Infectious human papillomavirus virions in semen reduce clinical pregnancy rates in women undergoing intrauterine insemination

Objective: To study the influence of human papillomavirus (HPV) virions present in different sperm fractions of male partners of women undergoing IUI on fertility outcome. Design: Prospective noninterventional multicenter study. Setting: Inpatient hospital fertility centers. Patient(s): Seven hundred thirty-two infertile couples undergoing 1,753 IUI cycles with capacitated sperm. Intervention(s): None. Main Outcome Measure(s): Biochemical and clinical pregnancy rate in IUI cycles with HPV-positive or HPV-negative semen. Result(s): Five hundred seventy-three infertile couples undergoing 1,362 IUI cycles were enrolled. Work-up of the 1,362 sperm samples that were used for IUI generated 3,444 separate sperm fractions. Each of the sperm fractions was tested with quantitative polymerase chain reaction for 18 different HPV types (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, and 68). HPV prevalence in sperm was 12.5%/IUI cycle. When infectious HPV virions were detected in sperm, a significant decrease in clinical pregnancies was observed when compared with HPV-negative cycles (2.9% vs. 11.1 %/cycle). Above a ratio of 0.66 HPV virions/spermatozoon no pregnancies occurred (sensitivity 100%, specificity 32.5%). Conclusion(s): Women inseminated with HPV-positive sperm had 4 times fewer clinical pregnancies compared with women who had HPV-negative partners. Detection of HPV virions in sperm is associated with a negative IUI outcome and should be part of routine examination and counseling of infertile couples. ((C) 2019 by American Society for Reproductive Medicine.)