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Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 52-57

COVID-19 and male fertility

Department of Reproductive Medicine, Mother and Child Hospital, New Delhi, India

Correspondence Address:
Dr. Nalini Kaul
Department of Reproductive Medicine, Mother and Child Hospital, D-64, Defence Colony, New Delhi 110024
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tofj.tofj_7_22

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COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented global health crisis. The virus entry into the host cell is facilitated by the coexpression of angiotensin-converting enzyme 2 (ACE2) and TMPRSS2 receptors. The male genital system is vulnerable to infection because of the presence of ACE2 and TRMPSS2 on the spermatogonial and somatic cells. Testicular damage leading to the impairment of spermatogenesis and semen parameters has been documented, though the exact mechanism of testicular injury is not confirmed. Immune response to infection, dysfunction of the steroidogenic pathway, impairment of the blood–testes barrier, and fever per se are implicated. The alteration in semen parameters has been demonstrated with COVID-19 infection leading to reproductive compromise. The recovery of semen parameters occurs within 3 months of the infection. It is recommended to wait for 3 months after infection to start infertility treatment. The possibility of sexual transmission and vertical transmission remains a concern, even though the virus has not been detected in semen in most studies. Fertility preservation procedures (semen and testicular tissue cryopreservation) must not be deferred because of their time-sensitive nature. Safety protocols to prevent crosscontamination in cryostorage and to maintain the safety of laboratory personnel should be strictly adhered to. ESHRE and ASRM recommend screening patients before initiating fertility preservation procedures. Testing semen samples for SARS-CoV-2 by RT-PCR has also been advocated to improve safety. Long-term follow-up should be considered in men and young boys exposed to infection and in children conceived during the infection. Vaccination for COVID-19 should be promoted as it does not compromise male fertility.

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