Feasibility of sperm cryopreservation for male COVID-19 patients

In a recently published article Endocrinology Frontier, Scientists have deciphered the possibility of cryopreserving sperm from patients with coronavirus disease 2019 (COVID-19). This article also suggests some suggestions to help Cryobank perform appropriate steps to preserve sperm in COVID-19 patients.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has various factors such as decreased sperm production, structural changes in testicular tissue, sex hormone disorders, and decreased sperm quality. It is known to induce various reproductive abnormalities. ..

In the male reproductive system, SARS-CoV-2 can impair the blood-testis barrier, attack germ cells directly, disrupt the hypothalamic-pituitary-testicular axis and alter sex hormone secretion. In addition, virus-induced oxidative stress, inflammation, and fever associated with infection can disrupt the overall functioning of the reproductive system.

Most studies report non-positive about the presence of SARS-CoV-2 in semen. Very few studies have detected viral RNA in semen. Due to the overlap of the distal urinary tract and the reproductive tract in men, viral RNA in semen can emerge from the excretion of urine. In addition, there is lack of evidence to support the presence of SARS-CoV-2 in testicular tissue.

Possibility of sperm cryopreservation

In the early stages of the COVID-19 pandemic, sperm cryopreservation and In vitro Fertilization (IVF) has been interrupted by many cryobanks and fertility centers due to fear of spreading work-related viruses between staff and patients. However, for patients with cancer and other serious illnesses, sperm cryopreservation is urgent before initiating intervention, as many treatments can cause temporary or permanent infertility in male patients. It is a requirement of.

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

Laboratory staff working at cryobanks or fertility centers are at increased risk of being directly exposed to the virus during the processing of semen samples collected from virus-infected individuals. In addition, many viruses can survive long periods of time in the ultra-low temperatures of liquid nitrogen, which can lead to cross-contamination between infected and uninfected samples during the cryopreservation phase. Therefore, semen samples containing infectious virus should be treated with special care to avoid unexpected virus exposure and mutual contamination.

Procedures to be followed during cryopreservation of sperm from COVID-19 patients

Although the risk of SARS-CoV-2 infection in semen is very low, cryobanks need to take precautions to avoid unnecessary health hazards. In the current article, scientists suggest some precautions based on the opinions of experts available in the literature.

Cryobanks planning to store sperm from COVID-19 patients must invite reproductive health authorities to assess laboratory conditions and facilities. They need to train staff for proper precautions and arrange for another laboratory to collect sperm from COVID-19 patients.

To minimize direct contact with patients, an online platform can be used to collect epidemiological and medical histories from patients with acute SARS-CoV-2 infections. Semen samples need to be analyzed via reverse transcription-polymerase chain reaction (RT-PCR) in order to detect SARS-CoV-2. The SARS-CoV-2 negative sample is then collected in a safe cryovial and stored in vapor phase liquid nitrogen.

Given the long-term presence of SARS-CoV-2 in the body, patients who have recovered with COVID-19 should be provided with a cryopreservation facility at least 3 months after their symptoms disappear. .. Specifically, for patients with long COVIDs, this interval should be extended by at least 6 months. In non-emergency situations, sperm cryopreservation in reinfected patients should be postponed.

Laboratories dealing with the physiological and pathological conditions of the male reproductive system need to utilize Class II safety cabinets for emergency sperm cryopreservation of COVID-19 patients suffering from other serious illnesses such as cancer. I have. Immediately after inspecting, processing and storing sperm, all equipment should be properly disposed of.

Direct freezing of sperm collected by surgery should be avoided given that SARS-CoV-2 may be present in other tissues. All sperm samples should be washed repeatedly and tested for SARS-CoV-2 prior to cryopreservation.

It is highly recommended to avoid storage of SARS-CoV-2 positive sperm. However, in emergencies where further sampling of semen is not possible, virus-positive samples should be washed with a double density gradient and then swimd up. These steps will help dilute the virus prior to cryopreservation.