Histopathology and ultrastructural findings of fatal COVID-19 infections on testis

Justin K. Achua, Kevin Y. Chu, Emad Ibrahim, Kajal Khodamoradi, Katiana S. Delma, Oleksii A. Iakymenko, Oleksandr N. Kryvenko, Himanshu Arora, Ranjith Ramasamy

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: To evaluate the presence and analyze the pathological changes within the testes of patients who died or recovered from severe acute respiratory syndrome coronavirus 2 (COVID-19) complications. Materials and Methods: Testis tissue was collected from autopsies of COVID-19 positive (n=6) and negative men (n=3). Formalin-fixed paraffin-embedded tissues were stained with hematoxylin and eosin (H&E) and subjected to immunofluorescence for angiotensin-converting enzyme 2 (ACE-2) expression. Fluorescent-labeled tissue slides were imaged on a quantitative pathology scope with various zoom levels allowing for qualitative and quantitative interpretation. Tissue from four COVID-19 positive autopsy cases and a live seroconverted patient was imaged with transmission electron microscopy (TEM). Results: H&E histomorphology showed three of the six COVID-19 biopsies had normal spermatogenesis while the remaining three had impaired spermatogenesis. TEM showed the COVID-19 virus in testis tissue of one COVID-19 positive autopsy case and the live biopsy, H&E stain on the same autopsy case demonstrated interstitial macrophage and leukocyte infiltration. Immunofluorescent stained slides from six COVID-19 positive men demonstrated a direct association between increased quantitative ACE-2 levels and impairment of spermatogenesis. Conclusions: The novel COVID-19 has an affinity for ACE-2 receptors. Since ACE-2 receptor expression is high in the testes, we hypothesized that COVID-19 is prevalent in testes tissue of infected patients. This study suggests the male reproductive tract, specifically the testes, may be targets of COVID-19 infection. We found an inverse association between ACE-2 receptor levels and spermatogenesis, suggesting a possible mechanism of how COVID-19 can cause infertility.

Original languageEnglish (US)
Pages (from-to)65-74
Number of pages10
JournalWorld Journal of Men?s Health
Issue number1
StatePublished - Nov 3 2020


  • Autopsy
  • COVID-19
  • Coronavirus
  • Infertility
  • Testis

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology
  • Psychiatry and Mental health
  • Public Health, Environmental and Occupational Health
  • Health Policy
  • Aging
  • Pharmacology (medical)


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