Sperm quality and absence of SARS-CoV-2 RNA in semen after COVID-19 infection: a prospective, observational study and validation of the SpermCOVID test

Objective: To study the contagiousness of sperm and its influence on fertility after recovery from COVID-19 infection. Design: Prospective cohort study. Setting: University medical center. Patient(s): One hundred twenty Belgian men who had recovered from proven COVID-19 infection. Intervention(s): No intervention was performed. Main outcome measure(s): Semen quality was assessed using the World Health Organisation criteria. DNA damage to sperm cells was assessed by quantifying the DNA fragmentation index and the high density stainability. Finally antibodies against SARS-CoV2 spike-1 antigen, nuclear and S1-receptor binding domain were measured by Elisa and chemilumenscent microparticle immunoassays, respectively. Result(s): SARS-CoV-2 RNA was not detected in semen during the period shortly after infection nor at a later time. Mean progressive motility was reduced in 60% of men tested shortly (<1 month) after COVID-19 infection, 37% of men tested 1 to 2 months after COVID19 infection, and 28% of men tested >2 months after COVID-19 infection. Mean sperm count was reduced in 37% of men tested shortly (<1 month) after COVID-19 infection, 29% of men tested 1 to 2 months after COVID-19 infection, and 6% of men tested >2 months after COVID-19 infection. The severity of COVID-19 infection and the presence of fever were not correlated with sperm characteristics, but there were strong correlations between sperm abnormalities and the titers of SARS-CoV-2 IgG antibody against spike 1 and the receptor-binding domain of spike 1, but not against nucleotide, in serum. High levels of antisperm antibodies developed in three men (2.5%). Conclusion(s): Semen is not infectious with SARS-CoV-2 at 1 week or more after COVID-19 infection (mean, 53 days). However, couples with a desire for pregnancy should be warned that sperm quality after COVID-19 infection can be suboptimal. The estimated recovery time is 3 months, but further follow-up studies are under way to confirm this and to determine if permanent damage occurred in a minority of men. (Fertil Sterile 2022;117:287-96. (c) 2021 by American Society for Reproductive Medicine.) El resumen esta disponible en Espanol al final del articulo.

Automated summary

This study aimed to investigate the contagiousness of sperm and its impact on fertility after COVID-19 infection. A prospective cohort study was conducted on Belgian men who had recovered from the infection. The results showed that SARS-CoV-2 RNA was not detected in the semen of the participants. However, a decrease in sperm motility was observed in a significant percentage of men shortly after COVID-19 infection. The study also found that sperm quality might be compromised after COVID-19 infection, but further follow-up studies are needed to confirm the recovery time and the possibility of permanent damage.