Presence of Hepatitis B virus DNA in follicular fluid in female Hepatitis B carriers and outcome of IVF/ICSI treatment: A prospective observational study

Hepatitis B virus in oocytes and embryos: pregnancy outcomes and children's health

Objective

To investigate whether the presence of hepatitis B virus (HBV) in oocytes and embryos affects pregnancy outcomes for in vitro fertilization and embryo transfer (ET) as well as is related to the vertical transmission of HBV to children.

Design

Retrospective cohort study.

Setting

A university-affiliated fertility center.

Patients

This study included 167 couples with at least 1 hepatitis B surface antigen-seropositive partner. These couples underwent in vitro fertilization-ET, and the discarded oocytes and embryos had been tested for HBV. Couples with HBV-positive oocytes or embryos were categorized as the positive group, whereas those couples with HBV-negative oocytes and embryos served as the negative group.

Interventions

None.

Main Outcome Measures

Pregnancy outcomes and the rate of children's HBV infection.

Results

The pregnancy outcomes of fresh and frozen ETs were not associated with the presence of HBV in the oocytes and embryos. Of the 106 infants born, 1 child whose mother tested positive for hepatitis B surface antigen but had negative oocytes and embryos was infected with HBV. Additionally, 26.09% of children who had been administered passive immunization and active vaccinations did not reach protective levels of anti-HBV antibodies (hepatitis B surface antibodies) and became nonresponders. The negative rate of children's hepatitis B surface antibody was associated with the presence of HBV in oocytes and embryos (odds ratio, 3.01; 95% confidence interval, 1.04-9.25).

Conclusions

The presence of HBV in oocytes and embryos did not affect pregnancy outcomes or result in the vertical transmission of HBV to the offspring of HBV carriers. Follow-up is needed for HBV-vaccinated children with an HBV-infected parent. Booster vaccinations are necessary for continued protection.

Hepatitis B virus infection, infertility, and assisted reproduction

BACKGROUND: Hepatitis B virus (HBV) is one of the most widespread viruses worldwide and a major cause of hepatitis, cirrhosis, and hepatocellular carcinoma. Previous studies have revealed the impacts of HBV infection on fertility. An increasing number of infertile couples with chronic hepatitis B (CHB) virus infection choose assisted reproductive technology (ART) to meet their fertility needs. Despite the high prevalence of HBV, the effects of HBV infection on assisted reproduction treatment remain limited and contradictory. OBJECTIVE: The aim of this study was to provide a comprehensive overview of the effect of HBV infection on fertility and discuss its effects on pregnancy outcomes, vertical transmission, pregnancy complications, and viral activity during ART treatment. METHODS: We conducted a literature search in PubMed for studies on HBV infection and ART published from 1996 to 2022. RESULTS: HBV infection negatively affected fertility in both males and females. Existing research shows that HBV infection may increase the risk of pregnancy complications in couples undergoing assisted reproduction treatment. The impact of HBV infection on the pregnancy outcomes of ART is still controversial. Current evidence does not support that ART increases the risk of vertical transmission of HBV, while relevant studies are limited. With the development of ART, the risk of HBV reactivation (HBVr) is increasing, especially due to the wide application of immunosuppressive therapy. CONCLUSIONS: Regular HBV infection screening and HBVr risk stratification and management are essential to prevent HBVr during ART. The determination of optimal strategy and timing of prophylactic anti-HBV therapy during ART still needs further investigation.

Effects of hepatitis B virus infection on the treatment outcomes following in vitro fertilization/intracytoplasmic sperm injection: An analysis of 21,999 first embryo transfer cycles

