Can a COVID19 infection impact vasectomy reversal success rates, damage testicles, hurt sperm production or lower testosterone levels? 2023 Update

Director of the International Center for Vasectomy Reversal, speaker and author of the textbook “Vasectomy Reversal: Manual of Vasovasostomy and Vasoepididymostomy.”

This page is written and updated to address the many concerns about COVID-19, sperm, testosterone and fertility as they relate to vasectomy reversal success rates, based on articles and updates from the American Society for Reproductive Medicine (ASRM) annual international meeting held October 2020, as well as more recent updates at conferences and in the scientific literature.

The answer is yes, research tells us that a COVID-19 infection may damage a man’s testicles and potentially hurt the sperm count as well as lower testosterone levels for up to 6 months or more. If men have any concerns about fertility after they have had a COVID19 infection, it is always best to see a urologist for an exam and to obtain a formal baseline semen analysis as well as check blood hormone levels for testosterone, FSH and LH (the hormones that stimulate sperm and testosterone production).

Of course, the news about COVID19 research is that even in 2023, doctors and researchers are still in the early phases so the information we receive is evolving every day. What this means is that what is known today may be wrong tomorrow. Learning the true impact of COVID19 on sperm, fertility and testosterone will likely take years. There are no definitive answers about short and long-term consequences, who will or will not have these problems and the treatments of coronavirus infection on male function and fertility.

Because the knowledge about COVID19 and the impact on testicular function is so dynamic and ever-changing, it is smart for men to talk to a urologist (the only specialty that deals with sperm and testicular function) about any questions and the possible impact of this infection on future fertility and vasectomy reversals. This way each couple can be assured that of getting the most up-to-date information to base any decisions on accurate data for shared decision-making with their doctor.

Though COVID-19 virus particles have rarely been seen in testicular tissue that has been analyzed, some research does show varying degrees of damage after an infection to the sperm producing and testosterone producing cells within the testicles. The question remains are these changes from the virus itself, the body’s inflammatory and immune response to infection, the fever itself (fever is well known to be bad for sperm), from other symptoms of the coronavirus infection or the treatments for the infection?

As of the writing of this page, there are no clearly defined rules or guidelines by leading fertility and urology organizations regarding sperm and exposure to the coronavirus (COVID-19). Many men that become infected with this virus often have zero symptoms. If they do, the problems are primarily cardiovascular and respiratory. Men can be very ill, have no symptoms and feel great, or anything in between. It is well known that the associated high fever seen with COVID19 can damage fertility by reducing sperm counts and motility. In fact, any high fever or serious infection is bad for sperm and fertility. We do not yet know if only men with serious symptoms have possible testicular damage or if men with no symptoms from a COVID19 infection can have damage as well. This is important to discuss if considering or after a vas reversal.

Sperm Damage.
Any fever-induced reduced sperm quality and count usually damages all the sperm in the body. This reduced sperm count and motility will persist until new sperm can be produced and matured after the fever and illness have resolved. This can take up to 3 to 6 more months for sperm counts and motility to return to normal levels.

In addition to the damage from the fever, significant systemic illnesses, such as those that can be seen with serious COVID19 infections, are also known to hurt sperm quality, counts and motility as well for many months.

Many experts have concerns that COVID-19 may actually damage sperm in the body, but this has not been confirmed. This is because there are known receptors for viruses on some of the cells within the testicles. Experts don’t know if this may or may not be with men with no symptoms or only with men who experience severe symptoms and illness. The hope is that with the continuous production of new sperm over time, this will not be a permanent problem.

Testosterone Levels and COVID19.
Early research shows that some men who have had a COVID19 infection may have damage to the testosterone producing cells within the testicles with dramatic changes in sex hormones, suggesting impairment of gonadal function. No one knows specifics about any long-term impact of the coronavirus infection and testosterone levels.

What should a couple do if there are questions or concerns about fertility and testosterone after a possible or confirmed COVID19 infection?
It is smart to see a urologist with special training and experience in male fertility. For most men, it is reasonable to wait 3 months after infection has resolved to check a semen analysis. That way any sperm damaged by the fever or infection will have passed out of the body and new, healthy sperm will be in the semen. If a man has a COVID-19 infection after a vas reversal, then it would be smart to maintain close monitoring of the sperm counts as directed by the vas reversal doctor. It would also be smart to check a delayed semen analysis specimen about 6 to 9 months later to be sure everything is normal. The testosterone level can be checked anytime and a follow-up level a few months later would be smart as well. If there are any abnormalities or issues with sperm counts, quality or motility or with testosterone levels, then a urologic fertility doctor can further assess and make recommendations for treatment and follow-up.

What is important to know about COVID-19, sperm and testosterone?
Because the information we have is still in the very early phases of understanding, expanded community-based population studies will need to continue, ideally over many months and years. This data with many thousands of patients looking at the different variants, including the delta and omicron variants, will need to be studied and analyzed to assess the specifics about any risks and impact of each variant COVID19 on sperm, hormones and fertility. Researchers will need to monitor regular sperm counts and fertility frequently over time to see if there are any issues or patterns. If problems are discovered, it is important to learn who is at risk, when these issues develop, do they resolve quickly, or do they persist and if so, for how long? If the virus gets into the testicles, how long do the virus particles remain viable and potentially damaging to the sensitive cells that produce sperm and testosterone? Most of the studies in this early phase of studying COVID19 are with small numbers of men over a short period of time, so we don’t know if these are real findings that have serious consequences or if they will be of low significance.

If couples still have any questions about COVID19, fertility or vasectomy reversals the doctors and professionals at ICVR are available to answer questions by calling us today.

This page was written, edited and updated by Dr Sheldon Marks on June 13, 2023.