P-003 Impact of SARS-CoV-2 infection on circulating male sex hormones and human semen quality: a systematic review and meta-analysis

Abstract Study question Does SARS-CoV-2 infection alter human male sex steroid hormones and semen quality? Summary answer SARS-CoV-2 infection reduced circulating testosterone but increased LH and prolactin levels. Also, SARS-CoV-2 infection reduced ejaculate volume, sperm count, concentration, viability, motility, and normal morphology. What is known already SARS-CoV-2 infection has been reported to be associated with a decline in semen quality, although this remains debatable given the novelty of the viral infection. In addition, available data on semen quality and circulating male reproductive hormones in association with SARS-CoV-2 infection is limited and inconsistent. Study design, size, duration This study provides a systematic review and meta-analysis of the impacts of SARS-CoV-2 infection on circulating male sex hormones and semen quality. Participants/materials, setting, methods This study was conducted according to PRISMA guidelines. Following a pre-defined strategic protocol, 852 studies were screened, and 40 articles were identified as eligible for this study. Included studies were from China (7), Germany (1), India (1), Indonesia (1), Iran (6), Iraq (2), Italy (5), Jordan (2), Russia (1), Turkey (12), UK (1), and USA (1). Main results and the role of chance A total of 4807 male subjects were included in the meta-analysis. SARS-CoV-2 infection significantly reduced circulating testosterone and testosterone/LH ratio (an index of Leydig cell function) but increased LH and prolactin levels even after sensitivity analysis when compared to SARS-CoV-2 uninfected patients. Also, SARS-CoV-2 infection significantly reduced ejaculate volume, sperm count, concentration, viability, total and progressive motility when compared to SARS-CoV-2 uninfected patients, although only ejaculate volume and sperm viability remained significant after sensitivity analysis. More so, ejaculate volume, sperm viability, and progressive motility were significantly reduced in SARS-CoV-2-infected patients before treatment when compared with after treatment; nonetheless, only sperm viability, and progressive motility remained significant after sensitivity analysis. Furthermore, ejaculate volume, sperm count, concentration, viability, total and progressive motility were significantly reduced in SARS-CoV-2-infected patients when compared with their pre-COVID state; these alterations, except sperm progressive motility, persisted after sensitivity analysis. Limitations, reasons for caution Although there is an increasing amount of data on the subject matter, SARS-CoV-2-infection is yet novel, and a continuous report and meta-analysis remains pertinent. Also, the included studies are from a few countries, which may not necessarily be a good global representation. Wider implications of the findings This study revealed that SARS-CoV-2-infection significantly reduced circulating testosterone, LH, and semen quality. SARS-CoV-2-induced reduction in semen quality is, at least in part, via a testosterone-dependent mechanism. These findings strengthen existing evidence in the literature on the negative impact of SARS-CoV-2-infection on male reproductive health. Trial registration number N/A