“Impact of COVID-19 and Other Viruses on Reproductive Health” (2020), by Osamah Batiha, Taghleb Al-Deeb, Esra’a Al-zoubi, and Emad Alsharu

In 2020, Osamah Batiha and colleagues published their article “Impact of COVID-19 and Other Viruses on Reproductive Health,'' hereafter “Impact of COVID-19,” in the journal Andrologia. The article is a literature review that encompasses various studies on how coronavirus disease 2019, or COVID-19, impacts male fertility and pregnancy. COVID-19 is a viral disease that primarily infects the respiratory system and causes infection through the virus severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2. The researchers published “Impact of COVID-19” during the middle of the COVID-19 pandemic, which was a time of global panic and uncertainty. “Impact of COVID-19” was one of the first studies to examine the potential effects of COVID-19 on male fertility and elicited discussion within the scientific community regarding the necessary safety precautions to take during viral pandemics.

1. Background
2. Article Contents
3. Impacts

Background

At the time of the article’s publication, Batiha and colleagues worked at various universities and medical centers in the northwestern region of Jordan. Batiha, the corresponding author, and co-author Esra’a Al-Zoubi both researched at the Department of Biotechnology and Genetic Engineering at Jordan University of Science and Technology in Irbid, Jordan. Taghleb Al-Deeb conducted his research at the Department of Biological Sciences at Al al-Bayt University in Mafraq, Jordan. Emad Alsharu was a physician at Hussein Medical Center in Amman, Jordan.

The authors published “Impact of COVID-19” during the COVID-19 pandemic, which has over 777 million reported cases, as of 2025. A pandemic is a widespread occurrence of an infectious disease that occurs worldwide or across multiple countries. Researchers recorded the first case of COVID-19 in November 2019 in Wuhan, China, and the disease continued to spread globally thereafter. The pandemic initiated a period of uncertainty for many people globally. As with many novel diseases, the public was worried that COVID-19 would also elicit serious implications on health and fertility. The publication of various research findings, such as Ranjith Ramasamy and colleagues’ findings from the University of Miami in Miami, Florida, that COVID-19 can remain in the male reproductive system after initial infection and reduce sperm count for three to six months after infection, caused public alarm. Thus, Batiha and colleagues compiled various studies on the effect of viruses, including COVID-19, on fertility to inform the public and contextualize the COVID-19 allegations.

Article Contents

The authors divide the article into seven main sections. In the “Introduction,” the authors address that COVID-19 originated from the SARS-CoV-2 virus, which primarily affects the respiratory system but can also impact the male reproductive system and fertility. In “Mechanism of Infection,” they describe how COVID-19 infects human host cells and replicates within them with ACE2 receptors, spike proteins, and the host cell's own cellular machinery. In “Common Viruses Linked to Male Infertility,” they detail that other previously studied viruses alter sperm quality and affect male fertility and assert that COVID-19 may cause similar results. In “Potential Effect of SARS-CoV-2 on Male Fertility,” the researchers explain that previous studies link COVID-19 to male infertility and demonstrate that the disease lowers sperm count, alters the composition of the sperm, and modifies male hormone levels. In “Potential Effect of SARS-Cov-2 on Pregnancy Loss/Miscarriages,” they cite research studies to demonstrate the contradictory findings within the literature on topics, such as whether there is a greater mortality rate associated with pregnant people infected with COVID-19, if COVID-19 infection impacts neonatal health and birth complications, and if the disease can transfer from mother to fetus during pregnancy. In “Management of Assisted Reproductive Technology at the Time of COVID-19,” Batiha and colleagues explain that artificial reproductive technologies, or ART, require additional safety precautions to prevent infection, such as telemedicine visits, antibiotics, or extra sanitary measures before and during procedures. In “Conclusions and Future Directions,” they conclude that males are at a greater risk for COVID-19 and infertility-related concerns and that future research must occur to determine the precise effects of COVID-19 on pregnancy and fertility.

