Association Between SARS-COV-2 Infection and Sperm DNA Fragmentation: A Systematic Review and Meta-Analysis

Introduction

SARS-CoV-2 infection affects various sperm quality parameters. This study examines the impact of COVID-19 infection on sperm DNA fragmentation (SDF).

Methods

A systematic literature search was performed across four databases for studies published between January 1, 2019, and January 1, 2025. The inclusion criteria focused on studies evaluating sperm DNA fragmentation in healthy men infected with the virus. The risk of bias was assessed using the Newcastle–Ottawa scale (NOS). A meta-analysis was conducted using a random effects model based on the tests employed in the studies to measure SDF. Data were reported as weighted mean differences (WMD) and corresponding 95% confidence intervals (CI). Out of 105 identified citations, seven articles were included in this analysis. The NOS results indicated that all studies were of high quality. Subgroup analysis revealed that all testing methods, including TUNEL, flow cytometry, and the sperm chromatin dispersion (SCD) test, demonstrated high heterogeneity, with the lowest heterogeneity found in the TUNEL test.

Results

The pooled analysis indicated a statistically significant increase in SDF (random effects model, WMD = 12.558, 95% CI: 4.482 to 20.635, I² = 99%, Z = 3.05, p < 0.0001). This meta-analysis suggests a statistically significant reduction in sperm DNA integrity 2–3 months following COVID-19 infection.

Conclusion

However, caution is warranted when interpreting these results due to the high heterogeneity, which may affect the outcomes. A thorough analysis considering participant characteristics and infection status is recommended.