By Chris D. Meletis, N.D. Scientists are just beginning to unearth the effects of COVID-19 on many aspects of health including fertility. There’s still a lot we don’t know about exactly how COVID-19 impacts reproductive health. But scientists are learning more and more every day. Here’s what the latest research says about COVID-19 and fertility. COVID-19 and Testicular Health A number of viral infections, including infection with SARS-CoV-2, the virus that causes COVID-19, are known to lead to a condition called orchitis, inflammation of one or both testicles. This testicular inflammation can interfere with fertility. One small study of men with COVID-19 found that although no virus was found in the men’s semen, nearly one-fifth (19%) of study subjects had discomfort in their scrotal area suggestive of orchitis.1 The researchers concluded that the effect of COVID-19 on male reproductive function remains unknown. There have also been reports of men suffering from testicular pain as a symptom of COVID-19.2 Additionally, examination of deceased male COVID patients found that 9 of 11 of the men had moderate or severe injury to parts of the testicles including Sertoli cells and seminiferous tubules, which are both involved in the production of sperm.3 Compared to controls, men with COVID-19 had a significantly reduced number of Leydig cells, which are cells that are the primary site of testosterone production in men. COVID-19 and Sperm Health COVID-19 may reduce sperm motility (the ability of sperm to swim to the egg) and increase DNA damage to sperm.2 Research indicates that men with mild COVID-19 may escape the effects to the sperm, while men with moderate disease are more at risk for problems like reduced sperm motility, a reduction in the number of sperm able to move toward the egg, and lower sperm levels.2 The negative effect of COVID-19 on sperm health appears to decline over time. In one study, mean progressive sperm motility declined in 60% of men tested less than one month after COVID-19 infection, 37% of men tested one to two months after COVID-19 infection, and 28% of men tested more than two months after COVID-19 infection.4 Mean sperm count fell in 37% of men tested less than one month after COVID-19 infection, 29% of men tested one to two months after COVID-19 infection, and 6% of men tested more than two months after COVID-19 infection. Other Effects on Male Fertility A couple of studies have investigated the effects of COVID-19 on male reproductive hormones. One study compared sex hormone levels between 119 reproductive age men with a SARS-CoV-2 infection and 273 controls.5 In most cases, the men with COVID-19 had moderately severe disease. The researchers observed higher levels of serum luteinizing hormone and a lower ratio of testosterone to serum luteinizing hormone in the men with COVID-19. Another study looked into sex hormone levels in men admitted to the respiratory intensive care unit with a SARS-CoV-2 infection.6 The men with the worse outcomes had a progressive decline in testosterone levels and an increase in serum luteinizing hormone. Unfortunately, the sex hormone levels before the men became sick wasn’t available. How COVID Affects Female Fertility In women, we know that being severely ill in general can decrease the production of estrogen and progesterone.2 However, there are no published studies measuring the effect of COVID-19 infections on female reproductive hormones. One way in which COVID-19 can affect female fertility is by altering the menstrual cycle. One study found that one-fifth of women of child-bearing age who were infected with SARS-CoV-2 experience either a decrease in menstrual volume or a prolonged menstrual cycle.7 These changes often resolve in a short period of time after the infection subsides. Polycystic Ovary Syndrome and COVID-19 In regards to women and COVID-19, one aspect to note is the increased risk of contracting COVID-19 in women who have polycystic ovary syndrome (PCOS). Not only do women with PCOS have unique fertility challenges, but they also have many of the underlying conditions associated with an increased risk for COVID-19 including obesity, diabetes, and high blood pressure.8 Women with PCOS have a 28% to 50% higher risk of becoming infected with SARS-CoV-2 compared to women without PCOS.8 The Mechanism By Which SARS-CoV-2 Affects Fertility SARS-CoV-2 uses