AUTHOR=Majzoub Ahmad , Khalafalla Kareim , Arafa Mohamed , El Ansari Walid , Nair Arun , Al Bishawi Ahmad , Saleh Mulham , Khair Ella Mohamed , ElBardisi Haitham , Khattab Muhammad Abu , AlRumaihi Khalid 

TITLE=COVID-19 and male fertility: short- and long-term impacts of asymptomatic vs. symptomatic infection on male reproductive potential

JOURNAL=Frontiers in Reproductive Health

VOLUME=6

YEAR=2024

URL=https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2024.1403143

DOI=10.3389/frph.2024.1403143

ISSN=2673-3153

ABSTRACT=<sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>This prospective cohort study included 48 patients with confirmed COVID-19 infection. Patients were subdivided into an asymptomatic group (<italic>n</italic> = 30) and a group with COVID-19 symptoms (<italic>n</italic> = 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.</p></sec><sec><title>Results</title><p>Patients with COVID-19 symptoms were significantly older (<italic>p</italic> = 0.02) and had significantly lower serum testosterone levels (<italic>p</italic> = 0.01) and significantly higher LH: testosterone ratio (<italic>p</italic> = 0.01) than asymptomatic patients. Multivariate analysis revealed older age (OR =  1.18, <italic>p</italic> = 0.03) and lower serum testosterone level (OR = 0.8, <italic>p</italic> = 0.03) as independent predictors of symptomatic COVID-19 infection. Significant increase in testosterone (<italic>p</italic> &lt; 0.001 for both) and decrease in LH (<italic>p</italic> = 0.02, <italic>p</italic> = 0.007) and LH: testosterone (<italic>p</italic> = 0.02, <italic>p</italic> = 0.005) levels were observed at 3 and 6 months in patients with COVID-19 symptoms. Asymptomatic patients demonstrated significant increase in testosterone (<italic>p</italic> = 0.02) and decrease in LH: testosterone (<italic>p</italic> = 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.</p></sec><sec><title>Conclusion</title><p>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.</p></sec>