In the “Introduction,” the authors describe that COVID-19 originates from the SARS-CoV-2 virus and causes infection in the respiratory system and other organs. The researchers state that COVID-19 initially appeared in China in 2019, and the virus originates from the Coronaviridea family. According to the article, the virus that causes COVID-19 is SARS-CoV-2, which presents similarly to the previously identified viral respiratory disease called severe acute respiratory syndrome coronavirus, or SARS-CoV. The researchers detail that SARS-CoV-2 transmits from person to person through direct contact and small droplets from coughing, sneezing, or talking. They note that the virus typically affects the respiratory system and can cause early infection symptoms of dry cough, breathing difficulties, fatigue, fever, and muscle pain. Those symptoms may later develop into more severe symptoms, including the loss of taste and smell, pneumonia, or a bacterial infection in the lungs, and lymphopenia, or a reduced level of the lymphocyte white blood cells. The authors explain that once the virus enters a host cell, it binds to a receptor called the angiotensin-converting enzyme 2, or ACE2 receptor, on the surface of the cell to elicit an infection. Many tissues and organs in the human body, including the lungs, kidneys, and testes, have cells that express the ACE2 receptor and are susceptible to SARS-CoV-2 infection.

In the article, the authors report that there were over seven million confirmed COVID-19 cases and 400,000 deaths worldwide at the time of publication. Due to the increase in COVID-19 cases at that time, the authors explain that they chose to evaluate the disease’s effect on fertility and compare their results to the effect of other common viral diseases on fertility.

In “Mechanism of Infection,” the authors outline the process of COVID-19 infection, which involves the binding of the virus to the host cell’s ACE2 receptor to replicate viral genetic material. The authors explain that viral entry begins when the spike, or S, glycoprotein on the surface of the virus binds to the ACE2 receptor on the host cell membrane. The researchers note that the S protein is composed of two regions known as S1, which binds directly to the ACE2 receptor, and S2, which assists the virus in fusing to the target host cell. They highlight that the virus releases its genome, or genetic material, into the host cell and uses the host cell’s organelles once the host cell membrane and the virus fuse together. That allows the virus to replicate its viral genome and infect other cells.

In the third section, “Common Viruses Linked to Male Infertility,” the research team hypothesizes that COVID-19 may have a similar effect to common viruses that impair sperm quality and male fertility. They note that previous studies had demonstrated that human papillomavirus, or HPV, can bind to the head of sperm cells to impair sperm motility. Sperm motility is the ability of sperm to move rapidly. It can cause infertility if the sperm cannot move quickly enough to reach and fertilize the egg. Batiha and colleagues also state that the herpes simplex virus, or HSV, which often appears as oral or genital sores, can affect the reproductive regions and cause low sperm count, poor sperm motility, and sperm cell death in men. Similarly, the authors address that human immunodeficiency virus, or HIV, infects immune cells and can reduce ejaculate volume, sperm motility, and sperm counts in infected men. The research team discusses that men infected with hepatitis B virus, or HBV, which is one of the most common life-threatening viruses that causes liver inflammation and disease, have low sperm counts, poor sperm motility, instability of sperm genetic material, and poor sperm morphology, or the size and shape of sperm. Other viruses, like hepatitis C virus, or HCV, and the mumps virus, or MuV, induce inflammation in the testes, or the male organ that makes sperm, which lowers sperm count and motility, decreases sperm lifespans, and causes poorer sperm quality and abnormal morphology compared to men without HCV.

In the fourth section, “Potential Effect of SARS-CoV-2 on Male Fertility,” the research team details that males are at a greater risk for COVID-19 than females and emphasize that fever can reduce sperm quality to cause infertility. The authors report that early studies in Italy, China, and the United Kingdom showed that males are more susceptible to COVID-19 than females, and thus, gender is a risk factor. They also cite previous studies that demonstrate males are more likely to develop severe symptoms and die from the virus more frequently than females. The research team notes that one of the most common symptoms of COVID-19 is fever, which may reduce sperm count and motility in males for several weeks before returning to normal levels. During a fever, the testes are not in their optimal temperature range and have trouble producing healthy sperm.

