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Clinical Guidelines and Standards · Guidelines by Issuing Body

SARS-CoV-2 infection, male fertility and sperm cryopreservation: a position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) (Società Italiana di Andrologia e Medicina della Sessualità)

Corona G, Baldi E, Isidori AM, Paoli D, Pallotti F, De Santis L, Francavilla F, La Vignera S, Selice R, Caponecchia L, Pivonello R, Ferlin A, Foresta C, Jannini EA, Lenzi A, Maggi M, Lombardo F

Published August 2020 Journal of endocrinological investigation
DOI 10.1007/s40618-020-01290-w PMID 32462316 PMC PMC7252417

RRM Academy Synopsis

SIAMS says data do not support SARS-CoV-2 in semen of infected men

An Italian andrology society states that available data do not support the virus SARS-CoV-2 in the semen of men who were infected. Its 2020 position statement rests on a review of reports. The authors note that the reports are clinical cases and case series, and a board of experts wrote three statements on the testis and semen.

Key Findings

  • Reports on the earlier SARS-CoV virus listed orchitis, or testicular inflammation, as a possible complication, and no such finding has been reported for SARS-CoV-2.
  • One report found no viral RNA in the semen of a man who had COVID-19, and a second report confirmed this in a small cohort of Chinese subjects.
  • A research letter reported 6 cases of virus-positive semen among severe COVID-19 cases, about 16% of subjects tested; concerns about its methods were raised.
  • Limited evidence showed a significant rise in luteinizing hormone (LH) and a dramatic fall in the testosterone to LH ratio in men with COVID-19, compared with age-matched healthy men of normal fertility.
  • From data on other SARS-CoV infections, the society suggests andrological consultation and gonadal function evaluation, including semen examination, for recovered patients, especially those of reproductive age.

Interpretation

The paper is a position statement based on a literature search and a board of experts. The authors state that all available data on testicular effects come from clinical cases or case series. They call this a major limitation and say more studies are needed for final conclusions. Evidence was too limited for graded recommendations under the Oxford 2011 Levels of Evidence criteria. The concern about the testis draws on the virus entry receptor ACE2 being present in testicular cells, and on findings from the earlier SARS-CoV virus. The statement was written while the pandemic was still spreading.

RRM Context

Restorative reproductive medicine is couple-centered. It looks for underlying causes in both partners, so the male partner is part of the diagnostic question from the start. Other SARS-CoV infections point to a possible effect on the testis. The statement suggests that recovered patients of reproductive age have gonadal function evaluated, including semen examination.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

The recent pandemic of severe acute respiratory syndrome (SARS) due to coronavirus (CoV) 2 (SARS-CoV-2) has raised several concerns in reproductive medicine. The aim of this review is to summarize available evidence providing an official position statement of the Italian Society of Andrology and Sexual Medicine (SIAMS)

Methods

A comprehensive Pubmed, Web of Science, Embase, Medline and Cochrane library search was performed. Due to the limited evidence and the lack of studies, it was not possible to formulate recommendations according to the Oxford 2011 Levels of Evidence criteria.

Results

Several molecular characteristics of the SARS-CoV-2 can justify the presence of virus within the testis and possible alterations of spermatogenesis and endocrine function. Orchitis has been reported as a possible complication of SARS-CoV infection, but similar findings have not been reported for SARS-CoV-2. Alternatively, the orchitis could be the result of a vasculitis as COVID-19 has been associated with abnormalities in coagulation and the segmental vascularization of the testis could account for an orchitis-like syndrome. Finally, available data do not support the presence of SARS-CoV-2 in plasma seminal fluid of infected subjects.

Conclusion

Data derived from other SARS-CoV infections suggest that in patients recovered from COVID-19, especially for those in reproductive age, andrological consultation and evaluation of gonadal function including semen analysis should be suggested. Studies in larger cohorts of currently infected subjects are warranted to confirm (or exclude) the presence of risks for male gametes that are destined either for cryopreservation in liquid nitrogen or for assisted reproduction techniques.

Topics

By this author

Related research

Clinical Guidelines and Standards › Guidelines by Issuing Body › European and United Kingdom Bodies · Male Fertility › Semen Analysis › Sperm Function Testing
Donatella Paoli, Luisa Caponecchia, Andrea Lenzi, Francesco Lombardo
D Paoli, L Caponecchia, A Lenzi, F Lombardo
PMID 32462316 32462316 DOI 10.1007/s40618-020-01290-w 10.1007/s40618-020-01290-w Corona et al. 2020, Corona 2020

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