To investigate the effects of hepatitis B virus (HBV) infection on the outcomes of Chinese couples undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and the clinical data of their neonates. A total of 21,999 first embryo transfer cycles were included. They were categorized into four groups based on the couple's hepatitis B surface antigen (HBsAg) result (Group A = female HBsAg- and male HBsAg- ; Group B = female HBsAg+ and male HBsAg- ; Group C = female HBsAg- and male HBsAg+ ; Group D = female HBsAg+ and male HBsAg+ ). The fertilization rate (FR), cleavage rate (CR), implantation rate (IPR), clinical pregnancy rate (CPR), live birth rate (LBR) and miscarriage rate (MCR) were analysed. Multilevel logistic regression was applied to evaluate the association. The total prevalence of HBV infection was 5.74% (2526/43998). There were no statistically significant differences in CRs (98.69%, 98.76%, 98.66%, 98.72%, p > .05), IPRs (45.86%, 47.33%, 45.19%, 39.61%, p > .05), CPRs (62.84%, 65.05%, 61.80%, 56.81%, p > .05), MCRs (12.70%, 11.99%, 12.58%, 4%, p > .05) and LBRs (53.43%, 55.38%, 52.70%, 54.54%, p > .05) among the four groups. However, there were significant differences in FRs (66.25%, 66.55%, 66.32%, 61.92%, p < .05). Group D had the lowest FR. After adjusting for confounders, the multilevel logistic regression showed that HBsAg+ had no impact on the LBR, CPR or MCR. We also analysed the data of 14,465 newborns, including 8593 singletons and 2936 twins. Among the four groups, no variables reached statistical significance, including neonatal birth weight (NBW), twin ratio, gestational age, premature birth, delivery type, fetal macrosomia or low birth weight (p > .05). Our study demonstrates that, although biparental HBV infection may affect the FR, neither single-parent infection nor biparental HBV infection affects IVF/ICSI outcomes or neonatal outcomes.

Maternal-to-Child Transmission of Hepatitis B Virus and Hepatitis Delta Virus

Maternal-to-child transmission of hepatitis B virus (HBV) and hepatitis delta virus (HDV) can lead to the risk of progressive liver disease in infants, but fortunately effective interventions exist to decrease transmission. Counseling on the risk of maternal-to-child transmission, care pathways to decrease transmission, and the implications of HBV and HDV on pregnancy outcomes are the key components of caring for pregnant people living with HBV and HDV.

Assessment of Prior Infection With Hepatitis B Virus and Fecundability in Couples Planning Pregnancy

IMPORTANCE

The association of hepatitis B virus (HBV) infection with reduced fecundability among reproductive-aged couples lacks large-population, in-depth study evidence.

OBJECTIVE

To investigate the association of HBV infection with time to pregnancy in couples planning pregnancy, and to explore whether this association varied by gravidity, health statuses, or lifestyles.

DESIGN, SETTING, AND PARTICIPANTS

This is a population-based cohort study of Chinese couples participating in the National Free Preconception Check-up Projects during 2015 to 2017. They were planning pregnancy and were followed-up every 3 months until getting pregnant, as confirmed by gynecologic ultrasonography, or were followed-up for 1 year. Data were analyzed between March 1, 2022, and September 30, 2022.

MAIN OUTCOMES AND MEASURES

The main outcome was time to pregnancy, assessed using fecundability hazard ratios (HRs). The Cox proportional hazards regression models were used to estimate the association of HBV infection with fecundability.

RESULTS

Among 2 419 848 couples (mean [SD] age, 27.87 [5.20] years for women and 29.58 [5.50] years for men), 126 728 women (5.24%) and 156 572 men (6.47%) were infected with HBV. Compared with the HBV-negative group, the fecundability of both women and men in the HBV-positive group decreased by 5% (HR, 0.95; 95% CI, 0.94-0.95). Compared with couples in which both partners were HBV negative, the fecundability of those in which both partners were HBV positive declined by 6% (HR, 0.94; 95% CI, 0.93-0.96) among all couples, by 3% (HR, 0.97; 95% CI, 0.95-0.99) among nulligravidas couples, and by 7% (HR, 0.93; 95% CI, 0.91-0.95) among multigravidas couples. Both the female-male and couple models suggested that the association of HBV infection with decreased fecundability was more pronounced in couples with multigravidas. The negative association was greater in people with overweight and obesity and was inconsistent in certain subgroups; in particular, it was more pronounced in women with reproductive tract infections, normal fasting plasma glucose, and no alcohol intake and in men with normal blood pressure.

CONCLUSIONS AND RELEVANCE

In this population-based cohort study, HBV infection was associated with decreased fecundability in a general reproductive-aged population, especially in couples with multigravidas. For women and men with certain health statuses and lifestyles, a comprehensive consideration of this association is recommended to provide personalized fertility guidance.

Impact of in vitro fertilization-embryo transfer on mother-to-infant transmission in women with chronic HBV infection

BACKGROUND AND AIMS

In vitro fertilization-embryo transfer (IVF-ET) may increase the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). The purpose of this study was to investigate the impact and safety of IVF-ET on MTCT in women with chronic HBV infection (CHB).

