Impaired spermatogenesis in COVID-19 patients

Honggang Li; Xingyuan Xiao; Jie Zhang; Mohammad Ishraq Zafar; Chunlin Wu; Yuting Long; Wei Lu; Feng Pan; Tianqing Meng; Kai Zhao; Liquan Zhou; Shiliang Shen; Liang Liu; Qian Liu; Chengliang Xiong

doi:10.1016/j.eclinm.2020.100604

Impaired spermatogenesis in COVID-19 patients

EClinicalMedicine. 2020 Nov:28:100604. doi: 10.1016/j.eclinm.2020.100604. Epub 2020 Oct 23.

Authors

Honggang Li^{1

2}, Xingyuan Xiao³, Jie Zhang⁴, Mohammad Ishraq Zafar¹, Chunlin Wu⁵, Yuting Long², Wei Lu⁶, Feng Pan³, Tianqing Meng², Kai Zhao¹, Liquan Zhou¹, Shiliang Shen⁶, Liang Liu⁴, Qian Liu⁴, Chengliang Xiong^{1

2}

Affiliations

¹ Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, China.
² Wuhan Tongji Reproductive Medicine Hospital, Sanyang Road 128, Wuhan 430013, China.
³ Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1277, Wuhan 430022, China.
⁴ Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, China.
⁵ Department of Obstetrics and Gynaecology, The No.1 Hospital of Wuhan, Zhongshan Avenue 215, Wuhan 430022, China.
⁶ Department of Pathology, Kindstar Global, Gaoxin Avenue 666, Wuhan 430075, China.

Abstract

Background: The current study aimed to determine the impact of SARS-CoV-2 infection on male fertility.

Methods: This is a single-center, hospital-based observational study that included autopsied testicular and epididymal specimens of deceased COVID-19 male patients (n=6) and recruited recovering COVID-19 inpatients (n=23) with an equal number of age-matched controls, respectively. We performed histopathological examinations on testicular and epididymal specimens, and also performed TUNEL assay and immunohistochemistry. Whereas, we investigated the semen specimen for sperm parameters and immune factors.

Findings: Autopsied testicular and epididymal specimens of COVID-19 showed the presence of interstitial edema, congestion, red blood cell exudation in testes, and epididymides. Thinning of seminiferous tubules was observed. The number of apoptotic cells within seminiferous tubules was significantly higher in COVID-19 compared to control cases. It also showed an increased concentration of CD3+ and CD68+ in the interstitial cells of testicular tissue and the presence of IgG within seminiferous tubules. Semen from COVID-19 inpatients showed that 39.1% (n=9) of them have oligozoospermia, and 60.9% (n=14) showed a significant increase in leucocytes in semen. Decreased sperm concentration, and increased seminal levels of IL-6, TNF-α, and MCP-1 compared to control males were observed.

Interpretation: Impairment of spermatogenesis was observed in COVID-19 patients, which could be partially explained as a result of an elevated immune response in testis. Additionally, autoimmune orchitis occurred in some COVID-19 patients. Further research on the reversibility of impairment and developing treatment are warranted.

Funding: This study was supported by Ministry of Science and Technology of China Plan, Hubei Science and Technology Plan, National Key Research and Development Program of China, HUST COVID-19 Rapid Response Call, China and National Natural Science Foundation of China; these funding bodies are public institutions, and they had no role in study conception, design, interpretation of results, and manuscript preparation.

Keywords: Autoimmune orchitis; Covid-19; Male infertility; Oligospermia; Spermatogenesis.