Impact of in Vitro Fertilization-embryo Transfer on Mother-to-infant Transmission in Women With Chronic HBV Infection

Wei Yi; Minghui Li; Fangfang Sun; Huihui Lu; Zhan Zeng; Xiaoyue Bi; Liu Yang; Yanjie Lin; Xiuzhen Cao; Yuhong Hu; Mingfang Zhou; Lu Zhang; Yao Lu; Gang Wan; Yao Xie

Disclosures

Liver International. 2022;42(10):2167-2174. 

In This Article

Abstract and Introduction

Abstract

Background and Aims: In vitro fertilization-embryo transfer (IVF-ET) may increase the risk of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). The purpose of this study was to investigate the impact and safety of IVF-ET on MTCT in women with chronic HBV infection (CHB).

Methods: The data of 298 women who got pregnant by IVF-ET and their 375 children were collected retrospectively. Mothers were divided into the CHB group (n = 224) and the control group (HBsAg negative, n = 74). After birth, newborns were routinely vaccinated with the hepatitis B vaccine, and infants in the CHB group were injected with hepatitis B immunoglobulin within 2 h after birth. Demographic information, clinical data and laboratory test results were collected. The primary outcome measures were the MTCT rate of HBV, and the secondary outcome measures were the safety of the mother and infant.

Results: There was no case of HBV MTCT in all 282 newborns born in the CHB group and 93 neonates born in the control group. Of the two groups, the birth weight (3056.74 ± 601.65 vs. 2926.24 ± 704.86, P = .083), length (49.22 ± 1.97 vs. 48.74 ± 3.09, P = .167), 5-min Apgar score (9.97 ± 0.21 vs. 9.90 ± 0.51, P = .212), days of pregnancy (265.70 ± 12.73 vs. 262.02 ± 17.50, P = .064) and neonatal malformation rate (0.71% vs. 0, P = 1.000) were similar. Two cases of neonatal malformation occurred in the CHB group. The incidences of pregnancy and childbirth complications were similar between the two groups.

Conclusion: IVF-ET does not increase the risk of MTCT in women with chronic HBV infection, and it is safe for mothers and infants.

Introduction

Approximately 2 billion people worldwide are infected with the hepatitis B virus (HBV), and ~ 292 million people live with chronic infections.[1] An estimated 0.88 million people die of HBV infection-related liver failure, cirrhosis and primary hepatic cancer every year.[1] Mother-to-child transmission (MTCT) is the most important route for chronic HBV infection (CHB) in Asia.[2–4] In Chinese adults, 30–50% of chronic HBV infections are from MTCT.[5]

The median prevalence of infertility is about 9%,[6] and it's estimated that 48 to 186 million people globally suffer from infertility.[6–8] Studies have shown that a spouse with HBV infection will increase the incidence of tubal infertility.[9] In vitro fertilization-embryo transfer (IVF-ET) is an important method to treat infertility. In a reproductive centre in China, it was reported that 21.75% of couples who had in vitro fertilization were of chronic HBV infection.[10] However, it is not clear whether IVF-ET in mothers with chronic HBV infection will increase the risk of MTCT of HBV.

The main steps of IVF-ET include drug-induced ovulation, ultrasound-guided oocyte retrieval, fertilization of eggs and sperm in vitro culture medium, and implantation of fertilized eggs into the uterine cavity after 3–5 days of in vitro development. Oocyte retrieval and zygote implantation are invasive procedures, which theoretically may increase the risk of MTCT of HBV. Studies have shown that HBV can be detected in follicular fluid and even oocytes of HBV-infected women.[11–13] Previous studies have been focused on the impact of HBV infection on sperm quality, fertilized egg implantation rate, pregnancy rate, abortion rate and live birth rate.[11,14–19] Only one study with 41 chronic HBV-infected samples focused on infant HBV infection, in which there were 5 cases of HBeAg-positive and 18 infants born.[10] Although none of these infants was infected, the incidence of MTCT through IVF-ET treatment in chronic HBV-infected women remains to be determined. What's more, there is limited literature that focuses on the intrauterine development of HBV-infected women after successful IVF-ET. Therefore, we conducted a retrospective study to explore whether IVF-ET for HBV-infected mothers increases the risk of MTCT of HBV and affects intrauterine growth.

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