HBV infection tied to infertility, but not a pregnancy hazard
Infection with hepatitis B virus (HBV) does not appear to independently affect pregnancy outcomes, although it contributes to prolonged infertility, higher odds of secondary infertility, ovulatory disorders and reduced implantation rate, a study has found.
“This piece of information is of importance for the counselling of seropositive females taking in vitro fertilization (IVF) treatment,” according to the investigators. “However, we still recommend HBV detection for IVF couples due to the risk of vertical transmission to the offspring, laboratory contamination, staff safety, and cross-contamination of other virus-free gametes or embryos.”
In the study, the investigators examined the medical records of 8,550 infertile women undergoing their first IVF treatments. Of the women, 180 were positive for both HBsAg and HBeAg, 714 were positive for HBsAg and negative for HBeAg, and 7,656 were HBsAg seronegative (controls).
Women in the HBsAg+HBeAg+ group vs HBsAg+HBeAg– and control groups were about a year younger (30.0 vs 31.0 and 31.0 years; p<0.001 for both) and had more ovulatory disorders (11.7 percent vs 5.2 percent and 6.8 percent; p=0.003 and p=0.010, respectively). Moreover, compared with HBsAg seronegative controls, HBsAg/HBeAg seropositive women were more likely to have prolonged infertility (3.96 vs 3.66 years; p=0.003) and experience secondary infertility (52.1 percent vs 47.6 percent; p=0.021). [Fertil Steril 2019;112:250-257]
There were fewer embryos transferred in the HBsAg+HBeAg+ group than in the HBsAg+HBeAg– group (p=0.006). On the other hand, implantation rate was lower in the HBsAg+HBeAg– vs HBsAg seronegative control group (35.7 percent vs 38.7 percent; p=0.013) but did not differ between the HBsAg+HBeAg+ and the other two groups.
HBsAg/HBeAg seropositive women, however, had slightly higher rates of preterm delivery (29.0 percent vs 22.5 percent in the HBsAg+HBeAg– group and 22.3 percent in the control group; p=0.188 and p=0.127, respectively) and eutocia (37.6 percent vs 25.8 percent and 26.8 percent; p=0.024 and p=0.020).
Nevertheless, pregnancy outcomes such as clinical pregnancy rate (p=0.297), miscarriage rate (p=0.580) and live-birth rate (p=0.817), as well as the number of live babies delivered (p=0.604), were similar across the three patient groups.
Logistic regression analysis confirmed that HBV infection status did not exert any influence on clinical pregnancy, miscarriage or live-birth rates. Higher maternal age, reduced endometrial thickness and use of lower-quality embryos emerged as risk factors for miscarriage.
“Although we have concluded that HBV serostatus does not affect pregnancy outcomes in infertile patients seeking IVF-embryo transfer (ET) treatment, several limitations should be further considered,” the investigators pointed out.
“First, this is a retrospective study, so a well-designed randomized controlled study should be conducted to verify these results. Second, our study did not include frozen-thawed ET cycles, which may to some extent induce some unknown bias,” they said.
The investigators acknowledged that the cumulative live-birth rate should be considered to verify the long-term effect of HBV serostatus on pregnancy outcomes. Well-designed clinical studies are required to shed light on the pathogenesis of HBV infection in the ovarian follicles of the endometrium in the population of HBsAg seropositive women.