Alterations in Human Semen After Infection with SARS-CoV-2: A Meta-analysis

Background: The purpose of the current study was to assess pooled prevalence (PP) of SARS-CoV-2 in semen and pooled estimates including weighted mean difference (WMD) and risk ratio (RR) of semen characteristics in infected cases as compared with healthy controls. Methods: Major databases were searched by two authors. SARS-CoV-2-positive cases were assigned to the exposed arm (group A), whereas the controls to the unexposed (group B). Risk of bias was assessed with Newcastle-Ottawa Scale and PRISMA guidelines were followed. Random-effects model was employed for analyzing the heterogeneity and fixed-effects model for homogeneity of studies. Results: Of 170 studies, 14 studies were eligible involving 507 subjects (316 in group A, 191 in group B). The risk of bias was the highest for "comparability" domain. SARS-CoV-2 RNA was found in only two studies among 7 subjects (PP= 2.10%, 95%CI 0.58–4.42). There was a significant decrease in sperm concentration (WMD= -15.29, 95%CI -24.70 – -5.88) and total sperm in ejaculate (WMD= -47.58, 95%CI -86.40 – -8.75) in group A. The effect of COVID-19 upon progressive motility, ejaculate volume, and leukocyte presence in semen was not significant. Conclusion: Prevalence of SARS-CoV-2 in semen among the infected cases is low. Sexual transmission through semen is improbable and of little concern for public health. Sperm concentration and total sperm in ejaculate are significantly reduced as compared with controls. Due to limited information of the current research, longer follow-up is needed to identify delayed or progressive impact.