Why New COVID-19 Patients May Cause Fertility Problems?

  • The initial symptoms of COVID-19 are high fever. It can be assumed that men infected with COVID-19 will also experience reduced fertility.
  • Fever can overheat the testicles, which can temporarily reduce male fertility.
  • Seasonal flu is also known to reduce male fertility. 
  • Allan Pacey, Ph.D., male fertility expert, explained to Newsweek that ” At present, it is somewhat premature to conclude that novel coronavirus will affect male fertility. 
  • Only ⅓ or ⅕ % of infected pregnant women experienced a severe illness that required medical attention

There is still much information that we don’t know about novel coronavirus and its impact on fertility of patients, but “we quite know a lot about a virus, flu, and male fertility,” described by Legacy advisor and reproductive urologist Dr. Paul Turek…… where he also explains, ” seasonal flu is also known to reduce male fertility.  We can suggest that it’s due to high fever associated with the illness, which overheats the testicles.

The effect of fever and flu demonstrated in several case studies of fertile men, such as in 2000, a case report determines that fever or influenza can have latent effects on sperm chromatin structure and may result in abnormal sperm production. Another case report in 2007, they found the high risk of temporary alteration of semen parameters after an acute febrile illness.

If considering the primary symptom of novel coronavirus is high fever (pyrexia), it can assume that infected men with coronavirus will also be experienced to reduce fertility temporarily. Dr. Turek currently believes that the COVID-19 is similar to a common seasonal flu regarding its impact on male fertility.

Where did the story come from?

In March, the Mail online web addressed that professors in reproductive medicine from Wuhan, claim new coronavirus ‘ may cause damage to a man’s testicles,’ and they urged it recovered male patients to test sperm quality and hormone level.

The same post was published on the Hubie government website, where they raised an affair about COVID-19’s potential to impact and male fertility based on the fact that SARS is a similar infection that has been known to cause orchitis and damage to the testicles. 

Why do they claim new COVID-19 may cause fertility problems?

SARS, MERS, and  COVID-19 are genetically similar, which has been known to damage multiple organs and also have a severe impact on the reproductive system.

Another basis for the claim was that the protein thought to be used by novel coronavirus to enter cells called ACE2 and it is found in the testes. So theoretically, the virus can infect the testes and this might affect sperm production. 

There are 2 studies we are discussing here, but remember these studies are not peer-reviewed. 

A  study is coming out from Wuhan on March 21, 2020, where they see the effect of SARS-CoV-2 infection upon male gonadal function and compared sex-related hormones between 81 infected men with 100 healthy non-infected men.

The study doesn’t find any clinical evidence about whether SARS-CoV-2 infection affects the male gonadal function. But show little difference in the levels of their reproductive -related hormone, but not in testosterone level. Thus professor Paolo Madeddu from the University of Bristol noted that ” Hormonal changes could be the result of general inflammation also affecting the gonad function. 

Another study published on March 31, 2020, the detection of coronavirus in semen and testicular biopsy specimens of COVID-19 patients. Where they found no positive results in semen or the testicular biopsy specimen, Hence no evidence of sexual transmission of COVID-19 from males.

However, no documented cases of testicular infection have been noted during the COVID-19 pandemic and still now.

Allan Pacey, Ph.D., male fertility expert, explained to Newsweek that ” At present, it is somewhat premature to conclude that novel coronavirus will affect male fertility. 

COVID-19 and its impact on female fertility:

Many people are curious and researching about coronavirus and its impact on female fertility because they are trying to decide whether it is a safe time to conceive or plan for the future.

As compared to males fertility, there is no evidence that pyrexia, flu, or illness similar to the coronavirus, have long or short term impacts on female fertility. And in this pandemic situation, the safety of pregnant people infected with COVID-19 and the safety of their babies is very limited and may be difficult as many health care facilities are dedicated to treating coronavirus patients.

Because of these reasons, many experts are recommending that people who plan a pregnancy may stop trying to conceive for a few months. 

What is the outcome of pregnancy during the COVID-19 pandemic?

Based on the limited data, only ⅓ or ⅕ % of infected pregnant women experienced a severe illness that required medical attention.  

According to limited data, we know that pregnancy alters the immune system in a way that increases the risk of infection like influenza, typhoid, and other related infections such as MERS and SARS can cause adverse pregnancy outcomes, which include miscarriage, premature deliveries, intrauterine growth restriction or maternal death. 

