A review on human reproductive systems encountering with the severe acute respiratory syndrome coronavirus 2 infection

Esmaeil Samadian, Samadian E, Bahman Aghcheli, Aghcheli B, Gharaei R, Roghaye Gharaei, Alijan Tabarraei
International journal of reproductive biomedicine · 2023 · vol. 21(1) , pp. 1–16 · doi:10.18502/ijrm.v21i1.12661 · PMID:36875501 · PMC9982318
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This review examines how SARS-CoV2 interacts with the human reproductive system, highlighting that synergistic effects between the virus and conditions like endometriosis increase susceptibility to severe COVID-19 complications.

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This review examines the pathophysiological mechanisms by which SARS-CoV-2 impacts human reproductive systems, focusing on the expression of ACE-2 receptors and viral entry proteases in male and female tissues. The authors detail how infection can lead to direct cellular damage, hormonal imbalances, oxidative stress, and cytokine storms that compromise spermatogenesis, sperm quality, and overall fertility potential in both sexes. While the paper extensively covers general reproductive health and infertility risks associated with COVID-19, it does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is the leading cause of the new deadly pneumonia named coronavirus disease 2019 (COVID-19) pandemic. This pathogen has different co-receptors on various tissues, resulting in vast pathophysiological circumstances. Here, we present a comprehensive narrative review focusing on the impact of SARS-CoV2 on human reproduction. Evidence-based literature revealed inconsistent results for this virus in the reproductive organs of patients with COVID-19, even in the critical phase. Conversely, numerous satisfactory data represented those different reproductive activities, from gametogenesis to pregnancy, can be targeted by SARS-CoV2. The severity of COVID-19 depends on the differential expression of the host cellular components required to enter SARS-CoV2. The cytokine storm and oxidative stress coming out during COVID-19 are associated with complications in reproductive endocrinopathies. Men are naturally more susceptible to COVID-19, especially accompanied by orchitis and varicocele. Synergistically the interaction of SARS-CoV2 and female reproductive failures (polycystic ovary syndrome and endometriosis) increases the susceptibility to COVID-19. Thus, pharmaceutical interventions that ameliorate the complications in individuals with reproductive disorders can be helpful to achieve good outcomes in assisted reproductive techniques. Soon, an increase in the infertility rate will likely be an overall impact of SARS-CoV2 in patients who recovered from COVID-19.
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Section

Different aspects of COVID-19 are still unclear in human reproductive biology. The reproductive system is sensitive to SARS-2, and this virus can directly affect its physiological activities. Even if this system is not permissive for this viral infection, the problems caused by COVID-19 are associated with reproductive failures, implying indirect interactions between SARS-2 and the reproductive system. Numerous distinctions affect the expressions of the receptors and proteases required for SARS-2 infection and consequently, the pathological results. High levels of androgens and ACE-2, and activation of TMPRSS-2 in the normal physiology of the male reproductive system naturally makes men a high-risk group in terms of the SARS-2 infection. The interaction between the OS and the inflammatory cross-talks in reproductive disorders (varicocele in men and PCOS and endometriosis in women) can cause these patients to become more risky groups in terms of being infected by COVID-19. These complications can also increase the severity of this infectious disease. Nevertheless, the excessive production of ROS and inflammatory cytokines during the pathogenesis of COVID-19 can multiply the complications in individuals with these reproductive failures and increase the infertility rate in patients recovering from COVID-19. Therefore, administering anti-androgens, estrogen agonists, and vitamin D and enrichment of oxidative scavengers in these patients can be an effective therapeutic strategy for antagonizing the complications in both SARS-2 infection and reproductive disorders.

Coi Statement

The authors do not have any affiliation beside any organization as an indirect or direct financial contribution the subject matter mentioned in the manuscript. All authors have taken part in (1) conception design and conception, or analysis and elucidation of the data; (2) article drafting or revising it in critical manner for significant intellectual content; also (3) approval of the last version. We have not submitted this manuscript yet, furthermore it is not under review with another journal or publishing venue.

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