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. 2022 May 4:9:835254.
doi: 10.3389/fmed.2022.835254. eCollection 2022.

Evaluation of the Presence of Bacterial and Viral Agents in the Semen of Infertile Men: A Systematic and Meta-Analysis Review Study

Mehrdad Gholami  1   2 , Mahmood Moosazadeh  3 , Mohammad Reza Haghshenash  1 , Hamed Jafarpour  4 , Tahoora Mousavi  2   5
Affiliations

Evaluation of the Presence of Bacterial and Viral Agents in the Semen of Infertile Men: A Systematic and Meta-Analysis Review Study

Mehrdad Gholami et al. Front Med (Lausanne). .

Abstract

Objectives: Infections in the male genitourinary system with bacterial and viral agents may play a significant role in male infertility. These agents usually infect the urethra, seminal vesicles, prostate, epididymis, vas deferens, and testes retrograde through the reproductive system. A meta-analysis review study was performed to evaluate the presence of bacterial and viral agents in the semen of infertile men and its correlation with infertility.

Methods: Relevant cross-sectional and/or case-control studies were found by an online review of national and international databases (Web of Science, PubMed, Scopus, Science Direct, and Google scholar), and suitable studies were selected. A checklist determined the qualities of all studies. Heterogeneity assay among the primary studies was evaluated by Cochran's Q test and I2 index (significance level 50%). A statistical analysis was conducted using the Comprehensive Stata ver. 14 package (StataCorp, College Station, TX, United States).

Results: Seventy-two studies were included in this meta-analysis. Publication bias was compared with Egger's test, and the impact of each research on overall estimate was evaluated by sensitivity analysis. In 56 studies, the rate of bacterial infections in the semen of infertile men was 12% [95% confidence interval (CI): 10-13]. Also, in 26 case-control studies, the association of infertility in men with bacterial infections was evaluated. The results show that the odds ratio of infertility in men exposed to bacterial infections is 3.31 times higher than that in non-infected men (95% CI: 2.60-4.23). Besides, in 9 studies that examined the prevalence of human papillomavirus (HPV), herpes simplex virus 1 (HSV1), herpes simplex virus 2 (HSV2), and herpes simplex virus 1-2 (HSV1-2) in infertile men, the frequency of these viruses was 15% (95% CI: 9-21). In 6 case-control studies, the association between human cytomegalovirus (HCMV), Cytomegalovirus (CMV), and HPV and male infertility was evaluated. The chance of male infertility due to exposure to these viruses was 2.24 times higher than those without exposure to these viruses (CI 95%: 1.9-4.52). The results show that the chance of infertility in men exposed to bacteria was significantly higher than that in the uninfected population.

Conclusion: This meta-analysis showed that viral and bacterial infections are a risk factor and could impair male fertility potential. Moreover, our study supports the hypothesis that bacterial and viral infections of the genital tract correlate positively with impairment of sperm quality in the male population.

Keywords: Iran; bacteria; infection; infertility; semen; virus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of primary studies included in the meta-analysis.
FIGURE 2
FIGURE 2
Estimation of odds ratio of male infertility due to exposure to viruses.
FIGURE 3
FIGURE 3
Publication bias based on a funnel plot.
FIGURE 4
FIGURE 4
Sensitivity analysis of the primary studies included in the meta-analysis.
FIGURE 5
FIGURE 5
Estimating the prevalence of viral agents in each of the initial studies and pooled estimate with a 95% confidence interval.
FIGURE 6
FIGURE 6
Estimation of odds ratio of male infertility due to exposure to different bacteria.
FIGURE 7
FIGURE 7
Publication bias (odds ratio of male infertility due to exposure to different bacteria based on the funnel plot).
FIGURE 8
FIGURE 8
Sensitivity analysis (overall estimation of the odds ratio of male infertility due to exposure to different bacteria).
FIGURE 9
FIGURE 9
Estimating the prevalence of bacterial agents in each of the initial studies and pooled estimate with a 95% confidence interval.
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