Evaluation of hormonal status and sperm parameters in reproductive-age men after COVID-19 infection

Introduction. The symptoms of novel coronavirus infection (SARS-CoV-2), observed in the long-term period after COVID-19 and collectively referred to as post-COVID syndrome, include not only pulmonary complications but also damage to other target organs, particularly the male reproductive system. Most published studies are based on data obtained during the acute phase of the disease, while reports on long-term reproductive complications are scarce. Therefore, assessment of post-COVID effects on male reproductive function remains a relevant clinical issue.

Aim. To evaluate hormonal status and semen parameters in men of reproductive age after recovery from COVID-19 in the long-term period.

Materials and methods. A prospective study included 120 men aged 21–44 years. Group 1 comprised 60 patients who had COVID-19 complicated by viral pneumonia, and Group 2 included 60 patients with COVID-19 presenting as an acute respiratory viral infection (ARVI). Peripheral blood and semen samples were collected on the 15th and 90th days after disease onset. The following blood parameters were analyzed: total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, and sex hormone-binding globulin (SHBG).

Results. Analysis of hormonal profiles showed a decrease in total testosterone relative to the diagnostic threshold on day 15 from disease onset by 46% in patients with COVID-19 complicated by pneumonia and by 17% in patients with ARVI-like COVID-19. A significant positive trend in TT level was observed in both groups by day 90: an increase of 20% in Group 1 (p ≤ 0.05) and 33% in Group 2 (p ≤ 0.05). Compared with reference values, SHBG levels exceeded the upper limit by 24% and 25% in Groups 1 and 2, respectively, on day 15, and remained elevated on day 90 (by 16% and 11%, respectively), despite a significant decline over time (p ≤ 0.05 in both groups). Level of pituitary hormones and estradiol remained within the reference range at all time points. A decrease in total sperm motility relative to reference values was recorded in both groups due to a reduction in progressively motile sperm. However, a significant improvement in progressive motility was noted by day 90, resulting in higher total sperm motility in Group 1 (p ≤ 0.05) and a 14% increase in the proportion of morphologically normal sperm in Group 2 (p ≤ 0.05).

Conclusion. Men recovering from COVID-19, both with and without pneumonia, showed significant alterations in total testosterone and SHBG levels on day 15 and by the end of the third month of observation. Microscopic semen analysis revealed reduced total sperm motility relative to reference values on days 15 and 90 after disease onset, primarily due to a decrease in progressive motility. Nevertheless, a significant improvement was observed by the third month in both total sperm motility and the proportion of morphologically normal spermatozoa.