Study On Semen Quality And In Vitro Fertilization Outcome Of Hepatitis B Surface Antigen Positive Patients

BackgroundChina is a high endemic area of Hepatitis B. Two billion people worldwide have evidence of hepatitis B virus (HBV) exposure, and 690 million in China. An estimated 350 million are actively infected, and one-third in China. In the 2353 pairs of infertility couples undergoing in vitro fertilization-embryo transfer (IVF-ET) in the Affiliated Obstetrics and Gynecology Hospital of Medical College of Zhejiang University in 2009, there were 243 husbands with hepatitis B surface antigen (HBsAg) positive, accounting for 10.33%. Study on human sperm chromosomes indicated that the total frequency of sperm chromosome aberrations in HBV infection group was significantly higher than that in the control group. A retrospective cohort study of IVF-ET cycles in HBV and HCV discordant couples found that, despite comparable response to COH, HBV and HCV positive discordant couples have significantly lower implantation and pregnancy rates compared with age-matched controls. Another study showed that sperm parameters (sperm density, total number, forward motility and morphology, viability) of patients with HBV infection were worse compared with HCV patients. And the additional presence of varicocele further impairs sperm output in HBV patients. Thus, HBV infection is an important factor affecting the semen quality. There are only a few studies on semen quality and IVF outcome of HBsAg-positive patients.ObjectiveTo analyse the influence of HBsAg-positive on semen quality and IVF outcome. And we hope the paper can provide reference for ARTs.MethodsInfertile couples with husbands being HBV seropositive (positive for HBsAg) of year 2009 of the Affiliated Obstetrics and Gynecology Hospital of Medical College of Zhejiang University were retrospectively analyzed. HBsAg positive group were observed in 202 male patients undergoing IVF or ICSI (Intracytoplasmic sperm injection). Other 175 cycles, during which cycles started almost simultaneously, were selected as controls. The semen quality, fertility rate and high-quality embryo rate were compared between the HBsAg-positive group and the control group.Results1. Basic informationThere were no significant difference between the HBsAg positive group and the control group in age, body mass index (BMI), infertility causes and infertility period.2. Comparison of Semen qualityThe sperm volume, total sperm number, forward motility rate (grade a+b) in the HBsAg-positive group were significantly lower than those in control group. There were no significantly difference in sperm density and sperm deformity rate between two groups.3. Failure to liquefy In 202 cases of HBsAg-positive group, semen of 39 patients (19.3%) failed to liquefy. And in the control group, liquefaction of 21 patients' semen (12.0%) failed. There was no significant difference between the two groups.4. IVF or ICSIIn HBsAg-positive group,48 of 177 cycles (27.12%) chose ICSI; and in the control group,24 of 130 cycles (18.46%) chose ICSI. There was no significant difference between the two groups.5. Fertility rate and high-quality embryo rateIn HBsAg-positive group and the control group, fertility rate of ICSI were significantly higher than that of routine IVF. And the fertility rate of ICSI in control group was significantly higher than that in HBsAg-positive group. There were no significant difference on high-quality embryo rate among each group.Conclusion1. Hepatitis B virus infection affects sperm volume, total sperm number and forward motility rate negatively. But there is little effect on sperm density and sperm deformity rate.2. Hepatitis B virus infection doesn't increase the risk of failure to liquefy; and there is no decisive influence on the choice of in vitro fertilization manner. 3. Hepatitis B virus infection doesn't affect the high-quality embryo rate and the fertility rate of routine IVF. But it may reduce the fertility rate of ICSI.