This document summarizes two papers about the potential effects of COVID-19 on male fertility. Paper 8 discusses how COVID-19 infection can lead to reduced sperm count and quality due to the presence of ACE2 receptors in testicular cells and fever-related impacts. Paper 9 finds that the SARS-CoV-2 virus may enter testicular cells via ACE2 receptors, disrupt spermatogenesis, and reduce sperm count due to immune response and high ACE2 expression in testes. Both papers call for further research but indicate COVID-19 appears to negatively impact male fertility.

1. Paper 8
Objective:This projectaims to develop international collaboration for data
registry, hormonalstudies and genomic studies to better understand the sex
difference for COVID-19 health-related consequences.
Introduction:Male infertility is linked to some viralinfections including human
papillomavirus (HPV), herpes simplexviruses (HSV) and human
immunodeficiency viruses (HIVs). Almostnothing is known aboutsevereacute
respiratory syndromecoronavirus 2 (SARS-CoV-2) effecton fertility. The
possiblerisk factors of coronavirus disease2019 (COVID-19) infection on
fertility comes fromthe abundanceof angiotensin-Converting Enzyme-2
(ACE2), receptor entry of the virus, on testes, a reduction in important sex
hormoneratios and COVID-19-associated fever.
Result:Totalspermcount and motility percentage were reduced significantly
at days 15, 37 after fever episodebefore going back to normal after several
weeks. Increaseof spermDNA fragmentation index and alteration in the
nuclear protein composition of ejaculated spermatozoon werereported after
fever episode.
Discussion:Morealarming is the result of a new systematic review—included
48 recently published articles and 16 databases—whereitfound that men are
more likely to suffer or to die from the complications of COVID-19 compared to
women. Large proportion of these vulnerable males is in their childbearing
age, and thus their reproductiveability can be affected. Finally, like influenza,
COVID-19 patients suffer from fever, which may affect sperm production. It
was reported that febrile illnesses had an impact on semen parameters.
Conclusion:The transmission of COVID-19 has been suggested to occur
through the respiratory routeand close contact, while the faecal–oral route is
also possible. While the presenceof ACE2 receptor on the surfaceof some
testicular cells may raisethe concern of testicular damage or sexual
transmission of the infection, a recent study has found no evidence of SARS-
CoV-2 in semen or testicular specimens taken from COVID-19 patients which
suggestthat the diseasehas no sexual transmission route.

2. Scope:This might be the first direct evidence for the influence of COVID-19on
testicles’ ability to producesex hormones; however, the results of this study
should be followed by a more direct analysis of the seminal fluid of COVID-19
patients to evaluate the effect—if any—on sperm count, volume, morphology
or motility. Ithas been reported that SARS-CoV causes orchitis in addition to
other complications, so it is also possiblethat SARS-CoV-2 may causethe same
complication in males.
Paper 9
Objective:Theobjectiveof this review is to providecurrently available
information on the potential effects of coronavirus disease2019 (COVID-19)on
male fertility.
Methodology: Dueto the similarity between the COVID-19and severeacute
respiratory syndrome(SARS) virus, somekeywords aresearched “SARS-CoV,
male reproductivesystem, infertility, COVID-19, SARS-CoV-2, and orchitis”. By
reviewing and analyzing the literature, it is analyzed the influence of
temperature on sperm, the expression of angiotensin-converting enzyme2
(ACE2) in the testes, and the impact of SARS- CoV-2 on the male reproductive
system.
Result:SARS-CoV-2enters the body through the ACE2 receptor. The high
expression of ACE2 on the surfaceof spermatogonia and supporting cells in the
testes, as well as the immune responsecaused by COVID-19, can lead to
testicular spermatogenesis dysfunction and reduced sperm count.
Conclusion: COVID-19 infection can affect male reproductivefunction, and
standard treatment strategies should be established in time to help male
patients infected with COVID-19.
Scope: It is necessary that infected men be examined for fertility soon after
recovery, especially for marriageable men and married men who want to have
children. Furthermore, measures should betaken to safeguard the
reproductivehealth of men infected with COVID-19, and itis necessary to
screen these patients. We can help these patients by formulating screening
criteria and via timely screening and formulating standard treatment
strategies.

3. Introduction: SARS -CoV-2 is the pathogen that has caused the coronavirus dis-
ease 2019 (COVID-19). COVID-19 is known to damage many organs in the
body, especially the lungs, but little is known about its effects on the
reproductivesystem. However, this bulletin was indicative of a possiblelink
between this novel disease and the male reproductivesystem.