A paucity of data exists regarding the outcomes of ART in women with HBV infection. Lee et al. found that the ongoing pregnancy and live birth rates in HBsAg-seropositive women (n = 131) do not differ significantly from those in HBsAg-seronegative women . Another study has reported that women who are HBsAg-seropositive (n = 77) have significantly lower fertilization and top-quality embryo rates than healthy controls, but the clinical pregnancy rates do not differ significantly between HBsAg-seropositive and -negative groups . However, Lam et al. showed that couples with at least one HBV-seropositive partner have higher pregnancy and implantation rates in IVF ET cycles than control couples (n = 56) . Nonetheless, data are limited and all the above studies include a small number of subjects. Recently, the study by Wang et al. considered the influence of HBeAg positive, but did not exclude the influence of HBV infection in their partners on the result . Therefore, it is difficult to draw a definitive conclusion. In the present study, we had a much larger sample size than that in previous studies and found no significant differences in clinical pregnancy or live birth rates between HBsAg-seropositive and -negative women. For the first time, our results reveal no significant difference in the birth weight, low birth weight rate or preterm rate of IVF/ICSI ET cycles between HBsAg-seropositive and healthy control women.
The serum HBV DNA concentration is a direct measure of viral load . To date, no study has evaluated the effect of the HBV DNA concentration on IVF outcome. HBeAg [18, 19] and preS1 [20, 21] are known serum markers for active HBV replication, indicating a high HBV DNA burden. To evaluate whether the status of viral replication affects the IVF/ICSI outcome in HBV-infected women, we compared HBeAg/preS1-seropositive women with healthy control women. In the present study, HBeAg/preS1-seropositive women had a similar live birth rate, clinical pregnancy rate, miscarriage rate, preterm rate, and low birth weight rate to uninfected women. This is the first report of a lack of association between HBeAg/preS1 seropositivity and pregnancy outcomes following IVF/ICSI treatment. Our retrospective cohort study found no significant increase in the miscarriage rate in HBsAg-seropositive women. However, a prior study reported a significantly increased incidence of miscarriage in pregnant women with chronic HBV infection as compared with uninfected controls , which is likely due to the non-inclusion of certain potential confounders that may affect pregnancy. In the present investigation, all HBsAg-seropositive women undergoing IVF/ICSI ET had normal liver function and had not received any antiviral treatment. Patients with a history of recurrent spontaneous abortion, autoimmune disease, surgery or congenital defects (urological or related to the reproductive organs), long-term drug use and/or toxin or radiation exposure, and any couples who were seropositive for HCV and/or HIV were excluded from the present study.
A higher incidence of secondary infertility and tubal factor infertility was detected in HBV-infected women as compared with healthy controls. This finding is consistent with those of previous studies [5, 13, 17]. This outcome may be due to the impaired immune response that facilitates infection with common pathogens that cause pelvic inflammatory disease and tubal subfertility [5, 25].
The present retrospective cohort study is the largest and first to report that HBeAg/preS1 seropositivity is not associated with post-IVF/ICSI-treatment pregnancy outcomes. In our cohort study, we found that active HBV infection in women had no effect on the birth weight or preterm rate following IVF/ICSI ET. Admittedly, our research has several limitations. Firstly, the HBV DNA serum concentration was not measured due to the retrospective nature of the study; thus, we were unable to evaluate whether viral load was correlated with pregnancy outcomes. Secondly, perinatal complications were not included and further research is required to address this subject.
In conclusion, HBV infection in women is associated with a higher risk of secondary infertility and tubal factor infertility, but has no significant impact on ovarian responses and pregnancy outcomes in HBsAg-seropositive women as compared with HBsAg-seronegative women, irrespective of their serum HBeAg and preS1 status.