COVID-19 may be more than just a detriment to your health – it may also reduce your chances of having children in the future. According to a review published in the journal Reproduction, infection from SARS-CoV-2 may potentially result in a drastic reduction of fertility in males through inflammation and destruction of the testes.
The review covers a broad range of recently-published studies into the reproductive impacts of COVID-19 infection, postulating on the potential mechanisms behind the ability of COVID-19 to affect fertility. Previous research has highlighted that COVID-19 may result in reductions in fertility in both males and females, but the underlying causes and interactions have not been understood yet.
Early theories revolved around a potential ability of SARS-CoV-2 particles to enter the genital tract of males, similar to the mumps virus. Some viruses directly attack the male testes within the first few days of infection, destroying the supportive tissue (parenchyma) and decreasing sperm production. However, the authors state that this mechanism is unlikely in COVID-19 infection. Studies on SARS-CoV-1 – which was involved in a breakout in 2003 and shares distinct similarities with the current strain of coronavirus – indicated that it was not regularly found in the testes, nor have recent studies on SARS-CoV-2 found any virus particles in that region either (except for patients with high viral load).
Much for the same reason, neither does the evidence support the sexual transmission of SARS-CoV-2.
However, the research does suggest that infection can lead to severe inflammation of the testes, a condition called orchitis. Due to a lack of virus particles, but a distinct reduction in fertility in males, it is therefore likely that damage to the testes is a result of inflammation instead of direct damage from the virus.
Not all patients with COVID-19 will suffer orchitis and see an impact on fertility, though it does seem to be relatively common in patients with acute disease. In two studies cited, 50% and 92% of autopsied patients had hallmarks of orchitis, although another study only found it in 20% of their autopsies.
There may also be more causes of the drop in fertility, relating to sperm DNA fragmentation and disruption in how the brain communicates with the gonads via hormones, but all require further study to verify.
The review highlights important avenues to explore on the long-term impacts of COVID-19 on survivors, but for now, much further exploration is required to fully understand why fertility can be reduced in patients. It may be the case that COVID-19 will have significant impacts across multiple generations, and with examples of ‘long COVID’ continuing to emerge, it is no doubt the pandemic will have lasting effects on many of those that were – or will be – infected.