Coronavirus infection has many unpleasant consequences – doctors note that patients who have had covid disease complain of the appearance or aggravation of problems with the lungs, heart, blood vessels, kidneys and liver, weakening of the immune system and deterioration of vision. But can covid harm your ability to conceive? Is this virus really capable of causing infertility?
The negative impact of the postponed coronavirus infection on male fertility, unfortunately, is confirmed by a number of studies and the experience of medical practitioners. In men who have had covid disease, doctors observe a catastrophic drop in spermatogenesis rates – the production of male germ cells (spermatozoa). In some cases, it comes to azoospermia – a situation in which sperm are completely absent. Azoospermia is one of the causes of male infertility.
But why is this happening? How can COVID-19 affect sperm production? Its mechanism of action is based on the fact that the ACE 2 receptor, through which the virus enters the cell, is highly expressed in the testes. Thus, the virus infects not only the lungs, liver, spleen, lymphoid system, but also the testicular tissue. In the reports of doctors on the condition of men who have had covid disease, orchitis, inflammatory changes in the testicles, are noted. In addition, covid triggers a number of autoimmune processes leading to immunological infertility in men.
However, if men after covid are at risk, then there is much less data for women and the impact of coronavirus on female fertility. To date, there are 73 studies reflecting the observation of pregnant women with COVID-19. According to these studies, 2.3% of babies born to mothers infected with coronavirus tested positive for covid. However, the decline in female fertility in isolation from covid is nowhere described.
Doctor of Medical Sciences, Head of the Department of Assisted Reproductive Technologies of the Center for Reproductive Health “CM-Clinic”
What to do if infertility is suspected?
If you are planning a child, but after suffering COVID-19, conception does not occur, then first of all it is important not to self-medicate on the Internet, but to contact a clinic that specializes in the treatment of infertility and undergo diagnostics. In the case of male infertility, this problem is corrected by an andrologist.
Examinations for the diagnosis of infertility in men necessarily include a semen analysis with an assessment of sperm morphology, a MAR test and DNA fragmentation. Spermogram with sperm morphology (it is also an extended spermogram according to Kruger) is an analysis that is needed to study general data on semen, to determine the concentration of spermatozoa in the ejaculate, which have an ideal morphological structure. When assessing the state of spermatozoa according to the Kruger parameters, the doctor examines the structure of their head, tail and neck.
With the help of sperm morphology, the doctor obtains information about a man’s fertility, identifies the causes of infertility and can assess the likelihood of fertilization as part of an in vitro fertilization program. For the onset of pregnancy in the natural cycle, 4% or more morphologically healthy spermatozoa are required. At 3% or less, the use of the ICSI method (ICSI) is required as part of an in vitro fertilization program.
The MAR test (mixed antiglobulin reaction) is needed to identify the immunological causes of reduced fertility in men. Using the MAR test, the percentage of spermatozoa that are associated with antibodies of the IgG and IgA classes is determined. This study is the international standard for the diagnosis of ACAT, the presence of antisperm antibodies. The MAR test helps to detect motile germ cells that have become unsuitable for fertilization. A positive test result indicates immune infertility, in which the majority of active sperm cells are attacked by antisperm antibodies.
The sperm DNA fragmentation test shows whether the integrity of the DNA strands in the germ cells is broken. If the level of DNA fragmentation does not exceed 15%, then this is considered normal and does not interfere with conception. However, the higher this percentage, the lower the chance of conception and the higher the risk that a child born as a result of fertilization with sperm with damaged DNA will suffer from cancer and genetic diseases.
What to do if infertility is still found?
If a man has a high DNA fragmentation, if he has a positive MAR test and a low sperm concentration, then the andrologist selects a course of treatment that lasts 2,5-3 months. The duration of therapy is due to the time of spermatogenesis – it is 3 months.
In addition, the doctor can use assisted reproductive technologies (ART) – including the selection of morphologically correct (healthy) spermatozoa and embryological support. Artificial insemination according to ICSI and PICSI methods also allows minimizing the consequences of covid lesions that caused infertility.
ICSI (ICSI) is the introduction of a sperm into the cytoplasm of an egg using a microneedle. To do this, you can select the healthiest and most mobile sperm, which is placed in a microneedle. She pierced the shell of the egg and injected it inside. With the PICSI technique, the embryologist selects a sperm cell according to its ability to interact with hyaluronic acid. Under natural conditions, the egg is surrounded by hyaluronic acid, and only the sperm that can dissolve it is able to fertilize the egg. For this, there are special receptors on its surface. Their presence determines the functional maturity of the sperm and is assessed using the PIXI method.
In the context of coronavirus infection, IVF (in vitro fertilization), ICSI or PIXI has additional advantages. It takes into account the possibility of selecting the correct genetic material, i.e. healthy gametes, and in case of a woman’s disease, in the process of stimulating the ovaries with the help of hormonal therapy, conditions are created to minimize complications. Puncture of the follicles is carried out in the patient in a separate box, with antibacterial prophylaxis and thrombosis prophylaxis, which are the pathogenetic links of covid. The embryologist selects high-quality mature oocytes (immature eggs), followed by fertilization using ICSI or PIXI.