PDF(Pubmed)
Abstract：
BACKGROUND: Studies investigating the effects of SARS-CoV-2 on male reproductive function are few and heterogeneous, and results are often conflicting. This systematic review and meta-analysis was carried out on studies conducted in men with active or anamnestic SARS-CoV-2 infection to evaluate its consequences on the male sex hormone profile and semen parameters.
METHODS: This meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. PubMed, Scopus, Cochrane, and Embase databases were searched to identify relevant studies. We originally selected 3553 articles. After the eligibility phase, 16 articles met our inclusion criteria encompassing 11 case-control studies and 5 cohort studies (2 prospective and 3 retrospective studies). We performed the quantitative analysis with Comprehensive Meta-Analysis Software. Cochran-Q and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed.
RESULTS: Overall, 1250 patients with active or recent (up to 80 days before) COVID-19 infection and 1232 matched healthy controls were included. Sperm concentration, total sperm count, and total motility were significantly lower in patients compared with controls. Patients also showed lower levels of total testosterone and follicle-stimulating hormone, and higher levels of luteinizing hormone, 17β-estradiol, and prolactin compared with healthy controls. None of the included studies found the presence of SARS-CoV-2 mRNA in the semen of infected patients.
CONCLUSIONS: The present systematic review and meta-analysis suggests the presence of an association between SARS-CoV-2 infection and primary testicular damage manifested with a picture of altered steroidogenesis and worsening spermatogenesis. The absence of the virus in the seminal fluid indicates a low possibility of sexual transmission of the infection to partners and offspring. However, our findings mostly show short-term follow-up, while few studies have considered the long-term consequences of the viral infection, thus further studies are needed to evaluate the long-term consequences on male reproductive health.
METHODS: This meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. PubMed, Scopus, Cochrane, and Embase databases were searched to identify relevant studies. We originally selected 3553 articles. After the eligibility phase, 16 articles met our inclusion criteria encompassing 11 case-control studies and 5 cohort studies (2 prospective and 3 retrospective studies). We performed the quantitative analysis with Comprehensive Meta-Analysis Software. Cochran-Q and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed.
RESULTS: Overall, 1250 patients with active or recent (up to 80 days before) COVID-19 infection and 1232 matched healthy controls were included. Sperm concentration, total sperm count, and total motility were significantly lower in patients compared with controls. Patients also showed lower levels of total testosterone and follicle-stimulating hormone, and higher levels of luteinizing hormone, 17β-estradiol, and prolactin compared with healthy controls. None of the included studies found the presence of SARS-CoV-2 mRNA in the semen of infected patients.
CONCLUSIONS: The present systematic review and meta-analysis suggests the presence of an association between SARS-CoV-2 infection and primary testicular damage manifested with a picture of altered steroidogenesis and worsening spermatogenesis. The absence of the virus in the seminal fluid indicates a low possibility of sexual transmission of the infection to partners and offspring. However, our findings mostly show short-term follow-up, while few studies have considered the long-term consequences of the viral infection, thus further studies are needed to evaluate the long-term consequences on male reproductive health.
摘要：
背景：研究SARS-CoV-2对男性生殖功能的影响的研究很少且异质，结果往往是相互矛盾的。这项系统评价和荟萃分析是对患有活动性或记忆性SARS-CoV-2感染的男性进行的研究，以评估其对男性性激素谱和精液参数的影响。
方法：本荟萃分析遵循系统评价和荟萃分析（PRISMA）方案的首选报告项目。PubMed,Scopus,科克伦,检索Embase数据库以确定相关研究。我们最初选择了3553篇文章。资格阶段之后,16篇文章符合我们的纳入标准，包括11项病例对照研究和5项队列研究（2项前瞻性研究和3项回顾性研究）。采用综合Meta分析软件进行定量分析。Cochran-Q和异质性（I2）指数用于评估统计异质性。还进行了敏感性分析和发表偏倚测试。
结果：总体而言，包括1250名活跃或近期（80天前）感染COVID-19的患者和1232名匹配的健康对照。精子浓度,精子总数,与对照组相比，患者的总运动明显较低。患者的总睾酮和卵泡刺激素水平也较低，和更高水平的促黄体激素，17β-雌二醇，与健康对照组相比，催乳素。纳入的研究均未发现感染患者的精液中存在SARS-CoV-2mRNA。
结论：本系统综述和荟萃分析提示SARS-CoV-2感染与原发性睾丸损伤之间存在关联，表现为类固醇生成改变和精子发生恶化。精液中不存在病毒表明感染向伴侣和后代的性传播可能性较低。然而,我们的发现主要是短期随访，虽然很少有研究考虑病毒感染的长期后果，因此，需要进一步的研究来评估对男性生殖健康的长期影响。
方法：本荟萃分析遵循系统评价和荟萃分析（PRISMA）方案的首选报告项目。PubMed,Scopus,科克伦,检索Embase数据库以确定相关研究。我们最初选择了3553篇文章。资格阶段之后,16篇文章符合我们的纳入标准，包括11项病例对照研究和5项队列研究（2项前瞻性研究和3项回顾性研究）。采用综合Meta分析软件进行定量分析。Cochran-Q和异质性（I2）指数用于评估统计异质性。还进行了敏感性分析和发表偏倚测试。
结果：总体而言，包括1250名活跃或近期（80天前）感染COVID-19的患者和1232名匹配的健康对照。精子浓度,精子总数,与对照组相比，患者的总运动明显较低。患者的总睾酮和卵泡刺激素水平也较低，和更高水平的促黄体激素，17β-雌二醇，与健康对照组相比，催乳素。纳入的研究均未发现感染患者的精液中存在SARS-CoV-2mRNA。
结论：本系统综述和荟萃分析提示SARS-CoV-2感染与原发性睾丸损伤之间存在关联，表现为类固醇生成改变和精子发生恶化。精液中不存在病毒表明感染向伴侣和后代的性传播可能性较低。然而,我们的发现主要是短期随访，虽然很少有研究考虑病毒感染的长期后果，因此，需要进一步的研究来评估对男性生殖健康的长期影响。
