Covid-19: A possible emerging impact on male fertility

Document Type : Original Article

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Department of Andrology, National Research Center, Cairo, Egypt

Abstract

SARS-CoV-2 is an emerging pandemic; main complementary protein and mediator for SARS-CoV-2 has been identified to be the angiotensin converting enzyme 2 (ACE2) that exists in various organs and highly expressed within the testicular tissue (spermatogonia, Leydig and Sertoli cells). SARS-CoV-2 binds to ACE2 and TMPRSS2 forming protein complexes mediating viral replication within the male gonads. Hence, an impact on testicular tissue could be observed post-infection. The structure of the sperm glycocalyx could serve as an adequate carrier for SARS-CoV-2. SARS-CoV-2 complex protein formation triggers an elevated immune response in a “cytokine storm” like action. Such leads to extensive tissue damage mediated by TFN-α, IL-1β, IL-18 and IFN-γ. ROS elevation is noted during the infection from the viral-induced cellular damage. Such aggressive immune response, ROS accumulation, complex proteins formation and renin system failure could also progress to intercellular oedema which could lead to intratesticular obstruction with forming consequences including sperm count reduction and elevated Sperm DNA Fragmentation Index (SDFI). Testicular ultrasonography, semen analysis and male hormone profiling are recommended. Post recovery repetition for the previously mentioned tests would provide a useful insight into the andrological observations. Semen cryopreservation is highly recommended for vulnerable patients. Semen purification techniques could be adopted prior to cryopreservation and handling.

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