COVID-19 og mandlig fertilitet - Opdateringen

COVID-19 og mandlig fertilitet - opdateringen
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Can COVID-19 damage sperm?

 

A year on from our (first) lockdown, we wanted to refresh this blog, which was originally posted in April 2020, with the latest research into the impact of Covid-19 on sperm health. 

As most of us will know by now, Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by the coronavirus, also called SARS-CoV-2. The most common symptoms of the coronavirus are fever, tiredness, and dry cough. The virus primarily affects the lungs, as we also see in typical influenza during the winter period. Still, the coronavirus can also enter other human organs that possess the entry protein that the virus uses to enter cells (ACE2). 

But should you fear COVID-19 when it comes to male fertility? What research has been done so far and what have we learned? 

Can the effects of Covid-19 impact sperm indirectly? 

 

In 2020, an early report from Chinese doctors in the Wuhan province suggested that the virus could cause testicular damage. The small report was not enough to draw any conclusions. Therefore, only a few hours after uploading, they deleted it. Since then, there have been further studies on this topic. Although most of them have still been relatively small, they do give some indication as to how Covid-19 could impact sperm health.

A paper published by the journal EClinicalMedicine at the tail end of last year investigated samples from the testis and epididymis (the tube that transports sperm from the testis) of 6 male Covid-19 patients who had passed away and 23 men who were recovering from mild or moderate cases of Covid-19. They did a number of tests, comparing them to men of similar ages who had not had the virus. 

Of the men recovering from Covid, 39% of them had low sperm counts – even though they all had at least one child before contracting the illness. Another interesting discovery was that 61% of the men had an increased number of white blood cells in their semen – which is usually a sign of inflammation – and potentially damaged sperm. Inflammation was also found in the samples taken from men who had died from the virus. 

Research is still inconclusive 

 

Whilst this study shows us some useful data, it’s important to remember that this was a very small sample size – and the researchers did not know what their sperm count or quality was like before they had Covid-19.

Another recent study, again indicated that Covid-19 could impact sperm directly, however, the results have also been brought in to question by fertility experts including Dr Alsion Campbell, Director of Embryology of the CARE Fertility Group who said ‘Overall, men should not be unduly alarmed by this research”. The prospective, cohort study published in Reproduction focused on 84 previously fertile men who had contracted Covid and tested their sperm at 10-day intervals over 60 days. One of the main issues experts have with the study is that they only tested for 60 days, even though we know that sperm regenerates every 72-90 days. 

Whilst the results may indicate short term damage to sperm cells when battling – and being treated for – Coronavirus, this study fails to show us whether this damage is a concern for the long term. Professor Allan Pacey, Professor of Andrology at the University of Sheffield commented “It would have been more useful to see whether there was a difference at 90 days between the two groups. A paper published last year suggested only a small difference in sperm concentration existed by that time.”

Can the effects of Covid-19 impact sperm indirectly? 

 

Hormonal disorders 

 

Recent studies have also highlighted how the impacts of Covid could have an indirect effect on sperm production – particularly via the nervous system. It has been reported that the brain cells (glial cells and neurons) also express ACE 2 receptors, making them a possible target to induce neuronal death for SARS‐CoV‐2. Importantly, the central nervous system plays a critical role in endocrine control and spermatogenesis. Neurons in the hypothalamus secrete a gonadotropin-releasing hormone (GnRH), for example, which triggers the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. Low levels of GnRH results in decreased FSH and LH, which in turn impacts the function of Sertoli cells and Leydig cells which may induce lower sperm quality. 

Schematic representation of the regulation of HPG axis in healthy and COVID-19 conditions.

Figure A represents the healthy human brain and testes in association with the HPG axis. Figure B represents a SARS-CoV-2 infected human brain and testes with neuroinflammation and dysregulation of the HPG axis in association with reduced steroidogenesis and spermatogenesis due to testicular inflammation and oxidative stress.

 

Covid 19 and fertility

Mental Health

 

Another way in which Covid could indirectly affect sperm health is its impact on our mental wellbeing. Depression and anxiety – which have increased for the general population during the pandemic, and have particularly affected those who have suffered from Covid 19 – are associated with increased levels of cortisol and prolactin – hormones associated with stress. This can have a knock-on effect on male fertility – you can read more about the impact of stress on sperm production here. 

 

How other viruses impact sperm count and quality

 

Whilst we wait for more research to be undertaken, we can look at how other, similar infections impact the body. We also know that many different factors both inside and outside the human body affect sperm production. Scientific papers show that infections that increase body temperature have a negative impact on semen quality. This is most likely a response to the increased heat, which harms semen quality. Interestingly, a case study from 2007 showed that fevers could have marked effects on not only semen parameters but also the sperm’s DNA [2][3]. This was a relatively short-term effect, normalizing about two months after the fever.

Genital tract infections can affect sperm directly, while viruses or bacterial infections not entering the genital tract may lower sperm production due to the fever effect [1][3]. One of the most well-known virus-induced infections leading to infertility is mumps. Infection with mumps results in an inflammation of the testicles (orchitis), causing permanent damage.

 

But are there any permanent effects of COVID-19 on male fertility?

First of all, it is essential to say that there are many people who have become infected with COVID-19 that don’t show any symptoms or feel unwell. Secondly, researchers have so far confirmed that about 80% of those infected with COVID-19 recover from the disease without needing special treatment. At present, it is too early to conclude anything about the permanent effects of a COVID-19 infection on male fertility.

The fever-effect of a coronavirus infection is, if it occurs, most likely a short-term effect. This was demonstrated in a case study from 2007 where the semen parameters return to the pre-fever levels approximately two months after recovering from the fever [3].

