Two delicate questions have emerged from the coronavirus pandemic and subjected to a lot of scrutiny:

Can the SARS-CoV-2 virus infect semen and be spread via sexual intercourse?

And does COVID-19 reduce fertility in men?

Based on the evidence so far, it’s probably no to the first question. You can’t catch the virus by having sex, unless you sneeze all over your loved one.

A large literature review published in January found that most of the studies “reported the absence of SARS−COV-2 in the semen and prostatic secretions, as well as testicular tissues, which may reduce the possibility of transmission through this route.”

In other words, the virus isn’t harboured and doesn’t breed in the testicles or sperm. However, researchers continue to investigate the possibility.

That’s the good news

The bad news is that, according to the review, carried out by researchers from South Africa and the UAE, male COVID-19 patients sustain damage to the testicles and sperm.

The review found that “it is evident that:

• There is testicular injury and inflammatory infiltration
• Viral orchitis (swelling) may occur, as patients experienced scrotal discomfort
• There are altered semen parameters and
• The number of spermatozoa with DNA fragmentation is increased.”

Sperm DNA fragmentation describes abnormal genetic material within the sperm, which in turn may lead to male sub-fertility, IVF failure and miscarriage.

The authors write: “These results collectively suggest that infection with SARS−COV-2 may lead to potential fertility issues.”

Although, it’s probably more correct to say that the disease, COVID-19, causes this damage, rather than the virus.

Other studies point to reproductive injury

The conclusion of the South African review is supported by a number of small studies that found COVID-19 appears to negatively affect sperm quality, increases sperm cell death, causes painful swelling in the scrotum and potentially reduces fertility in men.

An observational study by German and Iranian researchers concluded that men recovering from COVID-19 “may find it harder to conceive, due to abnormally low sperm quality.”

Men recovering from COVID-19 may suffer from “abnormally low sperm quality”.

The researchers suggest reproductive function should be monitored and evaluated by health professionals following infection, to detect and avoid more severe reproduction problems in the future.

The results from this study “also suggest that the male reproductive system should be considered a vulnerable route of COVID-19 infection and should be declared a high-risk organ by the World Health Organisation.”

So what’s the main agent of destruction?

One of the hallmarks of COVID-19 is damaging inflammation. It’s been found in the brain, where it appears to cause delerium, seizures and neurological deficits.

It’s been found in the feet, known as COVID toes, and looking much like a bad case of chilblains.

And of course it’s killed millions by invading their lungs.

So it’s no great surprise that researchers from Wuhan, China, in a newly published paper, say the damage to the male reproductive system is “in large part by inflammatory damage caused by a cytokine storm.”

But there is also orchitis to consider. This is an inflammation of one or both testicles, caused by bacterial or viral infections, including sexually transmitted diseases.

It’s painful and can damage fertility. Any teenager or adult coming down with a dose of mumps is generally told that if they don’t submit to bed rest, they risk losing their baby-making abilities.

Some querying dissent

Researchers not involved with the German study have pointed out that any kind of serious illness tends to temporarily inhibit sperm production.

So it’s possible that the damage described in this and other studies may not be a consequence of COVID-19 per se, but a result of being sick.

They also note that the participants in the study were heavily medicated hospital patients, and those drugs may have had an effect on sperm production and quality.

Professor Alison Murdoch, Head of Newcastle Fertility Centre at Life, Newcastle University, said, in a prepared statement:

“This study finds evidence of impaired semen production and sperm function in men after significant COVID-19 infection. It is well documented that adverse changes are frequently seen after systemic illness with recovery typically taking at least three months.

“As the authors acknowledge, their findings may be such a non-specific response. Thus, longer term studies are needed before the testes is considered to be a high-risk organ specific to COVID-19.”

It’s also unknown if the damage is permanent, as it can be with mumps, or temporary as it is with the flu. Or both, depending on circumstances.