Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis

Fertil Steril. 2020 May;113(5):955-969.e4. doi: 10.1016/j.fertnstert.2020.01.010.


Objective: To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes.

Design: Systematic review and meta-analysis.

Setting: Not applicable.

Patients: Men with HPV sperm infection and couples undergoing IVF.

Interventions: Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection.

Main outcome measures: Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR).

Results: Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR.

Conclusion: Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations.

Prospero registration number: CRD42019127419.

Keywords: Human papilloma virus; in vitro fertilization outcomes; male infertility; sperm analysis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Abortion, Spontaneous / etiology
  • Female
  • Fertility
  • Fertilization in Vitro* / adverse effects
  • Humans
  • Infertility, Male / diagnosis
  • Infertility, Male / physiopathology
  • Infertility, Male / virology*
  • Male
  • Papillomaviridae / isolation & purification*
  • Papillomavirus Infections / complications
  • Papillomavirus Infections / diagnosis
  • Papillomavirus Infections / virology*
  • Pregnancy
  • Pregnancy Rate
  • Risk Assessment
  • Risk Factors
  • Semen / virology*
  • Sperm Count
  • Sperm Motility
  • Spermatozoa / pathology
  • Spermatozoa / virology*
  • Treatment Outcome