THE INFLUENCE of paternal hepatitis B virus (HBV) infection on fertility outcomes has long been a concern for couples seeking assisted reproductive technology (ART). HBV is one of the most common chronic viral infections worldwide, and although mother-to-child transmission has been extensively studied, the impact of paternal HBV on reproductive outcomes remains less well understood. A recent meta-analysis aimed to clarify whether paternal HBV infection affects clinical pregnancy rates (CPR) and live birth rates (LBR) in ART, concluding that there is no significant association, a finding with direct implications for clinical reassurance and practice.
Researchers conducted a comprehensive literature search across six major medical databases: PubMed, Embase, CNKI, Scopus, Web of Science, and Wangfang. Studies were included if they reported on ART pregnancies and provided data on paternal HBV status, CPR, and LBR. A total of 10 studies were included in the analysis for CPR (4,848 participants per woman and 28,951 per cycle) and between four and seven studies for LBR (2,327 participants per woman and 26,324 per cycle). Data were pooled using a random-effects model to calculate odds ratios (ORs) with 95% CIs, with subgroup analyses based on matching status.
The meta-analysis found no statistically significant association between paternal HBV infection and ART outcomes. For CPR, the pooled OR per woman was 1.015 (95% CI: 0.860–1.199; p=0.857), and per cycle was 1.051 (95% CI: 0.870–1.271; p=0.603). Similarly, LBR showed no significant differences, with an OR per woman of 0.852 (95% CI: 0.717–1.012; p=0.068) and per cycle of 0.999 (95% CI: 0.851–1.172; p=0.987). These results remained consistent across subgroups.
The findings suggest that paternal HBV infection does not have a meaningful effect on clinical pregnancy or live birth outcomes in ART, which offers reassurance to both patients and practitioners. However, limitations include the observational nature of the included studies, potential variation in ART protocols, and a predominance of data from specific regions, which may affect generalisability. Nonetheless, the results support current clinical practices that do not exclude HBV-positive males from ART on the basis of infection status alone, highlighting the importance of evidence-based decision-making in fertility treatment.
Reference
Gao J et al. Impact of paternal hepatitis B on pregnancy outcomes in couples undergoing assisted reproductive technology treatment: a systematic review and meta-analysis. PeerJ. 2025;DOI: 10.7717/peerj.19824.
