Association of hepatitis B virus infection with oocyte quality, embryo development, and ART outcomes in couples with a freeze-all strategy at a single center.

STUDY QUESTION Does female or male hepatitis B virus (HBV) infection affect the oocyte and embryo quality, pregnancy outcomes, and neonatal outcomes in infertile couples undergoing ART treatment? SUMMARY ANSWER The female or male HBV infection did not have a statistically significant negative impact on the development of oocytes and embryos, pregnancy outcomes, or neonatal outcomes of ART. WHAT IS KNOWN ALREADY Only few studies assessing the effects of HBV infection on the reproductive outcomes among infertile population have been conducted with inconsistent results. There is limited research that focuses on the oocyte and embryo development of HBV-infected females and males. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was performed among infertile couples undergoing the first frozen embryo transfer (FET) after the first ovarian stimulation with a freeze-all strategy during the period from 1 January 2011 to 31 March 2023. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 24 836 infertile couples, including 133 couples with female HBV-positive and male HBV-negative, 1471 couples with female HBV-negative and male HBV-positive, and 23 232 couples with both female and male HBV-negative underwent their first FET after the first ovarian stimulation with a freeze-all strategy. Propensity score matching (PSM) was used to balance the baseline parameters between the groups. MAIN RESULTS AND THE ROLE OF CHANCE After PSM, no statistically significant differences were observed regarding the comparison in the number of oocytes retrieved, MII oocytes, 1-2-3 PN-fertilized oocytes, 2PN-fertilized oocytes, embryo cleavages, available embryos, top-quality embryos, and available blastocysts between comparison groups (group with female HBV-positive and male HBV-negative and group with female HBV-negative and male HBV-positive) and the reference group. Consistently, the differences in the mature oocyte rate, fertilization rate, cleavage rate, as well as top-quality embryo rate and available embryo rate between comparison groups and the reference group were not statistically significant. The clinical pregnancy rate and the live birth rate showed a decreasing trend for couples with female HBV infection compared with the uninfected couples, although this did not reach statistical significance (clinical pregnancy: adjusted odds ratio, 0.69 [95% CI: 0.45-1.05] and live birth: 0.64 [0.41-1.00]). Couples with female HBV infection and couples with male HBV infection were not associated with increased risk of adverse neonatal outcomes including preterm birth, low birth weight, high birth weight, small for gestational age, and large for gestational age. LIMITATIONS, REASONS FOR CAUTION This was a retrospective cohort study in a single center, which limited the generalization of our results. WIDER IMPLICATIONS OF THE FINDINGS HBV infection was not statistically significantly associated with development of oocyte and embryo quality, pregnancy outcomes, and neonatal outcomes. These findings indicate infertile women or male with HBV infection should not be prevented from seeking ART due to concerns about negative effects. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the National Natural Science Foundation of China (grant nos. 82273634, 81903324), the interdisciplinary program of Shanghai Jiao Tong University (YG2019QNA19), and the second round of Promoting clinical skills and clinical innovation in municipal hospitals New three-year Action Plan "Research physicians innovation and transformation ability Strength training program" (SHDC2023CRS031). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.