Covid-19 and Male Fertility: What is the Impact?
Essential Takeaways
- Fevers are known to overheat the testicles which can temporarily reduce male fertility
- Considering that one of the primary symptoms of Covid-19 is a high fever, it’s reasonable to assume that men infected with coronavirus will also experience reduced fertility.
- The impact should be temporary, and similar to that of baths or hot tubs.
Each day, we learn more about the novel coronavirus and how to protect ourselves. What about the pandemic’s effect on fertility? Here, we speak with some of Legacy’s male fertility experts and examine available data on the coronavirus and fertility, pregnancy, and global fertility trends.
Will Covid-19 affect male fertility?
In the short term: probably, temporarily. The long-term outcome is a little less clear.
There may not be a lot of information about the novel coronavirus and fertility, specifically, but “we know quite a lot about viruses, flus, and male infertility,” explains Legacy advisor and reproductive urologist Dr. Paul Turek. “Seasonal flus are known to reduce male fertility … we think that it’s due to the fever associated with the illness, which overheats the testicles.”
This effect is demonstrated in several case studies of fertile men experiencing fevers. In one, a patient recovering from influenza produced abnormal sperm for 45 days post-fever. In another, sperm count, motility, and genetic health was decreased for over two months after the patient’s fever resolved.
Considering that one of the primary symptoms of Covid-19 is a high fever, it’s reasonable to assume that men infected with coronavirus will also experience reduced fertility. “Currently, it is believed that the [novel coronavirus] is similar to a common seasonal flu virus regarding its impact on male fertility,” explains Dr. Turek. However, as he reassures, that impact should be temporary: “The effect is similar to that of baths or hot tubs, and is fully reversible.”
Will there be any permanent effects of the novel coronavirus on male fertility?
First, a note of reassurance: The novel coronavirus is not related to zika, the mosquito-borne illness with devastating effects on pregnancy and fetal health.
There are certain viral infections—namely mumps—that can cause permanent damage to male fertility. In some cases, mumps can cause a painful condition called orchitis, or inflammation in the testes that has a small chance of long-term damage. “It has to infect boys at puberty, when the testicles are actively growing, to harm future fertility,” explains Dr. Turek.
In a recent statement, researchers in Wuhan raised concerns about the novel coronavirus’ potential to impact male fertility based on the fact that SARS—a similar infection—has also been known to cause orchitis and damage to the testicles. Since SARS and the novel coronavirus are genetically similar, it’s possible, in theory, that today’s coronavirus could have similar results.
However, no documented cases of testicular infections have been noted during the Covid-19 pandemic, and in fact the researchers’ statement was quickly retracted.
Allan Pacey, PhD, male fertility expert and Legacy advisor, explained to Newsweek that the statement was highly theoretical. “At present it is somewhat premature to conclude [that] Covid-19 will definitely affect male fertility,” Dr. Pacey explains. “But it is useful that the authors have raised this concern.”
For those who have contracted Covid-19, any impact on fertility or sperm health can be evaluated with a semen analysis.
Coronavirus and female fertility
Many people are researching coronavirus and fertility because they’re currently trying to conceive, or trying to decide whether now is a safe time to do so. One thing to consider is that data on the safety of pregnant people infected with Covid-19, as well as the safety of their babies, is very limited at the moment.
There’s no evidence that illnesses similar to the coronavirus, such as influenza, have a long-term or short-term impact on female fertility, though respiratory illnesses are known to be more severe for women who are already pregnant.
Another is that—even if there are no direct concerns for safety—it may be difficult, during a period in which healthcare facilities are dedicated to treating a pandemic, to access the regular care that’s so important during pregnancy.
For both of those reasons, many experts are recommending that people planning a pregnancy may want to stop trying to conceive for a few months.
Is it safe to be pregnant during the coronavirus Covid-19 pandemic?
Based on existing, limited data from actual Covid-19 patients, only 1% of pregnant women infected experienced severe illness that required medical attention.
Right now, there’s very little data on how COVID-19 might affect pregnant people. We do know that pregnancy alters the immune system in such a way that increases the risk of infections, such as influenza, and could make illness more severe. And we know that related infections such as MERS and SARS can cause adverse pregnancy outcomes, such as miscarriage, premature delivery, intrauterine growth restriction, and maternal death.
Based on this information, American College of Obstetricians and Gynecologists (ACOG) has advised that pregnant women who get Covid-19 may have a higher risk for some complications.
A study of nine pregnant women in China who contracted coronavirus—and their nine subsequent healthy live births—demonstrated that their illness wasn’t more severe than it was among non-pregnant women, and that they did not pass the virus along to their babies in utero or via breast milk. However, there have been two (1, 2) reports of newborns with Covid-19 infections shortly after birth, so the possibility of “vertical transmission” of the virus from mother to baby cannot be excluded.
What if I’m already planning a pregnancy or fertility treatment?
