For more than six months now, we have been hearing about how to protect ourselves from the novel coronavirus that had its first outbreak in 2019 in the city of Wuhan, China. The World Health Organization (WHO) set guidelines for the world's population to protect themselves from the coronavirus infection as they declared it a global pandemic: mandatory use of face masks/face coverings and ensuing social distancing at all times when in public. We have even heard several reports on the dangerous implications the coronavirus infection has on our immune system, lungs, heart and overall body, but doctors have now found its alleged ill effects on men's testicles.
The COVID 19 disease is known to cause a range of unpleasant symptoms that include shortness of breath, fever, cough, fatigue, loss of smell and taste. According to relevant data, many viruses such as mumps virus, hepatitis viruses, herpes virus, Influenza (Viral flu), HIV virus and SARS-CoV-1 (severe acute respiratory syndrome coronavirus 1) is very likely to infect the male genital system and as a result impair male fertility. This made scientists curious about whether the covid 19 virus could affect the male reproductive system as well.
It is known that viruses could infect the testis directly. The male reproductive system has an immunosuppressive environment due to the blood-testis barrier which might protect seminal viruses from immune surveillance. For example, mumps viruses have high tropism for the testes, developing Orchitis (inflammation in one or both testicles) in 20% to 30% of cases and could destroy testicular tissue, causing testicular parenchyma. Even though the main mechanism for testicular damage remains unknown as yet to be clarified, the most common hypothesis is that testis degeneration is attributed to an increase in testicular temperature as an indirect effect of the inflammatory milieu.
In March 2020, comments were made by Professor Li Yufeng and his team at the Wuhan's Tongji Hospital's Centre for Reproductive Medicine that affirmed that the COVID 19 virus is capable of causing possible male infertility and other testicular damage in the male coronavirus patients. In their study, which has been widely shared on Chinese social media, Professor Yufeng explained, "New coronavirus infections are mainly caused by damage to the lungs and immune system, but in theory new coronavirus infections can also cause testicular damage."
A study conducted on the 2002 Severe Acute Respiratory Syndrome (SARS) coronavirus outbreak, analyses the impact of the virus on the male reproductive system. Jian Xu, Lihua Qi, Xiaochun Chi, Jingjing Yang and other scholars involved in this research, examined the pathological changes of testes from six patients who died of SARS. Results suggested that SARS caused orchitis. Every SARS infected patient's testes displayed widespread germ cell destruction, few or no spermatozoon in the seminiferous tubule, thickened basement membrane, and leukocyte infiltration. Although symptoms of orchitis in these patients were not observed or reported clinically, the leukocyte infiltration could affect the function of Leydig cells, damage the blood testis barrier, and destroy directly the seminiferous epithelium as the cells stop receiving oxygen and nutrients from the interstitial vasculature. This interference may cause congenital bilateral absence of the vas deferens in males where the tubes that carry sperm out of the testes (the vas deferens) fail to transport sperm through the vas deferens to become part of semen. As a result, male patients with this condition are unable to father children (male infertility) unless they use assisted reproductive technologies.
According to the experts, the new coronavirus known as SARS-CoV-2, is highly similar to the SARS-CoV-1 and the two share the same host cell ACE2 receptor. It enters human cells and causes tissue damage by binding its spike protein to cell membrane protein Angiotensin Converting Enzyme 2 (ACE2). ACE2 is known to be present in other human organs apart from the lungs, especially abundant in a man's testes. It is found concentrated in several cells which are directly related to the male reproductive abilities - the germ cells, supporting cells and Leydig cells, the team claimed. Owing to the similarity in both strains of the virus , the team concluded that, theoretically, the new coronavirus could cause damage to men's testicles and significantly affect their sperm count.
A hospital report warned : 'Therefore, for men who have had the infection, especially those who need to reproduce, it is best to undergo relevant fertility tests, such as sperm quality and hormone level tests, upon recovery to detect possible problems as soon as possible.' Tongji Hospital, affiliated with the Huazhong University of Science and Technology, is one of the foremost hospitals appointed by the government to treat coronavirus patients since the beginning of the outbreak in Wuhan.
Several researches have indicated that some covid 19 patients developed abnormal renal function and even kidney damage in addition to the inevitable harm to the respiratory system, while the related mechanism of the prior is unknown. In another study that used the online datasets to analyze ACE2 expression in different human organs to determine whether coronavirus infection affects the urinary and male reproductive systems. The results ultimately indicated the evident presence of ACE2 in renal tubular cells, Leydig cells and cells in seminiferous tubules in testis. Therefore, the virus might directly bind to such ACE2 positive cells and damage the kidney and testicular tissue of patients. It has been suggested that the renal function be vigilantly evaluated and special care be performed in covid 19 patients during clinical work to measure the kidney damage caused by the virus and antiviral drugs with certain renal toxicity. Moreover, due to the potential pathogenicity of the virus to testicular tissues, clinicians must pay attention to the risk of testicular lesions in patients during hospitalization and later clinical follow up, especially the assessment and appropriate intervention in young male patients' fertility.
The coronavirus disease has claimed over 900,000 lives worldwide as of September, 2020 while the world population awaits a viable vaccine to free them from the fear of contracting this deadly infection. Every day, it is hard to keep up with more serious implications of the viral disease that are discovered, forcing doctors and scientists for more vigilant health care and civilians to be more cautious for maintaining personal and public health.