Impact of cervical human papillomavirus infection on pregnancy outcomes of intrauterine insemination in unexplained infertility patients

Abstract Background Intrauterine insemination (IUI) is a common treatment for couples with unexplained infertility. However, the impact of human papillomavirus (HPV) infection on IUI outcomes remains uncertain. This study therefore aims to investigate whether HPV infection in women with unexplained infertility affects pregnancy outcomes following IUI. Methods This retrospective cohort study, which adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, analyzed 435 women with unexplained infertility who underwent intrauterine insemination (IUI) at the Reproductive Centre of Sun Yat-Sen Memorial Hospital between January 2018 and December 2022.Based on their HPV infection status within one year prior to treatment, participants were categorized into an HPV-positive group (n = 33) and an HPV-negative group (n = 402). We first utilized univariate analysis to compare the baseline characteristics and assisted conception data between the two groups. Subsequently, a multivariate logistic regression model was employed to further assess the independent correlation between HPV infection and the key clinical outcome of live birth. Results Sixty-six women achieved live births and 369 did not. Cervical cytological abnormalities were more frequent in the HPV-positive group (25.0% vs. 1.3%, P < 0.05). No significant differences were found in live birth, clinical pregnancy, biochemical pregnancy, early abortion, ectopic pregnancy, or cesarean section rates between HPV groups (P > 0.05). Preterm birth was significantly higher in HPV-positive women (66.7% vs. 4.8%, P < 0.05). After adjusting for confounders, HPV infection was not independently associated with live birth (P > 0.05). Increased maternal age reduced the odds of live birth (OR 0.946, 95% CI 0.932–0.961, P = 0.000), higher anti-Müllerian hormone (AMH) improved live birth odds (OR 1.096, 95% CI 1.022–1.176, P = 0.011), and husband’s smoking decreased live birth odds (OR 0.385, 95% CI 0.187–0.793, P = 0.010). Conclusion HPV infection does not significantly influence IUI pregnancy outcomes in women with unexplained infertility Trial registration This study was supported in part by the Sun Yat-Sen Clinical Research 5010 Program (grant number SYS-5010-202410), Guangzhou Science and Technology Program (grant number 2024A03J0983),in October 2024.