Reproductive health organizations are recommending, out of caution and concern for lack of data, that couples planning pregnancies hold off for now. The European Society of Human Reproduction and Embryology states that “all fertility patients considering or planning treatment, even if they do not meet the diagnostic criteria for Covid-19 infection, should avoid becoming pregnant at this time.”
Similarly, the American Society for Reproductive Medicine has recommended that fertility clinics postpone new fertility treatments until more is known about the virus, due in part to “the known and unknown impact of coronavirus on fertility, pregnancy, and transmission patterns.”
Coronavirus and sperm freezing
Considering the lack of data about male fertility and the recommendation that couples wait to get pregnant, sperm freezing may be beneficial—both biologically and emotionally—during the coronavirus pandemic.
In addition to the potential impact of coronavirus on fertility (either short-term or long), we also know that time (age) affects male fertility, especially for men over 35. Sperm acquire a new genetic mutation—which is passed onto offspring—every eight months. If the Covid-19 pandemic is pushing off your family plans, sperm freezing may be a good option for you.
Social distancing recommendations are still in place, so visiting a doctor’s office or hospital to discuss sperm freezing is not recommended, or perhaps possible, at the moment. Mail-in sperm testing and freezing options, like the Legacy kit, are a valuable option to preserve your fertility from the safety and comfort of your own home.
Learn more about the Legacy kit.
The rise of “coronababies”: Looking nine months ahead
Each day, we learn more about the novel coronavirus and how to protect ourselves. What about the pandemic’s effect on fertility? Here, we gather the available data on the coronavirus and fertility, pregnancy, and global fertility trends.
Trying to conceive is currently on hold for couples relying on fertility technology, as well as for many others who are concerned about the potential impact of Covid-19 on their pregnancies, health as pregnant people, or newborns. But how is the coronavirus pandemic affecting worldwide fertility trends?
Are people having sex?
The CDC’s recommendations for “social distancing” may be cutting down on sex. Anna Muldoon, a PhD candidate researching infectious disease and former science policy adviser at the Department of Health and Human Services, advises that dating and casual sex is risky at the moment. “The short line on this is all sex is close contact,” she explains. “So there’s no way to have it without risking transmission.”
Even among long-term couples, caution around passing the virus may be placing distance between partners. Muldoon recommends that, if one partner may be sick, they should “sleep in their own room.” The CDC also recommends separating members of the household who may have been exposed to the novel coronavirus or who have any symptoms.
The stress and anxiety around the Covid-19 pandemic can also feel all-encompassing. Stress is known to lower libido for both women and men, due to its impact on key sex hormones. Anecdotally, couples are feeling the impact of anxiety around the pandemic on their sex lives: as one women explained to Rolling Stone, despite being quarantined alone together, she and her partner “definitely haven’t been feeling the romance vibes the past two weeks or so just because we’ve been generally stressed.”
Will there be a coronavirus “baby boom”?
A common trope is that, when people are stuck together in close quarters—such as before a storm or during a quarantine—there’s a “baby boom” nine months later.
But that concept isn’t really demonstrated by the data. In fact, high-mortality events, like pandemics or natural disasters, are associated with significantly lower birth rates nine 9 – 10 months later. After the influenza pandemic of 1889 – 1890, for example, the lowest birth rate was seen nine and half months after the height of the flu’s fatality. (The same can be seen during the 1918 – 1920 flu pandemic.)
Researchers speculate that this drop in fertility could be due to impaired conception, “possibly due to effects on fertility and behavioral changes,” as well as an increase in pre-term delivery and maternal and fetal deaths.
However, it’s common, historically, to see a rebound of birth rates in the months or years after 10 months post-pandemic, when those who have put family planning on hold deem it safe to try to conceive.
The future of fertility post-coronavirus
The probable drop in births during and following the coronavirus pandemic comes amidst the lowest rates of birth and fertility in recorded history. In July of 2019, the CDC reported that the US birth rate had fallen to an all-time low of 1.72 children per woman. Infertility affects approximately 15% of couples, and nearly half of all cases of infertility are attributed to a male fertility issue.
There are economic, cultural, and biological factors at play here. For example, people are marrying less (and later). As of 2015, the average age at first marriage was 29.3 for men; just 50 years before, in 1965, that average was 22.8. As a result, the age of parents is increasing, too—since the 1970s, the median age for men becoming first-time fathers has increased by 10 years, from 28.1 to 38.2.
Sperm health decreases with age, which means couples with older men have a higher likelihood of infertility and miscarriage. We know, for example, that women with partners over the age of 35 have a higher likelihood of miscarriage. We also know that sperm acquire a new genetic mutation every eight months.
Our modern environment and lifestyles, too, are likely impacting fertility rates. Studies of sperm counts demonstrate that men today are half as fertile as their grandfathers were. Researchers have proposed that pollution, diet, or exposure to chemicals that disrupt the endocrine system could be to blame, but the cause isn’t 100% clear.
What is clear is that—even post-coronavirus—male fertility is in crisis.
Learn more about male fertility.
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