Covid19 graph

What to do in case of any concerns?

You can evaluate your sperm health with a sperm test. An easy and accurate way of doing this could be the ExSeed at Home sperm kit. It includes five sperm tests. This way you can test your current sperm quality and track sperm parameters over time if you have any concerns.

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Brug af stramme bukser og undertøj

Undersøgelser viser, at mænd, der bærer løsere undertøj, har en højere sædkoncentration og et højere samlet antal sædceller sammenlignet med mænd, der bærer strammere undertøj. Så smid det stramme tøj og tag noget løst tøj på for at give dine testikler lidt luft.

KONKLUSION: Få mere at vide om, hvordan varme kan påvirke sædkvaliteten her.

Stress

Ud over en højere dødelighed og forskellige sygdomme er stress forbundet med lav sædkvalitet. Stress er kendt for at være forbundet med lavere testosteronniveauer og oxidativ stress, der begge spiller en vigtig rolle i produktionen og opretholdelsen af sunde sædceller.

KONKLUSION: Hvis du føler dig stresset, anbefaler vi, at du får hjælp, så du kan få et afbalanceret mentalt helbred. Du kan downloade en vejledning i stresshåndtering i ExSeed-appen gratis, og start din personlige handlingsplan i dag.

Fysisk aktivitet

Videnskabelige undersøgelser viser, at mænd, der er fysisk aktive, har bedre sædparametre end mænd, der er inaktive. Fertilitetsspecialister siger også, at regelmæssig fysisk aktivitet har en gavnlig indvirkning på sædets fertilitetsparametre, og at en sådan livsstil kan forbedre mænds fertilitetsstatus.

Hvis du prioriterer motion, kan du forbedre dit generelle helbred og få sunde, hurtigt svømmende sædceller, der har gode chancer for at befrugte et æg.

KONKLUSION: Prøv at indarbejde motion i din ugentlige planlægning, så du sikrer, at du træner mindst to gange om ugen. Vi anbefaler en kombination af konditionstræning og styrketræning. Læs mere om motion og mandlig fertilitet på vores blog.

Ernæring

Fastfood
Forarbejdede fødevarer skader sædproducerende cellers sundhed og forårsager oxidativ stress, hvilket fører til dårligere sædkvalitet. Et stort forbrug af junkfood (hver uge) kan øge sandsynligheden for infertilitet, da mænd, der indtager store mængder usund mad, er i risiko for at få dårlig sædkvalitet. Ud over at skade din frugtbarhed øger junkfood din talje, skader dit hjerte-kar-system, dine nyrer og meget mere.

Grøntsager
Hvis du spiser mere frugt og grøntsager, kan du øge din sædkoncentration og motilitet. Det er vigtigt, at du spiser en sund kost fyldt med antioxidanter, og at du spiser grøntsager hver dag. Fødevarer som abrikoser og røde peberfrugter har et højt indhold af A-vitamin, som forbedrer mænds fertilitet ved at nære sundere sædceller. Mænd, der har mangel på dette vitamin, har tendens til at have langsomme og sløve sædceller.

Sukkerholdige snacks/drikkevarer: flere gange om ugen Overdreven indtagelse af sukkerholdige produkter kan føre til oxidativt stress, hvilket har en negativ indvirkning på testosteronniveauet og sædmotiliteten. Sukkerholdige snacks og drikkevarer er også i høj grad forbundet med fedme og lav frugtbarhed.
KONKLUSION: For at øge sædkvaliteten skal du holde dig fra fastfood, forarbejdede fødevarer og sukkerholdige snacks eller drikkevarer. Du skal implementere en sund og fornuftig kost fyldt med de nødvendige superfoods, der er nødvendige for en god sædproduktion. Tjek vores guide til Superfoods til mandlig fertilitet. Til personlig vejledning og støtte til, hvordan du kan begynde at forbedre din sædkvalitet, kan du tjekke den Bootcamp.

Varme

Direkte varme kan hæmme optimal sædproduktion og forårsage DNA-skader på sædceller. Sædceller kan lide omgivelser, der er et par grader lavere end kropstemperaturen. Undgå overophedning fra varme tæpper, sædevarmere, varme fra din bærbare computer, varme brusere og saunaer.

Cigaretrøgning

Eksponering for tobaksrøg har betydelige negative virkninger på sædkvaliteten. Skaden af cigaretter og nikotin afhænger naturligvis af, hvor mange cigaretter du ryger om dagen og hvor længe, men selv et lavt forbrug (op til 10 cigaretter/dag) kan hæmme en sund sædproduktion.  

KONKLUSION: Hold dig så langt væk fra cigaretrygning som muligt, hvis du er interesseret i dit generelle helbred og din fertilitet. Læs mere her.

Mobiltelefon

Når du har din mobiltelefon i din forlomme, udsættes dine testikler for elektromagnetisk stråling, som undersøgelser har vist, at den skader sædcellerne. Læg din telefon i baglommen på dine bukser eller i din jakkelomme.

BMI

Der er en klar sammenhæng mellem fedme og nedsat sædkvalitet. Dette skyldes i det mindste til dels, at overvægtige mænd kan have unormale reproduktive hormonprofiler, hvilket kan forringe sædproduktionen og føre til infertilitet. 

Et BMI på over 30 kan føre til flere processer i kroppen (overophedning, stigning i oxidativ stress i testiklerne, DNA-skader på sædcellerne, erektil dysfunktion), som kan have en negativ indvirkning på mandens fertilitet. Dette kan resultere i problemer, når man forsøger at blive gravid.  

KONKLUSION: BMI er en af de risikofaktorer, der påvirker sædkvaliteten og f.eks. sædmotiliteten.