Study: Can We Cryopreserve the Sperm of COVID-19 Patients During the Pandemic?. Image Credit: WHITE MARKERS/Shutterstock.com

The feasibility of sperm cryopreservation for male COVID-19 patients

In a recently published article in Frontiers in Endocrinology, scientists have deciphered the possibility to cryopreserve sperm from patients with coronavirus disease 2019 (COVID-19). The article also proposes some suggestions to help cryobanks perform the correct procedure to preserve the sperm of COVID-19 patients.

Study: Can we cryopreserve the sperm of COVID-19 patients during the pandemic?† Image Credit: WHITE MARKERS/Shutterstock.com

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has been found to cause several reproductive abnormalities, including reduced sperm production and structural change in testicular tissue, sex hormone disorders and poor sperm quality.

In the male reproductive system, SARS-CoV-2 can affect the blood-testicular barrier to directly attack the sex cells and disrupt the hypothalamic-pituitary-testicular axis to alter the secretion of sex hormones. In addition, the virus-induced oxidative stress, inflammation and infection-related fever can disrupt the overall functioning of the reproductive system.

As for the presence of SARS-CoV-2 in semen, most studies have not produced a confirmatory report. Only a few studies have detected viral RNA in sperm. Due to the overlapping of distal urinary and reproductive tracts in males, the viral RNA in the semen can potentially appear through urine leakage. In addition, evidence to support the presence of SARS-CoV-2 in testicular tissues is lacking.

Possibility of cryopreservation of sperm

During the initial stages of the COVID-19 pandemic, various fertility procedures, including cryopreservation of sperm and in vitro Fertilization (IVF), have been suspended by many cryobanks and fertility centers due to fears of work-related viral spread among staff and patients. However, for patients with cancer or other critical illnesses, cryopreservation of sperm is an urgent requirement before initiating therapeutic interventions, as many therapies can cause temporary or permanent infertility in male patients.

Studies have detected more than 27 viruses in semen, including human immunodeficiency virus (HIV), Zika and mumps. Some viruses, such as Zika virus, can even be detected in the semen of asymptomatic patients for up to a year after recovery.

Laboratory personnel working in cryobanks or fertility centers are at high risk of direct viral exposure while processing semen samples collected from virus-infected individuals. In addition, cross-contamination between infected and uninfected samples can occur during the cryo-storage phase, as many viruses can survive for a long time in the ultra-low temperature of liquid nitrogen. Therefore, semen samples containing infectious virus should be handled with extra care to avoid unexpected viral exposure and cross-contamination.

Procedures to follow during cryopreservation of semen from COVID-19 patients

Although the risk of SARS-CoV-2 infection in semen is very low, precautions should be taken in cryobanks to avoid unnecessary health risks. In the present article, the scientists have suggested some precautions based on the expert opinion available in the literature.

Cryobanks wishing to store sperm from COVID-19 patients must invite reproductive health authorities to evaluate laboratory conditions and facilities. They must train their staff on appropriate precautions and set up a separate laboratory for collecting semen from COVID-19 patients.

To minimize direct patient contact, online platforms can be used to collect the epidemiological and medical histories of patients with acute SARS-CoV-2 infection. Sperm samples must be analyzed via reverse transcription polymerase chain reaction (RT-PCR) to detect SARS-CoV-2. Thereafter, SARS-CoV-2 negative samples should be collected in high-security cryo vials and stored in liquid nitrogen in the vapor phase.

Given the potential for long-term presence of SARS-CoV-2 in the body, recovered COVID-19 patients should be provided with cryopreservation facilities for at least 3 months after symptom resolution. In particular, this interval should be extended by 6 months or longer for patients with long-term COVID. In non-emergency conditions, cryopreservation of sperm from patients with reinfection should be postponed.

In laboratories dealing with physiological and pathological conditions of the male reproductive system, a Class II biosafety cabinet should be used for emergency sperm cryopreservation of COVID-19 patients with other critical illnesses, such as cancer. Immediately after examination, processing and storage of the semen, all equipment should be properly disposed of.

Since SARS-CoV-2 may be present in other tissues, direct freezing of sperm collected through surgery should be avoided. All semen samples should be washed repeatedly and tested for SARS-CoV-2 before being frozen.

It is strongly recommended to avoid the retention of SARS-CoV-2 positive sperm cells. However, in emergency situations where further semen samples are not possible, virus positive samples should be washed with a double density gradient followed by a swim-up. These procedures help to dilute the virus before cryopreservation.

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