Impact of hepatitis B virus and hepatitis C virus infection on sperm parameters of infertile men

The Effect of Hepatitis B Virus Infection on Semen Quality of Infertile Men: A Systematic Review and Meta-Analysis of Observational Studies

Semen quality is considered as an alternative measure for men's fertility. Several studies have examined the association between the hepatitis B virus (HBV) infection and semen quality, but the findings have been inconclusive. This study investigated the effects of HBV on semen quality. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020, as well as Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. In this study, international electronic databases including PubMed (National Library of Medicine), Web of Science, Scopus and Cochrane Library and also Persian databases including Scientific Information Database (SID) and Magiran were searched without a time limit until June 2023. All cohort and case-control studies examining the effects of HBV infection on the semen parameters of infertile men were included in the study. Animal studies, letters to the editor and case reports were excluded. The Newcastle-Ottawa scale was used to evaluate the quality of the included articles. Data analysis was done with Stata software. Of the 913 studies, 13 observational studies comprised a total of 10156 patients were included in this review, nine of which were included in the meta-analysis. The results showed that HBV infection has a negative effect on semen volume (95% confidence interval (CI): [-0.33, -0.09], P<0.001), sperm concentration (95% CI: [-8.53, -2.66], Pv<0.001), sperm motility (95% CI: [-10.06, -3.39], P<0.001), sperm normal morphology (95% CI: [-6.42, -1.06], P<0.001) and sperm viability (95% CI: [-11.64, -0.31], P<0.001). These results suggest that the HBV infection has a negative effect on the semen quality in infertile men. Nonetheless, further research with more robust design is recommended.

Update on known and emergent viruses affecting human male genital tract and fertility

Many viruses infect the male genital tract with harmful consequences at individual and population levels. In fact, viral infections may induce damage to different organs of the male genital tract (MGT), therefore compromising male fertility. The oxidative stress, induced during viral-mediated local and systemic inflammation, is responsible for testicular damage, compromising germinal and endocrine cell functions. A reduction in sperm count, motility, number of normal sperm and an increase in DNA fragmentation are all common findings in the course of viral infections that, however, generally regress after infection clearance. In some cases, however, viral shedding persists for a long time leading to unexpected sexual transmission, even after the disappearance of the viral load from the blood.The recent outbreak of Zika and Ebola Virus evidenced how the MGT could represent a reservoir of dangerous emergent viruses and how new modalities of surveillance of survivors are strongly needed to limit viral transmission among the general population.Here we reviewed the evidence concerning the presence of relevant viruses, including emergent and re-emergent, on the male genital tract, their route of entry, their adverse effects on male fertility and the pattern of viral shedding in the semen.We also described laboratory strategies to reduce the risk of horizontal or vertical cross-infection in serodiscordant couples undergoing assisted reproductive technologies.

Vertical transmission of hepatitis B virus from father to child: what can be concluded about this possibility?

Vertical hepatitis B virus (HBV) transmission is defined as transmission that occurs during pregnancy or postpartum from an HBV-infected mother to her fetus or child. It is an efficient route for the spread of HBV and is responsible for most of the cases of chronic HBV infection in adults. During pregnancy, vertical transmission can occur in the intrauterine phase, by placental infection via peripheral blood mononuclear cells, by placental leakage, or through female germ cells.The detection of HBV DNA in semen and spermatids from HBV-infected men has provided strong evidence that the male genital tract may act as a reservoir of the virus in HBV-infected men, supporting the possibility that vertical HBV transmission from an HBV-infected father to his child may also occur via the germ line at the time of fertilization, as occurs in HBV transmission from mother to child. Furthermore, it has been shown that integration of the HBV genome into the sperm cell genome can compromise sperm morphology and function and even cause hereditary or congenital biological effects in the offspring when an HBV-infected sperm fuses with an ovum.Since vertical HBV transmission from father to child can be a topic of interest and of global importance for controlling the spread of HBV, this article addresses the evidence supporting its occurrence via germ cells, the biological impact of integration of the HBV genome into the male germ cell genome, and the role of maternal immunoprophylaxis in vertical HBV transmission from father to child.

