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

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. This retrospective cohort study 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. Univariate analysis was used 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 association between HPV infection and the key clinical outcome of live birth. Based on their HPV infection status within 1 year prior to treatment, 435 women were categorized into an HPV-positive group (n = 33) and an HPV-negative group (n = 402). Sixty-six women achieved live births and three hundred sixty-nine 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 the two 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) levels improved live birth odds (OR 1.096, 95% CI 1.022–1.176, P = 0.011), and the husband’s smoking decreased live birth odds (OR 0.385, 95% CI 0.187–0.793, P = 0.010). 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), and the Guangzhou Science and Technology Program (grant number 2024A03J0983), in October 2024.