Males who suffer from moderate or severe cases of COVID-19 could experience reduced fertility, according to a new study conducted by Dr. Dan Aderka of Sheba Medical Center.
Aderka reported that not only was the virus found within the sperm of some 13% of screened male COVID-19 patients, but that there was a 50% decrease in the sperm volume, concentration and motility in patients with moderate disease even 30 days post diagnosis.
Post-mortem tests of 12 COVID-19 patients demonstrated moderate to severe changes in the testicular cells supporting sperm development and those producing testosterone, the hormone that induces sperm division and multiplication.
Aderka, whose article was published in the medical journal Fertility and Sterility, told The Jerusalem Post that the cause for this phenomenon seems to be the presence of the ACE2 receptor on the surface the cell of the Sertoli and Leydig cells of the testis, the same receptors on the cells of lungs, kidneys and hearts.
The Sertoli cells support sperm maturation. The Leydig cells produce testosterone.
He said the coronavirus binds to the ACE2 receptors and destroys the cells, which causes infertility.
“As normal sperm maturation takes 70 to 75 days, it is possible that if we are doing a sperm examination two and a half months after recovery, we may see even more reduced fertility,” Aderka said. “It could be even more detrimental.”
He added that it is also still unclear if the effects on the quality and quantity of the sperm are reversible or persistent. He said doctors will need to examine these same patients six months and a year after recovery to see if the damage “stands the test of time.” This is something his team is planning to do.
Aderka said that there is another hypothesis that can now be explored, also as a result of his research: “Interestingly, an enzyme called TMPRSS2 assists the virus in binding to the ACE receptor, facilitating its internalization into the cells.”
TMPRSS2 is activated by testosterone.
“This phenomenon may explain the higher COVID-19 morbidity and mortality of men compared to women,” he told the Post, adding that it also may explain the lower morbidity and mortality of children, whose testosterone levels are low.