Systematic review and meta‐analysis of COVID‐19 association with human semen quality: Changes in semen parameters pre‐ and post‐COVID

Abstract Coronavirus disease (COVID‐19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which may infect the cells through binding with the angiotensin‐converting enzyme 2 (ACE2) receptors that can also be found in the male reproductive organs. Relevant studies were searched in medical databases and gray literature using controlled search terms including COVID‐19, SARS‐CoV‐2, semen, and sperm, among other related keywords. The authors of this systematic review assessed the eligibility of selected articles, followed by analysing the quality and reliability of the studies using the Cochrane Risk of Bias in Nonrandomized Studies of Exposure (ROBINS‐E) tool. Collected data were processed using RevMan5 software, with a random effects model for meta‐analysis. Combined mean difference and confidence intervals of semen parameters were obtained by using inverse variance method for assigning the weight of each included article. Seven studies with complete pre‐ and post‐COVID‐19 semen analysis data of the same individuals were included in the systematic review. Compiled data from a total of 153 participants revealed that COVID‐19 is associated with semen quality impairment, with meta‐analysis showing significant decrease of sperm concentration and progressive motility. However, the risk of bias analyses considered all the included studies as “very high risk.” This study revealed the susceptibility of semen parameter impairments in association with COVID‐19. However, this finding is limited by the small number of high‐quality studies and the lack of control for other confounding variables of semen quality and male fertility.