METHODS

The data of 298 women who got pregnant by IVF-ET and their 375 children were collected retrospectively. Mothers were divided into the CHB group (n = 224) and the control group (HBsAg negative, n = 74). After birth, newborns were routinely vaccinated with the hepatitis B vaccine, and infants in the CHB group were injected with hepatitis B immunoglobulin within 2 h after birth. Demographic information, clinical data and laboratory test results were collected. The primary outcome measures were the MTCT rate of HBV, and the secondary outcome measures were the safety of the mother and infant.

RESULTS

There was no case of HBV MTCT in all 282 newborns born in the CHB group and 93 neonates born in the control group. Of the two groups, the birth weight (3056.74 ± 601.65 vs. 2926.24 ± 704.86, P = .083), length (49.22 ± 1.97 vs. 48.74 ± 3.09, P = .167), 5-min Apgar score (9.97 ± 0.21 vs. 9.90 ± 0.51, P = .212), days of pregnancy (265.70 ± 12.73 vs. 262.02 ± 17.50, P = .064) and neonatal malformation rate (0.71% vs. 0, P = 1.000) were similar. Two cases of neonatal malformation occurred in the CHB group. The incidences of pregnancy and childbirth complications were similar between the two groups.

CONCLUSION

IVF-ET does not increase the risk of MTCT in women with chronic HBV infection, and it is safe for mothers and infants.

The negative impact of most relevant infections on fertility and assisted reproduction technology

Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.

The effects of hepatitis B virus infection on natural and IVF pregnancy: A meta-analysis study

BACKGROUND

Hepatitis B virus (HBV) has been considered a significant cause of human reproductive failure in different studies; however, there is a considerable disagreement on the true impacts of HBV on female reproduction. This study has evaluated the impact of HBV infection on pregnancy complications in natural pregnancy and also on pregnancy outcomes in women undergoing in vitro fertilization (IVF) treatment.

METHOD

We searched Embase, Web of Science, PubMed and Google Scholar databases to identify the potentially relevant studies. Summary odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI) was applied to assess the relationship. Heterogeneity testing, sensitivity analysis and publication bias testing were also performed.

RESULTS

A total of 42 studies concerning the effect of HBV infection on the natural and IVF pregnancy were included in this study. Our meta-analysis results revealed that HBV infection had a positive correlation to gestational diabetes mellitus (GDM) [OR = 1.32 (1.17-1.48) (p < 0.01)] and preterm birth [OR = 1.26 (1.14-1.40) (p < 0.01)] in natural pregnancy; however, HBV infection was not significantly associated with decreased fertility rates among the patients who underwent IVF.

CONCLUSION

This study revealed a strong association of GDM and preterm birth with higher rates of HBV infection in pregnant women. Also, our results suggested that HBV infection in patients undergoing IVF may not negatively influence the pregnancy outcome. It may be rational to conclude that IVF might be rather a safe and effective method for HBV+ females who desire to have children.

Co-expression of the SARS-CoV-2 entry molecules ACE2 and TMPRSS2 in human ovaries: Identification of cell types and trends with age

The high rate of SARS-CoV-2 infection poses a serious threat to public health. Previous studies have suggested that SARS-CoV-2 can infect human ovary, the core organ of the female reproductive system. However, it remains unclear which type of ovarian cells are easily infected by SARS-CoV-2 and whether ovarian infectivity differs from puberty to menopause. In this study, public datasets containing bulk and single-cell RNA-Seq data derived from ovarian tissues were analyzed to demonstrate the mRNA expression and protein distribution of the two key entry receptors for SARS-CoV-2—angiotensin-converting enzyme 2 (ACE2) and type II transmembrane serine protease (TMPRSS2). Furthermore, an immunohistochemical study of ACE2 and TMPRSS2 in human ovaries of different ages was conducted. Differentially expressed gene (DEG) analysis of ovaries of different ages and with varying ovarian reserves was conducted to explore the potential functions of ACE2 and TMPRSS2 in the ovary. The analysis of the public datasets indicated that the co-expression of ACE2 and TMPRSS2 was observed mostly in oocytes and partially in granulosa cells. However, no marked difference was observed in ACE2 or TMPRSS2 expression between young and old ovaries and ovaries with low and high reserves. Correspondingly, ACE2 and TMPRSS2 were detected in the human ovarian cortex and medulla, especially in oocytes of different stages, with no observed variations in their expression level in ovaries of different ages, which was consistent with the results of bioinformatic analyses. Remarkably, DEG analysis showed that a series of viral infection-related pathways were more enriched in ACE2-positive ovarian cells than in ACE2-negative ovarian cells, suggesting that SARS-CoV-2 may potentially target specific ovarian cells and affect ovarian function. However, further fundamental and clinical research is still needed to monitor the process of SARS-CoV-2 entry into ovarian cells and the long-term effects of SARS-CoV-2 infection on the ovarian function in recovered females.

