COVID-19

COVID-19 could cause male infertility

COVID-19 could cause male infertility

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.

Source: https://www.jpost.com/health-science/covid-19-could-cause-infertility-new-israeli-study-644767

Coronavirus transmitted to newborn through mother’s placenta

Coronavirus transmitted to newborn through mother’s placenta

Pregnant women infected with COVID-19 may pass on the disease-causing virus to their baby through the placenta, researchers in France suggest.

In their study, published in Nature Communications, the authors describe the case of a newborn child which presented with SARS-CoV-2 infection shortly after birth and subsequently suffered neurological conditions consistent with symptoms seen in adults with COVID-19.

Through analysis of the blood of mother and child as well as placenta and amniotic fluid, they give strong evidence for the virus to have been transmitted by the infected mother through the placenta. Scientists hope that taken together with other case reports, this could give indications for the risk and impact of COVID-19 infections during pregnancy.

‘This case study is indeed an important addition to the existing literature,’ commented Dr Ela Chakkarapani from the University of Bristol, who was not involved in the study. ‘Data to date has been suggesting in utero transmission may be occurring and this study adds data to further support that.’

In March 2020, the pregnant woman was hospitalised in Paris with symptoms of COVID-19 and tested positive for the virus. Despite immediate isolation after being born by caesarean section, the newborn boy developed neurological symptoms quickly – including distress and muscle spasms – which mirrored COVID-19-related effects in adults. With his health improving soon after, the baby and his mother recovered and were discharged from the hospital.

The authors conclude that based on their analysis of blood, amniotic fluid and placenta, transmission of the virus via the placenta was very likely in the reported case. This adds fire to the ongoing medical debate over the likelihood of an elevated risk of coronavirus infection for expectant mothers and their children, especially in the context of placenta-transmitted disease. According to the CDC, the major source of transmission to babies is contact with respiratory droplets from mothers or other caregivers immediately after birth.

‘It remains rare for babies to become infected; in 244 live-born babies of infected mothers in the UK, 95 percent had no sign of the virus, and outcomes are similar to non-infected babies,’ commented Professor Andrew Shennan from King’s College London. ‘This report adds knowledge to a possible mechanism of transfer to the baby, i.e, via the placenta while pregnant, but women can remain reassured that pregnancy is not a significant risk factor for them or their babies with COVID-19.’

Read more: https://www.nature.com/articles/s41467-020-17436-6

Placentas from COVID-19-positive pregnant women show injury

Placentas from COVID-19-positive pregnant women show injury

Findings suggest abnormal blood flow between mothers and babies in utero

The placentas from 16 women who tested positive for COVID-19 while pregnant showed evidence of injury, according to pathological exams completed directly following birth.

Αccording to the findings of a new Northwestern Medicine study, the type of injury seen in the placentas shows abnormal blood flow between the mothers and their babies in utero, pointing to a new complication of COVID-19. The findings, though early, could help inform how pregnant women should be clinically monitored during the pandemic.

The study was published in the journal American Journal of Clinical Pathology. It is the largest study to examine the health of placentas in women who tested positive for COVID-19.

“Most of these babies were delivered full-term after otherwise normal pregnancies, so you wouldn’t expect to find anything wrong with the placentas, but this virus appears to be inducing some injury in the placenta,” said senior author Dr. Jeffrey Goldstein, assistant professor of pathology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine pathologist.

“It doesn’t appear to be inducing negative outcomes in live-born infants, based on our limited data, but it does validate the idea that women with COVID should be monitored more closely.”

This increased monitoring might come in the form of non-stress tests, which examine how well the placenta is delivering oxygen, or growth ultrasounds, which measure if the baby is growing at a healthy rate, said co-author Dr. Emily Miller, assistant professor of obstetrics and gynecology at Feinberg and a Northwestern Medicine obstetrician.

“Not to paint a scary picture, but these findings worry me,” Miller said. “I don’t want to draw sweeping conclusions from a small study, but this preliminary glimpse into how COVID-19 might cause changes in the placenta carries some pretty significant implications for the health of a pregnancy. We must discuss whether we should change how we monitor pregnant women right now.”

Fifteen patients delivered live infants in the third trimester, however one patient had a miscarriage in the second trimester. “That patient was asymptomatic, so we don’t know whether the virus caused the miscarriage or it was unrelated,” Goldstein said, “We are aware of four other cases of miscarriage with COVID. The other reported patients had symptoms and three of four had severe inflammation in the placenta. I’d like to see more before drawing any conclusions”, Goldstein said.

The placenta is the first organ to form in fetal development. It acts as the fetus’ lungs, gut, kidneys and liver, taking oxygen and nutrients from the mother’s blood stream and exchanging waste. The placenta also is responsible for many of the hormonal changes within the mother’s body.

Examining a woman’s placenta allows a pathologist to follow a retroactive roadmap of a woman’s pregnancy to learn what happened to the baby in utero or what could happen to both the mother and the infant after birth.

“The placenta acts like a ventilator for the fetus, and if it gets damaged, there can be dire outcomes,” Miller said. “In this very limited study, these findings provide some signs that the ventilator might not work as well for as long as we’d like it to if the mother tests positive for SARS-CoV2.”

The placentas in these patients had two common abnormalities: insufficient blood flow from the mother to the fetus with abnormal blood vessels called maternal vascular malperfusion (MVM) and blood clots in the placenta, called intervillous thrombi.

In normal cases of MVM, the mother’s blood pressure is higher than normal. This condition is typically seen in women with preeclampsia or hypertension. Interestingly, only one of the 15 patients in this study had preeclampsia or hypertension.

“There is an emerging consensus that there are problems with coagulation and blood vessel injury in COVID-19 patients,” Goldstein said. “Our finding support that there might be something clot-forming about coronavirus, and it’s happening in the placenta.”

Between 30 and 40 patients deliver at Prentice daily. The team began testing placentas of COVID-19-positive mothers in early April. Fourteen of the live-born infants in the study were born full term and with normal weights and Apgar scores. One live-born infant was premature.

“They were healthy, full-term, beautifully normal babies, but our findings indicate a lot of the blood flow was blocked off and many of the placentas were smaller than they should have been,” Miller said. “Placentas get built with an enormous amount of redundancy. Even with only half of it working, babies are often completely fine. Still, while most babies will be fine, there’s a risk that some pregnancies could be compromised.”

Read more: https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa089/5842018

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