Batiha and colleagues also note that there is a high expression of ACE2 in the testes because sperm cells commonly express ACE2 receptors, which provide an entry route for SARS-CoV-2 infection in the male reproductive system. The authors analyze a previous study from 2020 by Zhengpin Wang, who studies cell biology at the National Institutes of Health in Bethesda, Maryland, and colleagues. According to Wang and colleagues, spermatogonia cells, or undifferentiated male cells, typically express ACE2 receptors. They explain that the study showed that ACE2-positive spermatogonia cells express genes that facilitate virus reproduction and transmission, which increase the risk of COVID-19 on sperm cell production and testicular cells.

At the end of the fourth section, the authors reference another study that compares the male sex hormone levels of people with COVID-19 to healthy individuals that found both a decrease in luteinizing hormone, or LH, and follicle-stimulating hormone, or FSH, in the tose COVID-19. Low LH and FSH levels in males can cause a deficit of testosterone and sperm, which directly affects fertility. The findings indicate that COVID-19 may decrease male fertility. The authors argue that additional research needs to directly analyze the seminal fluid of people with COVID-19 to determine the disease’s effect on sperm count, motility, and morphology.

In the fifth section, “Potential Effect of SARS-Cov-2 on Pregnancy Loss/Miscarriages,” Batiha and colleagues discuss that some previous studies demonstrated that COVID-19 led to an increased fatality rate in pregnant people, while others did not. The authors highlight that during the previous viral infection of SARS-CoV, the virus similar to SARS-CoV-2, pregnant women had a fifteen percent higher fatality rate than the general population. Due to the global increase in SARS-CoV-2 infection rates prior to the article’s publication, the research team states that researchers worldwide deemed it necessary to determine if pregnancy was a risk factor for COVID-19. The researchers discuss the results of multiple studies in Wuhan and Iran. They explain that those studies in Wuhan did not report any fatalities in pregnant people nor find a difference between the symptoms of COVID-19 infection in pregnant and non-pregnant people, while the study in Iran reported a high rate of maternal death.

Next, in the same section, the research group state that studies overall demonstrated that neonates delivered to COVID-19-infected mothers did not have an increased risk of clinical complications compared to normal pregnancies. The authors cite various studies to support their claim, including a study from Wuhan that demonstrated thirty-three neonates born to mothers with COVID-19 had no health complications other than shortness of breath in four cases. They note that the majority of studies analyzing neonatal health and COVID-19 infection in the mother reported no complications other than low birthweight and premature delivery in some instances. They detail that those studies did not report any miscarriages in the first trimester due to COVID-19, but several studies did report rare neonatal deaths.

Finally, Batiha and his research team explain that the studies they analyzed have not concluded whether mother-to-fetus transmission of COVID-19 during pregnancy is possible and reiterate that they cannot draw firm conclusions regarding the effect of COVID-19 on pregnancy due to conflicting findings. The researchers state that transfer of SARS-CoV-2 from mother to fetus may be possible during pregnancy because the ACE2 receptor is present in both the uterus and placenta. They communicate that few studies had reported a positive test in infants after delivery, although most neonates born to a pregnant person have tested negative. Therefore, researchers still do not know whether COVID-19 transmission can occur. The authors also cite a meta-analysis of eighty hospitalized pregnant people that found a zero percent mortality rate from COVID-19 but an increase in preterm birth, preeclampsia, or high blood pressure during pregnancy, and cesarean sections, or C-sections. They assert that researchers worldwide have not made concrete conclusions regarding COVID-19’s effect on pregnancy due to the conflicting results.

In the sixth section, “Management of Assisted Reproductive Technology at the Time of COVID-19,” the research team outlines the recommended global guidelines at the time of the publication for handling procedures and treatments for ART. Those guidelines include the implementation of telemedicine visits, antibiotics to prevent infection, and at-home sample collection when possible. The researchers highlight that people undergoing ART typically have infertility and may be at greater risk for COVID-19 infection. They emphasize that global guidelines from countries worldwide, including Jordan and the United States, advise medical professionals to implement telemedicine visits and online education resources to inform people undergoing ART during the pandemic. The authors also report that those global guidelines recommend that physicians prescribe antibiotics to people after collecting their eggs for ART procedures as a prevention to further minimize the risk of COVID-19, a protocol that was not routine practice prior to the pandemic. They also note that those guidelines recommend people obtain semen samples for in vitro fertilization, or IVF, a medical procedure in which a healthcare professional fertilizes an egg cell with sperm in a test tube, at home rather than in the medical office to minimize contact and transmission of the virus. The research team concludes that treatments with ART require additional safety precautions to effectively limit the virus’ spread due to the spread of COVID-19.

