Dr. Warren Lo On FERTILITY AND COVID-19

With the coronavirus (COVID-19) pandemic spreading fast across the globe right now, people are rightfully concerned, not just about their physical well-being, but also about how it might impact the various facets of human life, be it in the short or the long term. From the domestic economy to global trade and from social norms to leisurely pursuits, the virus seems to have signalled threats in areas to which we are not fully armed to respond.

Recently I’ve received questions from curious patients about how the coronavirus might affect fertility. Not the “locked-down with nothing else to do” sort (that would be another topic) but the physical variety – 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 patients 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 this gives us some ideas 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 the 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 the 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 2 to 3 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 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 SARS – which is genetically similar virus to the novel coronavirus – has also been known to cause orchitis and damage to the testicles and suggested that men who get infected might consider getting semen quality tests. 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 testis, 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 investigations. 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, U.K, was of the view that the study presented a “reasonable speculation without any direct supporting evidence.” Sharpe explained generally that a spike in body temperature caused by viruses (or any other infections, for that matter) was detrimental for 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, emphasized that at 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 or not there is a potential problem. He also suggested it would be valuable for experts to look at the potential link between COVID-19 and male fertility on a population-wide scale. The issue here, however, is that interpreting the results from semen analysis and establishing the link for men who are infected with COVID-19 will be challenged by the fact that people wouldn’t have had their fertility tested before the infection. It would mean there is difficulty in assessing if any abnormal test result was 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 this concern is 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 fetal birth defect and neonatal mortality. Numerous researches conducted in South America indicate that Zika might impair male fertility after the infection has resolved.

LONG TERM

So far, during the COVID-19 pandemic, there are no documented cases of testicular infections that lead to male infertility. However, we should not dismiss the possibility of a temporary impact on sperm production, like what can occur with the seasonal flu. Scientists typically agree that long-term studies and research need 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 this 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.

Dr. Warren Lo Hwa Loon is a Urology Specilist.

Qualification: MBBS, MS, MBU Cert, FRCS (Urol) (Glasgow), Fellowship in Neuro Reconstructive & Female Urology, Fellowship in Robotic Urology

Content provided by Gleneagles Hospital, Kuala Lumpur