The impact of the virus on male fertility needs to be properly studied writes Dr Warren Lo Hwa Loon
WITH Covid-19, people are rightfully concerned, not just about their physical well-being, but also how it might impact other facets of life, be it in the short or long term.
Recently I've received questions from curious patients about how the coronavirus might affect fertility.
Does Covid-19 harm your ability to have babies in the future?
Scientists too are interested in exploring whether the coronavirus poses a threat to the male reproductive and urinary systems. This is after the discovery that some infected individuals experienced abnormal kidney function and damage, in addition to the expected problems with the respiratory system.
I'll be upfront and state that at the time of this writing, there is no conclusive answer to this given that Covid-19 needs further study.
However, it's worth considering the various discussions on this topic as it gives us some idea of the risks involved for Covid-19 patients.
THE FLU-FACTOR
It's well documented how the seasonal flu can affect male fertility. The flu sometimes adversely affects sperm count resulting in male sterility, as demonstrated in several case studies of fertile men experiencing flu fevers.
One of the studies showed that patients recovering from the flu produced abnormal sperm for around two months after recovery while another study showed that sperm count, motility, and genetic health decreased for over two months after getting well.
This condition is not permanent in most cases as further analysis within two to three months usually indicates a return to normalcy.
It's often believed that persistent high fever is the cause of this condition, as "overheating" of the testicles disrupts sperm production.
FOOD FOR THOUGHT
Recently, a team led by Li Yufeng, a professor from the Center for Reproductive Medicine of Tongji Medical College in Wuhan, published a now-retracted report on the Hubei government's website that the coronavirus can potentially damage male testicles and adversely hurt male fertility.
The findings were based on the fact that the SARS virus – which is genetically similar to the novel coronavirus – has also been known to cause orchitis and damage to the testicles. The report suggested that men who get infected might want to consider getting a semen quality test.
The report also stated that it was possible for male fertility to be heavily impacted as the virus infects us through the receptors called angiotensin-converting enzyme 2 (ACE2), which happen to be also highly expressed in the testes. Apart from the testes, researchers also found that it was highly expressed in other organs such as the kidneys and tongue. Whether this will warrant regular monitoring of the kidney function and fertility requires further investigation.
The report was retracted recently as many scientists considered it too premature and needed long-term data to substantiate.
REASONABLE SPECULATION
Professor Richard Sharpe, a world-renowned expert in fertility at the MRC Centre for Reproductive Health at the University of Edinburgh, UK, is of the view that the study presents a "reasonable speculation without any direct supporting evidence."
Sharpe says that generally, a spike in body temperature caused by viruses (or any other infection, for that matter) is detrimental to sperm production as the cells need to be at 3 to 4 degrees Celsius lower than the core body temperature for normal sperm production and function. Professor Allan Pacey, a leading expert in male fertility at the University of Sheffield, emphasizes that it is still too early to derive conclusively from this study that Covid-19 affects male fertility. He also thinks that those involved in the care of men infected by Covid-19 should consider doing some long-term follow-up of their reproductive function to establish whether there is a potential problem. He also suggests it would be valuable for experts to look at the potential link between Covid-19 and male fertility on a population-wide scale.
However interpreting the results from semen analysis and establishing the link for men who are infected with Covid-19 will be challenging. This is because these men may not have had their fertility tested before the infection.
It means there will be difficulty in assessing if any abnormal test results are due to the virus or not.
Across a large population however, it should be possible to see if rates of poor sperm quality are higher than expected.
THE VIRAL CHALLENGE
All these concerns are not unfounded. It's worth noting that the virus that causes mumps, which doesn't cause the flu, does permanently affect fertility. Boys can get mumps during puberty when the testicles are actively growing. In some cases, mumps can cause a painful condition called orchitis, or inflammation in the testes that result in long-term damage.
Another virus that affects male fertility is the Zika virus, a flu virus transmitted by mosquitoes.
This virus infects pregnant women, resulting in various foetal birth defects and neonatal mortality. Numerous studies conducted in South America indicate that Zika might impair male fertility after the infection has resolved.
LONG TERM
So far, there have not been any documented cases of testicular infections leading to male infertility during this pandemic. However, we should not dismiss the possibility of a temporary impact on sperm production, like what can occur with the seasonal flu.
Scientists agree that long-term studies and research needs to be done before anyone can draw a definite conclusion on this matter. Those who have tested positive for the coronavirus and are feeling anxious about their fertility should discuss it with their family doctor. For now, the best thing to do is not to worry, stay at home, follow social distancing rules and maintain good hygiene.
*The writer is a consultant urologist at Gleneagles Hospital Kuala Lumpur. (GKL).