An Assessment of Men Semen Alterations in SARS-CoV-2: Is Fever the Principal Concern?

The SARS-CoV-2 virus (COVID-19) was identified as a pandemic in March 2020 by the World Health Organization. The virus spreads primarily through saliva droplets or nasal discharges, in addition to coughing or sneezing from an infected person. The most common symptom at the onset of illness is fever, which may appear within 2-14 days after exposure. The high fever (above 38 °C) can persist from one to 4 days. The febrile illness usually has a variable negative impact on sperm characteristics such as sperm output, motility, morphology, and DNA fragmentation. These defects proliferated due to an increase in testicular temperature, and disturbance in the thermoregulatory systems that are responsible for the testicular heat loss. Coronavirus studies suggest that fever from SARS-CoV-2 virus infection induces a reversible negative effect on the sperm parameters until one cycle (74 days) of spermatogenesis. We believe that SARS-CoV-2 can have long-term adverse effects on testicles via immune or inflammatory reactions after the patient has fully recovered. This evidence could be added to the list of the long-term post-COVID-19 syndromes. Long-term follow-up and evaluation of the sperm parameters are necessary for all recovered male patients, especially the young ones.

Molecular detection of HHV-1, HHV-2, HHV-5 and HBV in semen of fertile and infertile men by multiplex PCR method

Background and Objectives

A great diversity of factors including viruses such as human herpes virus 1&2 (HHV-1&2), human herpes virus 5 (HHV-5), and hepatitis B virus (HBV) play key roles in sterility and it is worth noting that male infertility accounts for nearly 50% of barrenness, globally. In this regard, we evaluated the prevalence of the aforementioned viruses in semen specimens of two distinct groups of men referred to Novin Infertility Center in Mashhad, Iran.

Materials and Methods

In this cross-sectional study, 300 semen samples were collected from 150 infertile and 150 fertile men. Subsequently, genomic DNA was extracted before performing multiplex polymerase chain reaction (PCR). Eventually, the results were analyzed via SPSS Statistics V.16.0.

Results

Out of 300 specimens, 183 (61.1%) were positive at least for one of the forenamed viruses; genome detection of HHV-1&2, HHV-5, and HBV were 27%, 18%, 36.66%, and 4%, respectively.

Conclusion

The current study found no correlation between infertility and HBV, HHV-5, and HHV-1&2, which may have to do with factors like sample size, the geographical distribution of the viruses, and the lifestyle (sexual behavior) of the participants. These results emphasize the implementation of such studies on a broader scale to determine the exact factors involved in infertility.

Human seminal virome: a panel based on recent literature

Background

The seminal virome and its implications for fertility remain poorly understood. To date, there are no defined panels for the detection of viruses of clinical interest in seminal samples.

Results

In this study, we characterized the human seminal virome based on more than 1,000 studies published over the last five years.

Conclusions

The number of studies investigating viruses that occur in human semen has increased, and to date, these studies have been mostly prospective or related to specific clinical findings. Through the joint analysis of all these studies, we have listed the viruses related to the worsening of seminal parameters and propose a new panel with the main viruses already described that possibly affect male fertility and health. This panel can assist in evaluating semen quality and serve as a tool for investigation in cases of infertility.

Hepatitis B Virus and Cytomegalovirus Infections Disrupt Sperm Parameters in Males through Decreasing Mitochondrial Membrane Potential: A Case-control Study

Background: Infertility is a global problem that affects more than 15% of couples. The occurrence of this problem is about 50% in males. Viral infections cause infertility in men by different mechanisms. Objectives: This study is designed to evaluate the effects of hepatitis B virus (HBV) and cytomegalovirus (CMV) infection on male fertility and determine the mechanisms involved. Methods: A total of 73 males were included in the present study. They were assigned to the groups healthy fertile (n = 22 volunteers) as the healthy controls, non-infected infertile (n = 27), HBV-infected infertile (n = 14), and CMV-infected infertile (n = 10). The sperm parameters, including count, morphology, progressive motility (PR), and progressive + non-progressive motility (PR + NP), were analyzed in their semen. The semen samples of all studied participants were subjected to polymerase chain reaction to determine the presence of HBV or CMV infection. Mitochondrial membrane potential (MMP) and tumor necrosis factor-alpha (TNF-α) were also assessed. Results: Our findings showed that all sperm parameters, including count, morphology, PR, and PR + NP, decreased in males with HBV and CMV infections compared to the healthy control group (P < 0.01 in all cases). MMP declined in HBV- and CMV-infected males compared to the healthy control group (P < 0.001). Conversely, the TNF-α level of semen in HBV- and CMV-infected men was significantly higher than in the healthy control group (P < 0.001). Conclusions: The results of the present study demonstrated that HBV and CMV infections lead to male infertility through increasing TNF-α and decreasing sperm MMP.

