swelling or tenderness was observed indicating no enough evidence of orchitis

Limitations, reasons for caution
Further investigations using larger population and longer following-up evaluation on reproductive functionality are required. Histopathological evaluation of testicular samples post-recovery is recommended.Additionally, infection severity and differences in treatment protocols used should be addressed. Psychological stress due to infection is another factor required to be included

Wider implications of the findings
This study can act as a starting point for investigating short and long term effects of COVID-19 infection on male fertility, which support Andrologists to set protocols for preventing the deterioration of reproductive situation and thus reduce future necessity for assisted reproductive technologies

Trial registration number
not applicable