Human Papillomavirus (HPV) and Infertility: A Cross-Sectional Study Exploring Its Prevalence and Effects in Iranian Couples.

Background and Aims: Infertility, defined as the inability to conceive after 12 months of regular unprotected intercourse, affects approximately 16% of the global population and is a growing concern in Iran. This study aimed to evaluate the prevalence of high-risk human papillomavirus (HPV) genotypes in infertile couples and to investigate the association of HPV infection with infertility. Methods: This cross-sectional study examined the relationship between HPV and infertility in 354 participants (177 females, 177 males) from Hazrat Zainab Hospital's ART clinics in 2024. Participants were aged 20-45 years and diagnosed with primary or secondary infertility. Biological samples (semen, cervical swabs, and uterine aspirates) were tested using real-time PCR for HPV detection and genotyping. Demographic, clinical, and lifestyle data were collected via questionnaires. Results: Among female participants, 30 (16.9%) tested positive for HPV, with 3 (12.5%) harboring high-risk types. The prevalence in male participants was slightly higher, with 23 (13%) testing positive, including 8 (40%) with high-risk HPV types. Key findings included a slightly lower age at marriage in HPV-positive females (24.73 ± 6.10 years vs. 26.23 ± 6.41 years in HPV-negative females) and reduced utilization of assisted reproductive techniques (e.g., IVF and IUI) was observed in HPV-positive individuals. Interestingly, smoking was less frequent in HPV-positive males (52.2%) compared to HPV-negative males (65.6%). HPV-positive males exhibited higher rates of self-employment and partner change but no significant differences in semen parameters. Conclusion: Our findings align with previous studies reporting moderate HPV prevalence rates (15%-25%) in infertile populations globally, emphasizing the potential role of HPV in reproductive dysfunction. While HPV's impact on sperm quality and endometrial receptivity may contribute to infertility, further research is needed to clarify causal relationships. Vaccination and targeted screening strategies could mitigate HPV-related risks and improve reproductive outcomes.