SUMMARY: CAN HELICOBACTER PYLORI AFFECT FERTILITY
In this study Helicobacter Pylori infection did not significantly affect common indicators of both male and female fertility, specifically sperm parameters in males, and sex hormones in females. On the other hand, a meta-analysis did show the CagA strain negatively affects sperm progressive motility (-16.2%).
doi.org/10.1002/fsn3.1837
Background
Up until recently, experts thought that Helicobacter Pylori (HP) affected only the gastrointestinal system. However new studies have shown that HP can actually impact other internal systems including the reproductive system.
A study carried out in 2002 was the first to report that HP infection was significantly more prevalent in an infertile male group compared to the control group. During the last decade, this potential link has been explored further with some experts reporting that HP infection can indeed affect sperm parameters.
Similarly, researchers have also investigated the impact of HP infection on the female reproductive system. There have been reports of a possible increase in incidence of early pregnancy loss after assisted reproductive technology (ART) in cytotoxin-associated gene A (CagA) -positive patients. At the same time, one study found that HP infection was almost doubled among women suffering from polycystic ovarian syndrome (PCOS).
Although, there appears to be a correlation between HP infection and infertility, the majority of the studies done until now are from Italy. Additional studies involving other ethnicities could provide further irrefutable evidence.
Aim
To examine the effect of HP infection on sperm quality in males, and ovarian reserve in females.
Methodology
Researchers recruited participants between January 2016 and June 2019 from the Second Hospital of Zhejiang University School of Medicine.
The inclusion criteria for final analysis was:
- Abdominal discomfort
- Planning for pregnancy
- Previous sperm analysis, or ovarian reserve test, within the last 3 months
A total of 565 eligible patients then underwent a 13C-urea breath test (UBT) or 14C-UBT for HP infection diagnosis.
Sperm samples was collected from males, after 2-7 days of sexual abstinence, and analysed according to WHO guidelines.
In female participants, serum AMH, a good indicator of ovarian reserve, was assessed using the Elecsys® AMH assay from Roche Diagnostics, while sex hormone levels were assessed using assay kits from Siemens Healthcare Diagnostics Inc..
Results
A total of 16,522 patients presented to the hospital with abdominal pain during the study period, but only 565 had undergone sperm analysis or ovarian reserve testing in the previous 3 months.
Out of these 565 patients, 363 were men and 202 were women. These men and women were further divided into 2 groups, those who were suffering from a HP infection (HP+) and those who were not (HP-).
Initial analysis of baseline characteristics, among the male study population, found no significant differences between the 2 male groups (HP+ and HP-) in terms of age, weight, height or body mass index (BMI).
Following analysis of sperm parameters, no statistically significant differences were found between the 2 groups of men (P>0.2).
| HP+ | HP– | |
| No. of males per group | 136 | 227 |
| Concentration (Sp/ml × 106) | 53.0 | 53.9 |
| Progressive Motility (%) | 39.3 | 39.9 |
| Normal sperm morphology (%) | 6.7 | 6.6 |
| Sperm head defects (%) | 86.6 | 84.8 |
In the female study population, analysis of baseline characteristics revealed similar age, weight, height and BMI between the HP+ and HP– groups.
Analysis of sex hormones, confirmed that AMH levels correlate negatively with age, however there was no statistically significant differences, between the HP+ and HP- groups, across the full range of hormones tested (P>0.1).
| HP+ | HP– | |
| No. of females per group | 55 | 147 |
| AMH (ng/ml) | 3.49 | 3.25 |
| Estradiol (pmol/L) | 194.46 | 192.56 |
| Testosterone (nmol/L) | 0.94 | 1.12 |
| Luteinizing hormone (IU/L) | 6.31 | 4.98 |
| Follicle-stimulating hormone (IU/L) | 8.36 | 8.38 |
| Prolactin (mIU/L) | 256.19 | 234.81 |
| Progesterone (nmol/L) | 1.99 | 1.65 |
Finally, the authors carried out a meta-analysis of 10 previous studies. This analysis revealed progressive motility to be 16.2% lower in males positive for the cytotoxin‐associated gene A (CagA) strain of HP, which may be caused by an increase in sperm antibodies, although further studies are required to confirm possible association.
Limitations
- Study involved only 1 ethnicity.
- Normal sperm parameters does not strictly define a fertile male.
Funding
The study was funded by the National Key R&D Program of China, National Natural Science Foundation of China and the Medical and Health Science and Technology Plan of Zhejiang Province.
Glossary
Anti-Mullerian Hormone (AMH)
A hormone produced by the small follicles in a woman’s ovaries, commonly used as a marker of oocyte quantity.
Assisted Reproductive Technology (ART)
Any fertility treatment in which either eggs or embryos are handled (i.e. IVF, ICSI).
P-value
The probability that a result occurred by random chance.
Similar studies
Moretti E, et al. (2017). Infectious Burden and Semen Parameters. https://doi.org/10.1016/j.urology.2016.10.032
Moretti E, et al. (2015). Sperm parameters and semen levels of inflammatory cytokines in Helicobacter pylori–infected men. https://doi.org/10.1016/j.urology.2015.02.068
Moretti E, et al. (2013). CagA-positive Helicobacter pylori infection and reduced sperm motility, vitality, and normal morphology. https://doi.org/10.1155/2013/919174
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