Possible links between COVID-19 and male fertility

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have a ripple effect that puts men at a risk of infertility. This article reviews the possible link between SARS-CoV-2 infection and male reproduction following speculations that the single- stranded RNA viruses could directly invade the testes. SARS-CoV-2 enters the human lung cells via angiotensin converting enzyme 2 (ACE2). ACEs, its products, angiotensin-(1-7), and its receptor, MAS receptor, are expressed in the testes. Although the binding of SAR-CoV-2 to ACE2 could lead to excess angiotensin II with possible enhanced inflammation, angiotensin II could also promote sperm motility. In addition, the pathophysiology of SAR-CoV-2, especially in relation to male fertility, is yet to be fully understood; the suppression of androgen observed in COVID-19 infected men calls for the need for andrological assessment in infected male.