HPV infection and ART: the andrologist’s point of view

Abstract

Human papilloma virus infection is a common sexually transmitted disease. In addition to its tropism for epithelial mucosae and skin, HPV can also infect the male urogenital tract and strongly bind the sperm head, causing a reduction of semen quality, with detrimental effects on both natural and assisted fertility. An association between HPV and assisted reproductive technology (ART) programs has been reported, and HPV infection of semen seems to have a negative influence on the outcome of these procedures. None of the standard procedures commonly used for sperm selection before ART showed efficacy in eliminating HPV from the sperm head. Several strategies have been suggested to improve viral clearance in semen of infertile patients, such as counseling and anti-HPV vaccination. Moreover, these strategies were able to increase the natural fertility of couples with HPV semen infection. Finally, a modified swim-up with the addition of an enzymatic treatment, despite reducing sperm motility, was reported to eliminate the virus from the sperm head. In this manuscript we propose a flow chart for the management of infertile couples with HPV semen infection. KEY WORDS: HPV, HPV semen infection, assisted reproductive techniques, HPV vaccines.