Effect of SARS-CoV-2 on semen parameters: A meta-analysis of 39 articles from 15 countries.

Background Declining birth rates during the pandemic have led to concerns about the potential impact of the of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on fertility among men. As previous studies have had inconsistent conclusions, we conducted a meta-analysis to evaluate the effects of SARS-CoV-2 on semen parameters. Methods We searched several databases for articles published between 1 January 2020 and 25 July 2023. We performed a robust screening process based on predetermined inclusion and exclusion criteria and, following quality assessment, extracted data from high-quality studies for the meta-analysis. We determined the P-values and 95% confidence intervals (CIs) for both continuous and dichotomous variables, which we described using mean differences (MDs) and odds ratios (ORs), respectively. Lastly, we used the leave-one-out approach for our sensitivity analysis, and Begg’s and Egger’s tests to determine publication bias. Results We included 39 articles with 1887 cases and 2097 controls. In patients infected with SARS-CoV-2, the sperm volume (MD=−0.29; 95% CI=−0.50, −0.07; P = 0.008) and concentration (MD= −8.71; 95% CI = −16.94, −0.48; P=0.04) were decreased, which increased oligospermia risk (OR=2.49; 95% CI = 1.04, 5.99; P = 0.04). Furthermore, we observed reduced sperm motility (MD=−8.18; 95% CI=−12.19, −4.17; P<0.001) and increased immotility (MD=4.06; 95% CI=1.57, 6.54; P=0.001) in infected patients, which increased asthenospermia risk (OR=3.86; 95%CI=1.83, 8.14; P=0.0004). We also saw a decreased proportion of semen with normal sperm morphology (MD=−1.67; 95% CI=−2.68, −0.66; P=0.001) and an increased proportion of semen with abnormal sperm morphology (MD=−1.31; 95% CI=−2.14, −0.49; P=0.002,), along with increases in teratospermia (OR=1.98; 95% CI=1.00, 3.92; P=0.05) in infected compared non-infected patients. Although we found consistency within most subgroups, we observed differences in severity, follow-up time, and country of origin. The results of the main meta-analysis results remained stable in the sensitivity analysis, while Begg’s and Egger’s tests showed no publication bias. Conclusions Based on sufficient evidence, we see that the effects of SARSCoV-2 on semen parameters resulted in a decline in male fertility. The increased severity and shorter duration of the SARS-CoV-2 infection increased the likelihood of altering of semen parameters. [ABSTRACT FROM AUTHOR]