[Outcomes of cumulative transfers of fresh and frozen embryos in in vitro fertilization in women infected by hepatitis B virus]

OBJECTIVE

To assess the impact of hepatitis B virus (HBV) infection in women on in vitro fertilization (IVF) outcomes.

METHODS

An observational monocentric case-control cohort study conducted between 2012 and 2019 compared the outcomes of the first cycle of IVF between 64 woman infected with HBV and 128 seronegative controls. Frozen embryos transfers made within 18 months of the puncture were included. The exclusion criteria were severe infections, viral co-infection in women, any viral infection in their spouse, or lack of fresh embryo transfer. The matching was performed according to age, primary infertility or secondary, conventional or intracytoplasmic injection IVF technique and date of attempt. The main analysis focused on cumulative live births rates (LBR).

RESULTS

The clinical and ovarian stimulation characteristics were comparable except for a longer period of infertility in the HBV group. The LBR in the HBV group, when compared to controls, was not different after transfer of fresh (14.06 vs. 25.00% P=0.08) or frozen embryos (4.17 vs. 18.92% P=0.08), but significantly decreased in cumulative analysis (15.63 vs. 35.94% P=0.003). HBV infection was negatively associated with LBR in multivariate analysis OR=0.38 (95% CI 0.14-0.92) P<0.05. The implantation rate was lower in the HBV group versus controls, in fresh (14.89 vs. 27.72% P=0.02) and frozen (3.03 vs. 21.65% P=0.01) embryo transfers.

CONCLUSION

This study suggests a negative impact of HBV infection in women on the cumulative LBR after IVF.

Viruses in the reproductive tract: On their way to the germ line?

Studies of vertebrate genomes have indicated that all species contain in their chromosomes stretches of DNA with sequence similarity to viral genomes. How such 'endogenous' viral elements (EVEs) ended up in host genomes is usually explained in general terms such as 'they entered the germ line at some point during evolution'. This seems a correct statement, but is also rather imprecise. The vast number of endogenous viral sequences suggest that common routes to the 'germ line' may exist, as relying on chance alone may not easily explain the abundance of EVEs in modern mammalian genomes. An increasing number of virus types have been detected in human semen and a growing number of studies have reported on viral infections that cause male infertility or subfertility and on viral infections that threaten in vitro fertilisation practices. Thus, it is timely to survey the pathway(s) that viruses can use to gain access to the human germ line. Embryo transfer and semen quality studies in livestock form another source of relevant information because virus infection during reproduction is clearly unwanted, as is the case for the human situation. In this review, studies on viruses in the male and female reproductive tract and in the early embryo will be discussed to propose a plausible viral route to the mammalian germ line.

Assisted reproduction in hepatitis carrier couples

Chronic Hepatitis B virus (HBV) infection is endemic worldwide, and the prevalence is especially high in the Asia-Pacific regions. Despite its high prevalence, the literature regarding the impact of HBV infection on subfertility and fertility treatment remains limited and conflicting. Latest studies do not suggest any detrimental effect of HBV infection on the outcome of IVF/ICSI treatment in women having chronic HBV infection. There is evidence that HBV exists in ovarian tissue including oocyte and follicular fluid, and therefore has the potential risk of transmission to the embryo, which can explain the finding of vertical transmission despite immunoprophylaxis. Most recently, we have observed the evidence of HBV viral replication in female HBV carriers undergoing IVF/ICSI treatment. This raises the question of whether antiviral medication should be administered during ovarian stimulation in IVF/ICSI treatment cycles for women with chronic HBV infection to help reduce the chance of vertical transmission.