Does the COVID-19 Vaccine Affect Male Fertility?
In the past few years, we have been deep in the COVID-19 pandemic, and misunderstandings about family building are amplified. As a double board-certified OBGYN and reproductive endocrinologist, I’ve witnessed my patients’ confusion and fear, amidst medical misinformation, about making the right choices for their fertility and family-building goals.
We’ve come a long way with COVID-19. In the beginning, we didn't even know what the virus was, and we didn’t understand how it spread. In the middle of quarantine, many people had to put fertility treatments on hold until we could figure out exactly how to give medical care in a safe way.
Male reproductive health is half of the genetic equation with family building, and in this blog post, I want to answer common questions with evidence surrounding men's reproductive health in both a COVID-19 infection and the COVID-19 vaccine.
What do we know about viruses’ impact on sperm counts?
When we first faced the pandemic, it was challenging to reach definitive conclusions about the virus and fertility because we, the medical community, were all learning together. However, we know that other viruses impact male reproduction.
The SARS-CoV-2 virus is a single-stranded RNA virus from the Coronavirus sub-family. Other single-stranded RNA viruses that impact male reproductive health include mumps, HIV, and the Zika virus:
In mumps, 20-30% of men who are infected will get orchitis or inflammation of the scrotum. Some of the men infected with mumps will go on to have decreased sperm counts and significantly impacted fertility later in life.
HIV can lead to altered male hormone levels, including lower testosterone, and it can dramatically change and deplete sperm parameters.
Zika is relatively new (and we’re still learning a lot about it), but it can be found in semen for up to 180 days after symptoms have resolved.
With these examples, we can see that single-stranded RNA viruses can have an impact on male fertility and/or reproductive health, and we now have more data about COVID-19’s impact too.
What do we know about a COVID-19 infection’s impact on men’s reproductive health?
In the initial phases of the pandemic, men displayed some unusual presentations of COVID-19. Typical symptoms of infection include fevers, body aches, sore throat, loss of smell or taste, and occasionally diarrhea. However, some case reports, including one from the American Journal of Emergency Medicine, noted that men who tested positive for COVID-19 presented with scrotal or testicular pain as onset symptoms as well.
It was also noted that there could be vascular consequences of a COVID-19 infection. Some people (men and women) were getting blood clots, and men experienced vascular complications such as erectile and ejaculatory dysfunction both during and after their COVID infections. (You may recall a joke about this on SNL’s Weekend Update!)
Does a COVID-19 infection impair sperm counts?
Knowing that other viruses impact male reproduction and male fertility, it makes sense that we should pay attention to these risks for COVID-19. There are post-mortem studies that show the presence of the Coronavirus in testicles, and we have seen lower sperm counts after and during a Coronavirus infection.
These findings are not uncommon in the world of virus infections in men. Many viral infections, such as ones that lead to fever, will temporarily lower sperm counts during recovery. Sperm operates on a three-month cycle, so if you have a fever or fight a significant infection, you will likely have lower sperm counts for two to three months after recovery.
We see something similar with COVID-19 infections. In one study, the sperm parameters of 32 men (18 had a COVID-19 infection with mild symptoms, 14 did not have COVID-19) were compared. During the recovery period, the group with the COVID-19 infection had lower sperm counts, lower motility, and poor sperm parameters (but eventually recovered).
Another study in the Asian Journal of Andrology observed the symptoms and sperm parameters of 41 men during COVID-19 exposure and recovery. Most of the men studied also demonstrated a temporary lowering of sperm counts during the recovery phase of the virus.
Based on these studies and what we’ve seen with other viral infections, it makes sense that a viral infection temporarily impacts sperm production; as we recover, the sperm count does come back.
Does the COVID-19 vaccine impact male reproductive health?
If you’re like my patients who were struggling to build families during the pandemic, you likely did everything you could to avoid getting COVID-19. It’s now been conclusively found that the vaccine is the best treatment to decrease the pandemic’s impact on us.
We know that the COVID-19 vaccine decreases the following:
The risk of severe disease from COVID-19
The risk of hospitalization and ICU admission
The risk of death from COVID-19
These are all positive findings.
When you’re trying to have a baby, you might want more data to feel reassured that the vaccine is the right move for you and your family, and there are reassuring studies about the vaccine and male reproduction.
One study published in the Journal of the American Medical Association (JAMA) did a semen analysis of 45 men before and 70 days after being fully vaccinated for COVID-19. The sperm parameters (count, motility, and morphology) stayed the exact same. I especially appreciate this study because it compares the same people before and after the vaccine intervention, and it’s reassuring that there was no effect at all on sperm parameters.
Another interesting study in the International Journal of Gynecology and Obstetrics looked at multiple sperm samples in those sperm donor populations. In this study, over 800 sperm samples were observed before and after vaccination, and, similar to the other JAMA study, the sperm parameters of count, motility, and morphology were all the same.
What are the takeaways about COVID-19 infection, vaccine, and male reproductive health?
To recap:
Getting infected with COVID-19 has implications, and everyone will have varying reactions. However, some men are showing erectile dysfunction, ejaculatory dysfunction, changes in hormone levels, and lower sperm counts
As of what we know now, lowered sperm levels do eventually recover after a COVID-19 infection
The COVID-19 vaccine decreases the risk for severity of disease, hospitalization, and death from COVID-19
From the studies we’ve seen to date, the COVID-19 vaccine does not change sperm parameters or male reproductive health.
There’s still so much to learn about COVID-19, and we are navigating this together. If you have questions, please comment in my YouTube video.