what’s known as the ACE2 receptor to enter the body. This receptor is part of the renin-angiotensin system, which plays a lot of roles in the body, the best known of which is regulating blood pressure. However, the renin-angiotensin system also regulates basic functions in the male and female reproductive systems.2 In the female, these functions include the creation of follicles, production of sex hormones, maturation of oocytes, ovulation, and the regeneration of the endometrial lining.2 In men, testicular ACE2 can regulate testicular function, is involved in sperm function, and may play an important role in sperm’s contribution to embryo quality.2 SARS-CoV-2 enters the cell by binding to the ACE2 receptor, so reproductive cells and/or tissues that express ACE2 are susceptible to the virus. Once the virus enters those reproductive areas, it may alter their function.2 Ways to Stay Healthy There are a number of ways to keep your body healthy. Here are some of the most important: Stay well-nourished with the nutrients shown in the scientific literature to support immune health. These include vitamins C, and D, folate and other B vitamins, selenium, zinc, and omega-3 fatty acids.10 During acute illness of any kind, nutrient levels drop in the body. Talk to your healthcare provider about which supplements are right for you. Get enough sleep. Aim for seven to eight hours per night. Sleep is critical to immune health.11 Avoid processed foods and foods containing sugar. Eat lots of fresh fruit and vegetables. Dr. Chris Meletis Dr. Chris Meletis is an educator, international author and lecturer. His personal mission is “Changing World’s Health One Person at a Time.” Dr Meletis has authored 18 books and over 200 national scientific articles in journals including Natural Health, Alternative and Complementary Therapies, Townsend Letter for Doctors and Patients, Life Extension, Natural Pharmacy, and PubMed.gov articles. Dr. Meletis served as Dean of Naturopathic Medicine and Chief Medical Officer for 7 years for the National College of Naturopathic Medicine (now the National University of Natural Medicine). He was awarded the 2003 Physician of the Year by the American Association of Naturopathic Physician of the Year by the American Association of Naturopathic Physicians. He has a deep passion for helping the underprivileged and spearheaded the creation of 16 free natural medicine healthcare clinics in the Portland metropolitan area of Oregon. References: Pan F, Xiao X, Guo J, et al. No evidence of severe acute respiratory syndrome-coronavirus 2 in semen of males recovering from coronavirus disease 2019. Fertil Steril. 2020;113(6):1135-1139. Madjunkov M, Dviri M, Librach C. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res. 2020;13(1):140. Yang M, Chen S, Huang B, et al. Pathological Findings in the Testes of COVID-19 Patients: Clinical Implications. Eur Urol Focus. 2020;6(5):1124-1129. Donders GGG, Bosmans E, Reumers J, et al. Sperm quality and absence of SARS-CoV-2 RNA in semen after COVID-19 infection: a prospective, observational study and validation of the SpermCOVID test. Fertil Steril. 2022;117(2):287-296. Ma L, Xie W, Li D, et al. Evaluation of sex-related hormones and semen characteristics in reproductive-aged male COVID-19 patients. J Med Virol. 2021;93(1):456-462. Rastrelli G, Di Stasi V, Inglese F, et al. Low testosterone levels predict clinical adverse outcomes in SARS-CoV-2 pneumonia patients. Andrology. 2021;9(1):88-98. Li K, Chen G, Hou H, et al. Analysis of sex hormones and menstruation in COVID-19 women of child-bearing age. Reprod Biomed Online. 2021;42(1):260-267. de Medeiros SF, Yamamoto MMW, de Medeiros MAS, Yamamoto A, Barbosa BB. Polycystic ovary syndrome and risks for COVID-19 infection: A comprehensive review : PCOS and COVID-19 relationship. Rev Endocr Metab Disord. 2022;23(2):251-264. Galmés S, Serra F, Palou A. Current State of Evidence: Influence of Nutritional and Nutrigenetic Factors on Immunity in the COVID-19 Pandemic Framework. Nutrients. 2020;12(9). Berger MM, Herter-Aeberli I, Zimmermann MB, Spieldenner J, Eggersdorfer M. Strengthening the immunity of the Swiss population with micronutrients: A narrative review and call for action. Clin Nutr ESPEN. 2021;43:39-48. Silva E, Ono B, Souza JC. Sleep and immunity in times of COVID-19. Rev Assoc Med Bras (1992). 2020;66Suppl 2(Suppl 2):143-147.