Historically, respiratory tract infection in pregnant women has been thought to increase the risk and cause severe morbidity and mortality. But currently, data of COVID-19 do not indicate that pregnant women are at increased risk of infection or severe morbidity, such as the need for ICU admission, as compared to nonpregnant women. Still, there is no authentic evidence of vertical transmission of COVID-19. American College of Obstetricians and Gynecologists (ACOG) warns pregnant women who get coronavirus may have a higher risk for some complications and precautions to avoid it

Many studies of pregnant women who contracted during pandemic situations and subsequently gave healthy live births. Some of the studies are here;

The nine pregnant women from WUHAN, were all in their third trimester and underwent a cesarean section and had a history of exposure to COVID-19.  But none of the neonates shows signs and symptoms of COVID-19 and lab tests also show SARS-CoV-2 negative. It suggests that no intrauterine fetal infection occurred during the late stage of pregnancy. 

A 40-years old Hispanic female with 28 weeks and four days gestation, presented to the emergency with worsening shortness of breath, cough, and hypoxia in the setting of known COVID-19 infection.  The decision was made to proceed with delivery. Postoperatively, the patient underwent ten days under observation, and the infant’s COVID-19 testing was negative on the 2-day of life. Placenta from COVID-19 positive mother, which was submitted to the pathology lab, shows the first visualization of the SARS-CoV-2 virus in the human placenta.

These studies demonstrated that their illness was not severe and they did not pass the virus along to the babies in utero or through breast milk. 

Why New COVID-19 Patients May Cause Fertility Problems? 1 - Daily Medicos
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What if I’m planning a pregnancy or fertility treatment?

The European Society of Human Reproduction and Embryology advised that “ all fertility patients who are planning or considering treatment, or even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid or delay becoming pregnant at this time.”

Similarly, The American Society for Reproductive medicine expressed that fertility clinics and hospitals postpone new fertility treatments until more is known about the virus. 

Can the mother pass COVID-19 to their baby?

The passing of disease from mother to their baby is known as “ vertical transmission,” referring to infection that occurs during pregnancy, labor, soon after birth, or through breastfeeding. In the case of SARS-CoV-19, the vertical transmission may be rare, but still, it can’t be completely ruled out. 

In London, the newborn tested positive with COVID-19, just minutes after being born to a mother who was admitted to a hospital with the symptoms of coronavirus infection. Doctors can not say it happened while the baby was still in the womb or during or after birth. 

A study from Wuhan Children’s Hospital, in which 33 neonates born to mothers with coronavirus, including 3 neonates infected positive with novel coronavirus were identified, with the most common symptom was shortness of breath.

Another study of six mothers with confirmed SARS-CoV-19 shows negative results in serum or throat swab by RT-PCR in their newborns. However, virus-specific antibodies were noticed in neonatal blood sera samples. As these antibodies are too large to pass the placenta, it is believed that they were developed independently in the neonate. 

The good news is infected infants cleared virus quickly in general and deaths among babies and children are rare.

Can the mother protect themselves and their baby?

The CDC recommends some tips to avoid coronavirus infection for pregnant women and in general and includes maintaining self-isolation, social distancing, avoiding touching your face, and washing hands.

What would be impacted if I delay my pregnancy?

There are many peoples whose planning to conceive naturally or through fertility treatment has been delayed by the pandemic coronavirus. 

The answer is no. Dr.Bat-Sheva Maslow briefs that “ when we are talking about the decline of fertility with age, we are talking in terms of a year, not about months.” So there is no evidence that a delay 2-4 months any impact on the success rate.

May sperm freezing be a good option?

Sperm freezing may be a beneficial and favorable choice during this coronavirus pandemic situation for both biologically and emotionally support. 

As we know that time and age affect male fertility for men over 35. Every 8th month, sperm acquired a new genetic mutation that passed into offspring. If coronavirus is pushing off your family plans, then sperm freezing would be a good option. Sperm testing and freezing are valuable options to preserve your fertility. 

Takeaway:

There is no evidence found that the fertility rate reduces in COVID-19 patients. But still, there is a higher risk of transmission as CDC advised: “ separating members of the household who have been infected with novel coronavirus or who have any symptoms.” an unapproved report regarding coronavirus to male fertility is also removed.

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