Compared with reports that showed positive RT-PCR findings (7–9), they provide more granularity regarding clinical course, longitudinal assessment of sperm count, and host immune response.
Detection of SARS-CoV-2 RNA during the late convalescent phase might be attributed to COVID-19 severity, requiring mechanical ventilation and renal replacement therapy for the participant. This feature might have resulted in an enhanced systemic viremic state with subsequent seeding of accessory organs or the testes, an immune-privileged site, in the setting of generalized inflammation, and disruption of the blood–testis barrier (12).
This possibility is supported by the participant having adequate humoral and cell-mediated immune responses and associated viral clearance of stool and saliva specimens surrounding the time when SARS-CoV-2 RNA was detected in semen.
In addition, 4 other study participants had oligozoospermia.
Sperm count recovery was observed in 2 participants, but the other 2 did not provide longitudinal samples.
Numerous reports have suggested a detrimental effect on semen quality after COVID-19 (9,13,14), hypothesized to occur secondary to viral illness and fever causing spermatogenic dysfunction (15). Given this transient insult, it is not unexpected that some of these men showed recovery.
One limitation of our study is that the initial semen sample was collected late in the convalescent phase, and the high Ct value probably indicates detection of inactive virus without risk for sexual transmission. However, if an acute-phase or early convalescent-phase specimen were collected, the Ct value might have been lower.
Likewise, semen samples from the other 6 men were also limited to the late convalescence phase and mild acute COVID-19 illnesses, except for 1 participant who required mechanical ventilation, although his status was postvasectomy.
Given the small sample size, we cannot determine the contribution of other known etiologies of oligozoospermia, including obesity and oxygen therapy during hospitalization. In addition, we lacked preinfection semen analysis for comparison, and sperm motility would have been more accurately assessed if performed before freezing.
Last, because of inherent difficulty in recruiting for serial semen collection, semen was only collected from a small proportion of participants enrolled in the cohort study. These findings are not generalizable to all male COVID-19 survivors and warrant further research.
In conclusion, SARS-CoV-2 RNA in semen appears to be an extremely rare event, but oligozoospermia has been reported more frequently.
Risk factors for viral persistence in the male reproductive tract, longitudinal effects on semen quality, and viral transmission remain to be elucidated, but because of the large number of men in the convalescent phase worldwide, potential effects on reproductive health is not negligible.
reference link : https://wwwnc.cdc.gov/eid/article/28/1/21-1521_article