Objective:

To evaluate the impact of chronic hepatitis B virus infections on ovarian reserve in female patients undergoing in vitro fertilization (IVF).

Approach:

• Study Design: A multicenter retrospective cohort study analyzing data from over 38,000 infertile female patients treated between 2016 and 2022, including 1,574 HBsAg-positive patients.
• Data Analysis: Patients were matched by age and BMI with HBsAg-negative controls to assess ovarian reserve indicators, including AFC, AMH levels, FSH levels, and oocyte retrieval outcomes.

Key Findings:

• HBsAg-positive patients had significantly lower ovarian reserve markers compared to HBsAg-negative patients.
• Median AFC was 11 in the HBsAg-positive group vs 18 in the control group (P < .001).
• Median AMH levels were 2.25 ng/ml in HBsAg-positive patients vs 6.81 ng/ml in controls (P < .001).
• HBsAg-positive patients had higher FSH levels and required greater doses of gonadotropins for ovulation induction.
• The prevalence of diminished ovarian reserve (AMH < 1.1 ng/ml) was 23.08% in HBV-positive patients vs 0.38% in HBV-negative patients.
• HBV infections were associated with a 103.9-fold increased risk of diminished ovarian reserve (P < .001).
• No significant difference in ovarian reserve was found between HBeAg-positive and HBeAg-negative subgroups.

Interpretation:

The study suggests that HBsAg positivity is associated with decreased ovarian reserve, which may have implications for fertility evaluations.

Limitations:

• Retrospective design of the study.
• Lack of data on HBV DNA levels and infection duration.

Conclusion:

HBsAg positivity should be considered a significant factor during infertility evaluations due to its association with decreased ovarian reserve.

Sources:

• BMC Medicine