In the final section, “Conclusions and Future Directions,” Batiha and colleagues recapitulate that COVID-19 infection and fatality rates varied between countries, and further research is necessary to conclude the health risks of pregnancy and COVID-19. The authors note that at the time of publication, there was no drug or vaccine to treat COVID-19. As of 2025, drugs and vaccines do exist to treat and prevent COVID-19. They reiterate that there is not a direct link between maternal death and COVID-19, neonates born to an individual infected with COVID-19 do not have an increased risk of health complications compared to those born to unaffected people, and the possibility of viral transfer from mother to infant remains unconfirmed. The researchers advise that future researchers analyze those findings with larger sample sizes and evaluate the risks associated with COVID-19, such as miscarriage rates, for pregnant people in the first trimester.

Also, in the conclusion section, the authors report that males are at a higher risk than females for COVID-19 infection, comorbidity, and death, and COVID-19 may influence male infertility similarly to other viral infections. They note that HPV, HSV, HIV, HBV, HCV, and MuV infections are risk factors for male infertility and argue that SARS-CoV-2 may elicit similar effects in males. Due to the possible correlation of the disease with male infertility, Batiha and colleagues suggest that researchers perform a multidimensional research project, which includes multiple design approaches to address a problem from multiple perspectives, to understand the different impacts on males and females from COVID-19.

Impacts

As of 2025, researchers have cited “Impact of COVID-19” eighty times. At the time of the article’s publication in October 2020, no vaccine or treatment existed to minimize the spread of COVID-19. As of 2025, multiple COVID-19 vaccines exist and are available to the public, and administration of those began in December 2020. Since the article’s publication, various studies have cited “Impact of COVID-19” to develop further scientific understanding regarding the effect of COVID-19 on male infertility. In one study published in March 2023 in the Journal of Endocrinological Investigation, researchers from various medical institutions across China performed a literature review that analyzed the mechanism by which COVID-19 may affect male fertility. Those researchers conclude that COVID-19 infection disrupts a signaling pathway in the male reproductive system, which negatively impacts spermatogenesis. According to the researchers, physicians can address that concern by administering vaccines to male patients. Another study by Simone Morselli, a physician and researcher at the University of Florence in Florence, Italy, and colleagues evaluated the fertility of sexually active men who recovered from COVID-19 infection. Their study revealed that those individuals had impaired semen and inflammation within their seminal fluid, which demonstrates that COVID-19 infection could affect male fertility.

Other studies have cited “Impact of COVID-19” to demonstrate that the disease also influences female infertility. Researchers from Datta Meghe Institute of Medical Sciences in Wardha, India, analyzed studies evaluating the effects of COVID-19 infection on females worldwide, including in Germany, China, and Ireland. They conclude that many females experienced alterations in sex hormone levels after the COVID-19 pandemic compared to before. They were more susceptible to irregular menstruation, or the discharge of blood due to hormone changes, and infertility post-pandemic. In 2023, researchers across various institutions in Greece noted that several case studies linked early pregnancy loss with COVID-19, which suggests that the disease negatively impacts pregnancy. The team admitted that findings remain limited regarding the associated risks for pregnant people and COVID-19.

At the time of the article’s publication, researchers did not completely understand the effects of COVID-19 on fertility. Batiha and colleagues’ article provided a review of the available research examining the effects of the disease on both genders. “Impact of COVID-19” represents an early attempt to determine COVID-19’s impact on fertility at a time when researchers knew little about the virus. Researchers continue to further investigate that impact as of 2025. 

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