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There are voices from Wuhan that coronavirus infection may have a negative impact on male fertility. So far, there is no evidence, but scientists cite studies that proved several years ago that the SARS virus – similar to the new coronavirus – causes complications in the form of testicular inflammation.
What did Wuhan scientists find out?
Young men at highest risk? The report of Chinese scientists from Wuhan was deleted from the Internet by government authorities just hours after its publication!
According to doctors at a Wuhan hospital, men who contract COVID-19 and recover should seek medical advice about the “theoretical” risks to their reproductive health. Despite the shocking report being removed by government authorities as scientifically unsubstantiated, the article quickly took a life of its own on Chinese social media.
A dozen or so days ago, prof. Li Yufeng and his colleagues at the Wuhan Hospital Center for Reproductive Medicine published a report stating that SARS-CoV-2 coronavirus may impair male fertility, as does the SARS-CoV-1 virus responsible for the SARS outbreak in China in 2002 and 2003. At that time, cases of testicular inflammation in men were reported, leading to severe damage to them. In the opinion of Chinese researchers, SARS-CoV-2 may have a very similar effect on the testes, although only in theory, because no one has yet conducted studies that would confirm this thesis.
However, every week there is more research on the SARS-CoV-2 coronavirus and the disease it causes – referred to as COVID-19. There have been serious concerns about the future of male fertility among scientists around the world who are studying the virus, the disease it causes and its complications, following the publication of an as yet unreaded article by the Chinese.
The ACE2 receptor and male fertility
And there are indeed reasons for concern, because – as it turns out – male gonads are characterized by a fairly high expression of the ACE2 receptor. The results of the research showed that the protein and ACE2 mRNA expression in the testes is much higher than in many other organs and tissues, and this may give the impression, as one Chinese professor put it, that the virus appears to be “targeted” not only at the lungs or the kidneys, but also in the testicles.
Male gonads consist, inter alia, of seminal tubules, which are “lined” with Sertoli’s cells, whose task from adolescence to late old age is, inter alia, sperm production. In a study conducted in Wuhan high levels of ACE2 expression were observed both in the seminal tubules containing Sertoli cells and in Leydig cells. Leydig cells, also known as testicular interstitial cells, are mainly responsible for the production of testosterone, which is responsible, among others, for for the maturation of boys and the development of male characteristics. In adulthood, its deficiency can most often result in symptoms such as decreased libido and erectile dysfunction.
Men with hypogonadism, i.e. too low testosterone levels, additionally have an even higher risk of developing various metabolic diseases, such as diabetes, osteoporosis, metabolic syndrome and an increased risk of atherosclerosis. They are also characterized by a higher risk of depression, they are less self-confident, more often tired, and their concentration is usually worse.
Leydig cells also produce renin, which, through plasma angiotensin, regulates testosterone synthesis.
On the other hand, the changes leading to the damage of Sertoli cells, which – as mentioned before – may lead to serious impairment of fertility, including its complete loss.
There is still no scientific evidence
As Chinese researchers suggest, based on the knowledge about the SARS-CoV1 virus, which they have had for over 15 years, getting COVID-19, due to the similarity of two viruses, increases the risk of testicular inflammation, and sometimes also in predisposed people, it may contribute to the formation of tumors testicles and severe fertility problems including complete loss of fertility.
To the present however, no one has officially proved that SARS-CoV-2 led to symptomatic orchitis and severely impaired fertility or induced primary hypogonadism. Firstly, no one has conducted this type of research on a larger scale, but it cannot be ruled out that the effects in the form of deterioration of fertility will appear with some delay, after the underlying disease has subsided.
If the black scenario of Chinese scientists were to be confirmed, the biggest problem on a global scale would be the decline in the fertility of the part of the male population infected with the virus. As for the decrease in testosterone production, it is not a big problem for modern medicine.
Taking into account the report of scientists from the hospital in Wuhan, it is worth drawing the attention of scientists in other countries most affected by the pandemic to investigate this particularly sensitive topic more closely.
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Chinese scientists in their theory support the influence of the SARS virus on male fertility, described several years ago. Both viruses – both SARS-CoV-1 and the current one, which is the cause of the global SARS-CoV-2 pandemic, seem to have significant affinity for tissues showing higher ACE2 receptor expression.
