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Meta-Analysis
. 2024 Sep 9;19(9):e0307396.
doi: 10.1371/journal.pone.0307396. eCollection 2024.

SARS-CoV-2 impairs male fertility by targeting semen quality and testosterone level: A systematic review and meta-analysis

Ashonibare V J  1   2 , Ashonibare P J  2   3 , Akhigbe T M  2   4 , R E Akhigbe  2   3
Affiliations
Meta-Analysis

SARS-CoV-2 impairs male fertility by targeting semen quality and testosterone level: A systematic review and meta-analysis

Ashonibare V J et al. PLoS One. .

Abstract

Background: Since the discovery of COVID-19 in December 2019, the novel virus has spread globally causing significant medical and socio-economic burden. Although the pandemic has been curtailed, the virus and its attendant complication live on. A major global concern is its adverse impact on male fertility.

Aim: This study was aimed to give an up to date and robust data regarding the effect of COVID-19 on semen variables and male reproductive hormones.

Materials and methods: Literature search was performed according to the recommendations of PRISMA. Out of the 852 studies collected, only 40 were eligible for inclusion in assessing the effect SARS-CoV-2 exerts on semen quality and androgens. More so, a SWOT analysis was conducted.

Results: The present study demonstrated that SARS-CoV-2 significantly reduced ejaculate volume, sperm count, concentration, viability, normal morphology, and total and progressive motility. Furthermore, SARS-CoV-2 led to a reduction in circulating testosterone level, but a rise in oestrogen, prolactin, and luteinizing hormone levels. These findings were associated with a decline in testosterone/luteinizing hormone ratio.

Conclusions: The current study provides compelling evidence that SARS-CoV-2 may lower male fertility by reducing semen quality through a hormone-dependent mechanism; reduction in testosterone level and increase in oestrogen and prolactin levels.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flowchart for the strategic identification, screening, and inclusion of eligible studies.
Fig 2
Fig 2
Forest plot of ejaculate volume comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 3
Fig 3
Funnel plot of ejaculate volume comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 4
Fig 4
Forest plot of sperm count comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 5
Fig 5
Funnel plot of sperm count comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 6
Fig 6
Forest plot of sperm concentration comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 7
Fig 7
Funnel plot of sperm concentration comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 8
Fig 8
Forest plot of sperm viability comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 9
Fig 9
Funnel plot of sperm viability comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 10
Fig 10
Forest plot of total sperm motility comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 11
Fig 11
Funnel plot of total sperm motility comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 12
Fig 12
Forest plot of progressive sperm motility comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 13
Fig 13
Funnel plot of progressive sperm motility comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 14
Fig 14
Forest plot of normal sperm morphology comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 15
Fig 15
Funnel plot of normal sperm morphology comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 16
Fig 16
Forest plot of seminal leukocyte count comparing between COVID-19 positive and COVID-19 negative patients (A) and before COVID-19 treatment and after COVID-19 treatment (B).
Fig 17
Fig 17
Funnel plot of seminal leukocyte count comparing between COVID-19 positive and COVID-19 negative patients (A) and before COVID-19 treatment and after COVID-19 treatment (B).
Fig 18
Fig 18
Forest plot of serum testosterone level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 19
Fig 19
Funnel plot of serum testosterone level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 20
Fig 20
Forest plot (A) and funnel plot (B) of serum oestrogen level comparing between COVID-19 positive and COVID-19 negative patients.
Fig 21
Fig 21
Forest plot of serum prolactin level comparing between COVID-19 positive and COVID-19 negative patients (A) and before COVID-19 treatment and after COVID-19 treatment (B).
Fig 22
Fig 22
Funnel plot of serum prolactin level comparing between COVID-19 positive and COVID-19 negative patients (A) and before COVID-19 treatment and after COVID-19 treatment (B).
Fig 23
Fig 23
Forest plot of serum luteinizing hormone (LH) level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 24
Fig 24
Funnel plot of serum luteinizing hormone (LH) level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 25
Fig 25
Forest plot of serum follicle-stimulating hormone (FSH) level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 26
Fig 26
Funnel plot of serum follicle-stimulating hormone (FSH) level comparing between COVID-19 positive and COVID-19 negative patients (A), before COVID-19 treatment and after COVID-19 treatment (B), and COVID-19 positive and preCOVID-19 period (C).
Fig 27
Fig 27
Forest (A) and funnel (B) plots of serum testosterone/luteinizing hormone (T/LH) ratio comparing between COVID-19 positive and COVID-19 negative patients.
Fig 28
Fig 28
Forest (A) and funnel (B) plots of serum follicle-stimulating hormone/luteinizing hormone (FSH/LH) ratio comparing between COVID-19 positive and COVID-19 negative patients.
Fig 29
Fig 29. The Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of the current study.
See this image and copyright information in PMC

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Grants and funding

The author(s) received no specific funding for this work.