Charalampos Siristatidis, Wellington Martins, Dennis Vaidakis, Eleni Sertedaki
Tο identify, appraise and summarize the available data, concerning the impact of HPV infection on the reproductive outcomes following in vitro fertilization (IVF).
We searched for studies on PubMed, Embase, Scopus, Lilacs and the Cochrane Central Register of Controlled Trials from inception to Mar-2017. Any type of HPV infection in the woman assessed through PCR, subfertility factors and IVF indications and protocols were considered. Our primary outcomes were live birth/ongoing pregnancy and miscarriage, while secondary included clinical and laboratory parameters. Scheduled subgroup analyses were according to the status of cervical cytology and presence of infection on the male partner. We assessed the relative risk (RR), using a random-effects model; heterogeneity was assessed by I2 statistics. The quality of the evidence was evaluated using the recommendations from GRADE working group.
From the 14 studies eligible for inclusion, quantitative data from 10, evaluating 299 women with HPV infection and 2049 women without HPV infection, were included in the analyses. The pooled results showed no significant difference in live birth/ongoing pregnancy (RR=1.16, 95%CI=0.88-1.53, I2=0%, 6 studies, 983 women), clinical pregnancy (RR=1.06, 95%CI=0.74-1.54, I2=61%, 8 studies, 1173 women), and miscarriage rates (RR=1.58, 95%CI=0.93-2.69, I2=8%, 6 studies, 290 clinical pregnancies). The overall quality of the evidence was very low, downgraded two levels because of serious limitations of included studies (observational studies) and imprecision. In contrast, pooled results in the subgroup analysis based on the presence of infection on the male partner, showed significant differences in live birth/ongoing pregnancy (RR=0.43, 95%CI=0.23-0.82, I2=0%, 3 studies, 429 participants, p-0.01) and miscarriage rates (RR=3.70, 95%CI=1.94-7.05, I2=0%, 2 studies, 90 participants, p < 0.0001).
The available evidence is still insufficient to firmly conclude on the effect of the HPV infection of the woman on the most important reproductive outcomes following IVF; however, it suggests that the effect is not large for live birth/ongoing pregnancy and clinical pregnancy rates. When the infection is present in the male partner, it seems that there is a negative effect on live birth/ongoing pregnancy and miscarriage rates, a finding that has to be interpreted with caution, due to the low/very low quality of evidence supporting it.