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.

Semen analysis: a workflow for an appropriate assessment of the male fertility status

Infertility is a worldwide problem that affects 9-15% of couples of reproductive age. In about half of the cases, it recognizes, alone or in combination, a male cause. In addition to a reproductive problem, male infertility can result from a systemic disease. Consequently, semen analysis, a fundamental test in the diagnosis of male infertility, represents a useful indicator not only of a man's reproductive capacity but also of his health and lifestyle. Given the key role of semen analysis, only accredited laboratories should perform it and experienced clinicians should be called into play in its interpretation. In this article, we have extensively examined how the macroscopic and microscopic parameters of semen analysis, alone or associated with each other, allow clinicians to orient towards specific diagnoses that can be confirmed by further ad hoc tests. On this basis, we also proposed a diagnostic flowchart focused on the results of the semen analysis.

Relative frequency of hepatitis B virus, human papilloma virus, Epstein-Barr virus, and herpes simplex viruses in the semen of fertile and infertile men in Shiraz, Iran: A cross-sectional study

Background

About 8-12% of couples on reproductive age suffers from infertility worldwide. Since 1993, the role of genital tract infections by microbes, including viruses that can infect the sperm, in human infertility has been proposed.

Objective

To investigate the frequency of hepatitis B virus (HBV), human papilloma virus (HPV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV) infection in the semen of fertile and infertile men referred to the Mother and Child Hospital, Shiraz, Iran.

Materials and Methods

In this cross-sectional study, 350 men including 200 infertile and 150 fertile men were included. All semen samples were allowed to liquefy, followed by the assessment of sperm parameters. DNA was extracted using a DNA extraction kit (CinaGene, Tehran, Iran) according to the manufacturer's instructions. Detection of HBV, HPV, EBV, and HSV1/2 was done by the PCR method.

Results

The mean age of the participants was 36 ± 7 yr. Molecular results showed that 16 samples (8%) of infertile men and 5 (3.3%) of fertile men were positive for HBV, which was not statistically significant (p = 0.069). Only one sample of the fertile participants was positive for HPV. None of the semen samples of the infertile or fertile groups was positive for the presence of EBV or HSV1/2.

Conclusion

The results of this study indicated that HBV, HPV, EBV, and HSV might not be involved in men's infertility. Further studies are recommended for clarifying the role of these viruses in infertility.

Impact of COVID-19 and other viruses on reproductive health

Male infertility is linked to some viral infections including human papillomavirus (HPV), herpes simplex viruses (HSV) and human immunodeficiency viruses (HIVs). Almost nothing is known about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) effect on fertility. The possible risk factors of coronavirus disease 2019 (COVID-19) infection on fertility comes from the abundance of angiotensin-Converting Enzyme-2 (ACE2), receptor entry of the virus, on testes, a reduction in important sex hormone ratios and COVID-19-associated fever. Recent studies have shown a gender difference for COVID-19 rates and comorbidity. In this review, we will discuss the potential effect of COVID-19 on male fertility and talk about what needs to be done by the scientific community to tackle our limited understanding of the disease. On the other side, we will focus on what is known so far about the risk of COVID-19 on pregnancy, neonatal health and the vertical transfer of the virus between mothers and their neonates. Finally, because reproduction is a human right and infertility is considered a health disease, we will discuss how assisted reproductive clinics can cope with the pandemic and what guidelines they should follow to minimise the risk of viral transmission.