COVID-19 and Male Fertility: Short- and Long-term Impacts of Asymptomatic Vs. Symptomatic Infection on Male Reproductive Potential

Background: Studies exploring the effect of COVID-19 on male reproductive system suggest a detrimental association, however with conflicting results. The aim of this study was to assess the association between COVID-19 infection and male reproductive potential including hormone profiles and semen parameters.

Methods: This prospective cohort study included 48 patients with confirmed COVID-19 infection. Patients were subdivided into an asymptomatic group ( = 30) and a group with COVID-19 symptoms ( = 18). Serum hormone levels including testosterone, LH, FSH and estradiol were collected during active infection (baseline, time 0), and at 3 and 6 months following COVID-19 infection. Semen samples (basic semen analysis and oxidation reduction potential) were examined at 3 and 6 months following infection. Student and paired-t tests were used to compare continuous variables between the study groups and across the studied time intervals, respectively. Multivariate binary logistic regression analysis was performed to explore predictors for COVID-19 symptoms during active infection.

Results: Patients with COVID-19 symptoms were significantly older ( = 0.02) and had significantly lower serum testosterone levels ( = 0.01) and significantly higher LH: testosterone ratio ( = 0.01) than asymptomatic patients. Multivariate analysis revealed older age (OR =  1.18,  = 0.03) and lower serum testosterone level (OR = 0.8,  = 0.03) as independent predictors of symptomatic COVID-19 infection. Significant increase in testosterone ( < 0.001 for both) and decrease in LH ( = 0.02,  = 0.007) and LH: testosterone ( = 0.02,  = 0.005) levels were observed at 3 and 6 months in patients with COVID-19 symptoms. Asymptomatic patients demonstrated significant increase in testosterone ( = 0.02) and decrease in LH: testosterone ( = 0.04) levels only at 3 months following COVID-19 infection. No significant differences were observed between the two study groups with regards to the semen analysis results obtained at 3 or 6 months following COVID-19 infection.

Conclusion: Significantly lower testosterone values are associated with worse disease severity among men with COVID-19 infection. This association appears to be temporary as a significant increase in testosterone levels are witnessed as early as 3 months following recovery. No significant detrimental effect for COVID-19 infection on testicular sperm production is found in this patient population.