Dr. Sadeghi-Nejad discusses men’s health and fertility issues related to COVID-19
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It's a pleasure to be here. You had asked me to talk about the effects of COVID-19 infection on male reproductive function, as well as the effects of vaccination on reproductive function that includes male fertility, as well as sexual dysfunction. The truth is, in 2022, there is still very little that we know about this. And most of the studies are very preliminary and based on case reports, but there are a few important facts that we should all be aware of. One is that we are seeing patients who are presenting with altered fertility parameters. Their semen analyses are not as robust as they had been before. And this is during the infection or occasionally soon after the infection. But the good news is that seems to be a transient effect; there are really very few cases of documented COVID-19 making it into the semen. There is evidence that the virus can be found in the testis itself, the testis has an abundance of what we call angiotensin converting enzyme type two or ACE2 receptors. And this receptor is one for which the virus has an affinity and it therefore it can get into the testis. And this is by the way, the same receptor in the lung tissue in the respiratory system that the virus binds to. So this binding and the effects on the test is may explain part of the mechanism as to why reproductive function in men can be affected, ie, we know that men can have lower testosterone levels. Since most of the circulating testosterone comes from the testis, we believe that one of the effects at least during the acute stage of the infection is decreased testosterone level, and there is a pituitary brain hormone called luteinizing hormone or LH, that essentially goes up this is a mechanism for encouraging if you want to test this to make more testosterone since the circulating testosterone is decreased. So in summary, in a lot of these men, we see lower testosterone levels and elevated LH levels. But this typically is a transient phenomenon, which is encouraging and it's important for patients to know that. But also, there are some fascinating studies that show that the degree of this decrease in testosterone levels actually correlates with the severity of the COVID 19 infection. And in fact, those with COVID-19 pneumonia, as a group tend to have lower testosterone levels than then those that have milder versions of the infection. So this is all very interesting and encouraging information.
One of my colleagues at University of Miami, Dr. Ramaswamy, had done some studies, looking at penile tissues tissue inside the penis of COVID infected patients and actually found evidence of the virus in the penis. And where we think that comes in is that the vascular bed of the penis as the rest of our bodies has what we call endothelial cells and these vascular lined cells or rather, sort of the lining of the vasculature has these endothelial cells, which are also affected by the COVID-19. And this is the same mechanism by the way that can lead to what many patients may have heard of as thrombotic complications, patients can have disorders and clotting mechanism and even pulmonary embolism and all of this is related to the disruption in the vasculature which can happen during the acute phase of the infection.
The mechanism therefore, of affecting men's reproductive health, whether it be fertility or sexual dysfunction, has many possible causes. One of them as we said is vascular damage/endothelial damage, which by the way, as a general rule, this is not a COVID related issue that we have become aware of, but we have known that, for example, nitric oxide, which is a chemical in our bodies, that is released by these endothelial cells is a mediator of the vasodilation the dilation of the blood vessels that It isn't part of normal erection. And you can imagine that if that process is disrupted, then you will have you have changes in nitric oxide production and therefore, possible problems and erectile dysfunction. Again, fortunately, much of this is thought to be transient. And with the passage of time, we'll get better but the information is preliminary.
Another very important thing for our viewers to be aware of is that in terms of fertility, as I said, we know that the important parameters of the semen analysis, meaning sperm concentration, sperm motility, and morphology, can be affected during the acute phase. But there's absolutely no evidence that these parameters, nor the parameters that my female reproductive endocrinology colleagues look at as the important IVF parameters for in vitro fertilization, are affected by the vaccine. So as recently as April of 2022, the American Society of Reproductive Medicine strongly encourages us to talk to patients, those who are pregnant or those who are considering pregnancy, to be vaccinated, because there's absolutely no evidence that vaccination can adversely affect these fertility parameters. And that's also important for patients to be aware of.
And lastly, there are some very unusual side effects and the reproductive function that we see for example, there have been a few case reports of priapism. Priapism is a prolonged erection that typically lasts three to four beyond three to four hours and that compartment syndrome like phenomenon, meaning the pressure building up in the in the in the penis from a prolonged direction can actually itself lead to erectile dysfunction. And as I said, there have been a few cases of priapism reported in association with the COVID 19 infection. And the mechanism of that again appears to be disruption of the vascular system, an abnormal clotting process, which then leads to a thrombosis or the blood sort of staying around the penis and not draining normally, leading to this prolonged direction. Very rare phenomenon, not something for patients to be alarmed about, but rather be aware of in case they experienced that during an acute COVID 19 infection. And again, perhaps the most important message I want to relay is that to date, we have no information whatsoever, that vaccination causes a disruption of these mechanisms or that vaccination affects fertility adversely. And on the female side, as I mentioned, the ASRM—the American Society of Reproductive Medicine—strongly encourages discussing vaccination with our patients.