Impact of SARS-CoV-2 on Reproductive Health
Summary
The emergence of SARS-CoV-2 has prompted extensive investigation into its effects on human fertility and reproductive function. In males, evidence indicates transient declines in semen quality—including reduced sperm concentration, motility and normal morphology—often accompanied by local inflammation and oxidative stress in the testes. Viral entry via the ACE2 receptor expressed in spermatogonia, Leydig and Sertoli cells may underlie these alterations, while systemic fever and cytokine-mediated damage contribute to hormonal imbalances and impaired spermatogenesis. In females, SARS-CoV-2 infection has been associated with perturbations in ovarian reserve markers such as anti-Müllerian hormone, transient menstrual irregularities and adverse outcomes following assisted reproductive treatments. Early data suggest that infection shortly after embryo transfer may reduce clinical pregnancy rates, whereas full vaccination appears to mitigate these risks. Molecular studies have highlighted host factors—such as the aromatase enzyme CYP19A1—that modulate sex-specific responses to infection and offer targets for therapeutic intervention. Collectively, these findings emphasise the need for multidisciplinary management of reproductive-aged individuals affected by COVID-19, encompassing fertility counselling, endocrine evaluation and optimised timing of assisted reproduction to preserve long-term reproductive health.
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Impact of SARS-CoV-2 on Reproductive Health publication trend
The graph below shows the total number of articles in impact of sars-cov-2 on reproductive health across all publications each year (not limited to Nature Index journals).
Technical terms
ACE2 receptor: A cell-surface enzyme that facilitates SARS-CoV-2 entry into host cells, notably in testes and ovaries.
Semen quality: Measures of sperm concentration, motility, morphology and viability used to assess male fertility.
Ovarian reserve: The capacity of the ovary to provide oocytes capable of fertilisation, often estimated by hormone markers such as anti-Müllerian hormone.
Embryo transfer: The placement of a fertilised embryo into the uterine cavity during assisted reproduction techniques.
Aromatase (CYP19A1): An enzyme that converts androgens to estrogens, influencing sex-hormone balance and disease outcomes.
References
- Alterations in Semen Quality and Immune‐Related Factors in Men with Infertility who Recovered from COVID‐19. MedComm (2025).
- scRNA-seq Profiling of Human Testes Reveals the Presence of the ACE2 Receptor, A Target for SARS-CoV-2 Infection in Spermatogonia, Leydig and Sertoli Cells. Cells (2020).
- SARS-CoV-2 infection is detrimental to pregnancy outcomes after embryo transfer in IVF/ICSI: a prospective cohort study. BMC Medicine (2024).
- CYP19A1 mediates severe SARS-CoV-2 disease outcome in males. Cell Reports Medicine (2023).
- Analysis of Ovarian Injury Associated With COVID-19 Disease in Reproductive-Aged Women in Wuhan, China: An Observational Study. Frontiers in Medicine (2021).
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