Abstract
Objective: This study aimed to investigate the associations between previous TORCH infection (cytomegalovirus, toxoplasmosis, herpes simplex virus, and rubella) with pregnancy and neonatal outcomes in couples undergoing IVF/ICSI-ET.Materials and Methods: A total of 18,074 couples underwent fresh IVF/ICSI-ET (in vitro fertilization/intracytoplasmic sperm injection–embryo transfer) cycles were included in our analyses. TORCH infection status was determined by serological confirmation of cytomegalovirus, toxoplasmosis, herpes simplex virus, and rubella IgG in the absence of IgM antibodies. Clinical pregnancy, ectopic pregnancy, miscarriage, live birth, preterm birth, congenital malformation, and perinatal death were evaluated in both infection and non-infection group. Multivariate logistic regression was applied to calculate odds ratio.Results: Previous toxoplasmosis infection is associated with a significantly decreased preterm birth rate [P = 0.045, OR = 0.755 (95% CI, 0.571–0.997), Adjusted OR = 0.749 (95%CI, 0.566–0.991)]. No differences in clinical pregnancy, ectopic pregnancy, miscarriage, and perinatal death were observed between the corresponding TORCH infection group [IgM (–) IgG(+)] and the non-infection group [IgM (–) IgG (–)].Conclusions: Previous TORCH infections were not associated with adverse pregnancy and neonatal outcomes in IVF/ICSI-ET overall, and toxoplasmosis infection might be associated with a lower preterm birth rate in patients underwent IVF/ICSI-ET. The necessity of TORCH IgG screening in IVF procedure might need re-evaluation, and further cost-effective analysis might be helpful for the clinical management strategy.
Highlights
TORCH infections classically comprise cytomegalovirus (CMV), toxoplasmosis, rubella, herpes simplex virus (HSV), and other commonly seen intrauterine infections, such as varicella and enteroviruses
Toxoplasma gondii infection during pregnancy may result in severe fetal damage, which manifests as the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications with parasites transmitting through the placenta [7]
We found patients with previous CMV infection had a lower live birth rate in comparison with those without CMV infection after IVF/ICSI-ET [P = 0.063, odds ratios (OR) = 0.948, adjusted OR = 0.965 (95%confidence intervals (CI), 0.911–1.032)], indicating that previous CMV infection might have an adverse effect on live birth rate in patients undergoing IVF/ICSI-ET
Summary
TORCH infections classically comprise cytomegalovirus (CMV), toxoplasmosis, rubella, herpes simplex virus (HSV), and other commonly seen intrauterine infections, such as varicella and enteroviruses. CMV is a common viral pathogen which represents significant health concerns, as it could remain dormant in the host body over a long time, and may transmit from a mother to her developing fetus [3]. Toxoplasma gondii infection during pregnancy may result in severe fetal damage, which manifests as the classic triad of chorioretinitis, hydrocephalus, and intracranial calcifications with parasites transmitting through the placenta [7]. Rubella virus infection during pregnancy predisposes the fetus to developing a constellation of congenital deformities known as congenital rubella syndrome (CRS) secondary to maternal infection, especially during the first trimester [8]. Congenital HSV infection shares clinical features with other congenital infections, such as microcephaly, hydrocephalus, and chorioretinitis, and usually presents with clinical symptoms at birth, mainly due to exposure to HSV during delivery [9]. Most of the pathogens mentioned above have common clinical features of rash and ocular abnormalities that bring a huge burden on healthcare system and the society [11]
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