Presence of SARS-CoV-2 RNA in Semen and Reproductive Function of Asymptomatic and Mildly Symptomatic Male Patients with a High Viral Load

Background: The potential impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on male fertility is a complex and evolving area of research. Although there is some evidence to suggest that the virus might have negative effects on semen from mild to moderate symptoms or recovery of coronavirus disease 2019 (COVID-19) and might induce epididymal-orchitis, further research is needed to definitively determine the risks. Objectives: This study aimed to investigate the presence of SARS-CoV-2 ribonucleic acid (RNA) in semen and to determine any possible implications of SARS-CoV-2 infection on semen parameters and genital tract complications. Methods: Thirty-two subjects with a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) cycle threshold (Ct) value of less than 20 were recruited, and semen samples were collected. Additionally, testicular discomfort and urogenital abnormality were assessed. Results: No SARS-CoV-2 RNA was detected in the seminal sample of men; however, semen quality impairment was detected, especially in patients with Ct values less than 15 in the upper respiratory tract. Total sperm count, the number of motile spermatozoa, progressive motility, and the percentage of normal morphology were significantly reduced. Acute epididymo-orchitis and testicular tenderness were observed in 4 patients in the acute stage of the disease. Conclusions: This study showed no evidence of SARS-CoV-2 RNA in semen, suggesting that sexual transmission of the virus is unlikely. However, semen quality impairment was observed in patients with SARS-CoV-2 infection, particularly those with higher viral loads. Further research is needed to elucidate the mechanisms by which SARS-CoV-2 affects male fertility and develop effective interventions to protect men's reproductive health during the pandemic.