The association between HPV infection and endometriosis: Risk and fertility outcomes

While infections have been implicated in endometriosis pathogenesis, the role of human papillomavirus (HPV) remains unclear. This study combined a meta-analysis of seven studies with a case-control study (n = 432 surgically treated patients) to evaluate the association between HPV and endometriosis risk and fertility outcomes. The meta-analysis showed no significant association between any subtypes of HPV (pooled odds ratio OR = 2.60, 95% confidence interval CI:0.28–23.87) or high-risk subtypes (OR = 1.68, 95%CI: 0.49–5.75) infection and endometriosis risk, despite a higher HPV prevalence in patients (46% overall, 36% high-risk) compared with the general populations. Limited data existed on the association between HPV infection and fertility outcomes (two studies only). Our case-control analysis revealed that HPV-positive patients had significantly lower postoperative live birth rates, compared with HPV-negative counterparts (10.6% vs. 21.0%, P < 0.05). These findings suggest that HPV infection is not a primary risk factor for endometriosis development, but it may adversely affect post-surgical fertility outcomes. The dual-method approach strengthens the evidence for HPV's clinical impact on reproductive prognosis in patients with existing endometriosis.