However, in the case of the virus that causes COVID-19, no one has specifically focused on male fertility yet. There have also been no reports of hypogonadism among men who have already been cured. Officially, no one has conducted such research yet. However, for some time now doctors in China recommend that patients who have recovered have an assessment of testicular function, both in terms of testosterone production as well as spermatogenesis and sperm production.
What was the situation with the SARS-CoV-1 virus at the beginning of the XNUMXst century? The material from that period is also not very large.
In one study conducted years ago that looked at testicular lesions in six patients who died from SARS, the results indicated widespread inflammation of the testicles. In the entire group of people who died due to SARS, gonadal damage was found, with little or no sperm in the seminal tubules. In addition, a thickened basement membrane and leukocyte infiltrates were observed.
Compared to the control group, the testes of people who died from SARS were characterized by a greater number of CD3 + T cells and CD68 macrophages, much greater amounts of which were observed in the interstitial tissue compared to the control group. The researchers were surprised by the fact that no SARS viral genomic sequences were detected in the testes by in situ hybridization.
However, immunohistochemical studies have shown abundant precipitation of Ig G in the epithelium of the seminiferous tubules of people suffering from SARS, indicating a possible excessive immune response as the cause of the damage. Scientists then clearly identified orchitis as one of the complications of SARS. They also suggested in their study conclusions that reproductive function should be monitored in men who have had coronavirus infection.
A similar excessive inflammatory response occurs in the lungs of COVID-19 patients, causing them serious damage, including subsequent fibrosis.
Are young people at risk too?
Chinese scientists are currently most concerned about the fertility of young men of childbearing age and boys (although these may be more protected by certain natural mechanisms). Young people, because COVID-19 disease often passes asymptomatically or asymptomatically. At the same time, they are a group of people who most often disregard the government’s prohibitions and WHO guidelines. It is possible that these carefree young French people, who are now walking in large groups in the streets and having fun, and recently not doing anything about the official recommendations prohibiting staying in larger groups, will be struggling with fertility disorders and hypogonadism in a few years. May I be wrong, but it is better not to tempt fate and draw certain conclusions.
Read also: WHO chief to the young: “you are not invincible”
Report deleted from government sites
The report prepared by Chinese scientists from a hospital in Wuhan was available online for several hours on government websites. However, it was quickly removed by them. The official reason was the information that the theses contained in it are not officially confirmed by any studies and after the content of the report was leaked to social media, this information sowed great concern among young people.
Perhaps there are some positive sides to the situation, as this information made the younger male part of the Chinese population more obey the government’s recommendations. It turned out that the loss of the hormonal function of the testicles and the loss of fertility are something that teenagers and young men would like to avoid at all costs.
So far, no one has yet proven that the 2019-nCoV coronavirus leads to symptomatic orchitis and impairs fertility or causes primary hypogonadism. The biggest problem, much larger on a global scale, would be damage to the testicles leading to infertility. When it comes to too low testosterone production, modern medicine can easily deal with this problem.. It is worth drawing the attention of scientists to investigate this topic further, and if the theories of Chinese scientists are confirmed, additional work to find an effective drug should be started as soon as possible.
Will the new virus epidemic reduce fertility?
Chinese scientists in their theory support the influence of the SARS virus on male fertility, described many years ago. Both viruses appear to have an affinity for tissues that express the ACE2 receptor more, but in the case of the virus that causes COVID-19, no one has focused particularly on male fertility. It has not yet been reported that men who have been cured have a lower testosterone production, because no one has conducted such studies.
However, some doctors in China recommend that patients who have recovered should have their testicles checked for both testosterone production and sperm quality. This is especially true for people whose disease was more severe.
Fortunately, despite the high expression of the receptor in the kidneys, only about 19% of them become inflamed in the course of more severe forms of COVID-10. people. The nuclei have a slightly lower receptor expression, hence there is a chance that only a few percent of men will get damaged.
Doctors in China, however, continue to urge coronavirus-infected men to assess their fertility as soon as they recover. In their opinion, the infection may lead to damage to some functions of the testicles, because the similarity of the SARS-CoV-2 virus with the one we dealt with during the SARS epidemic at the beginning of the 1st century, i.e. SARS-CoV-2, is very high. Time will show what effect the SARS-CoV-XNUMX coronavirus will ultimately have on male gonads and whether it contributes to the global decline in fertility rates.
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Marek Derkacz, MD, PhD, MBA – doctor, specialist in internal diseases, diabetologist, endocrinologist. A specialist in the field of economics and health protection. Medical journalist.
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The text comes from the site Medexpress.pl
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