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Zika Virus and Fertility Treatment

Recently, The World Health Organization (WHO) reported a “very large outbreak” of the Zika virus. The Zika virus, first identified widely in Brazil in May 2015, began spreading across the Americas over the last six months.

As of late January 2016, 25 countries have reported locally-transmitted cases of Zika, a virus spread through mosquito bites. Several states in the United States have also reported cases of Zika infection, including Illinois; so far, these have been detected in travelers from other areas. The Zika virus is related to the viruses of Dengue and Chikungunya fever.

The virus has also been reported to be spread in other ways, such as through sexual intercourse and blood transfusions, as well as by intrauterine and intrapartum (during labor or delivery) transmission. This information confirms that the virus can be spread through body fluid contact with an individual that has been exposed to this virus, and the virus can also be passed to the fetus during pregnancy and delivery.

There are no vaccines to prevent the spread of the disease, no anti-virals to treat the infection, and testing can currently only be done through the Centers for Disease Control and Prevention (CDC). Commercial testing may be available soon, and a vaccine may be available in 18 months. The WHO has reported that up to four million people could be infected in the Americas alone.

August 31,2018 | CDC releases an update to recommended wait times for fertility treatment for males that have traveled to a Zika endemic area. The 6 month guideline was reduced to 3 months due to a study analyzing shedding of the virus in semen. Click here to learn more.

Most people who are infected with the Zika virus have no symptoms; only 1 in 5 experience mild symptoms, such as headache, fever, conjunctivitis, rash, and coryza. Rare cases of Guillain-Barre, an ascending polyneuritis, have been ascribed to Zika. Most concerning is the association of Zika infection with fetal anomalies.

The virus is known to cause microcephaly in the fetus, as a result of forebrain shrinkage caused by the virus. Visual impairment is also commonly seen. The physical and developmental results of this condition are devastating. The fetus is most susceptible to the infection in the first trimester, but miscarriage does not necessarily occur. The condition may be detectable by ultrasound examination in the late first trimester, but not as reliably as later in gestation.

This outbreak has prompted the Centers for Disease Control to issue a travel advisory to the affected countries particularly among pregnant women at risk of passing the virus to their baby. The CDC’s general recommendations include postponing travel to countries where the Zika virus has been documented recently.

Our advice is to cancel any trip to a region where Zika is present unless the patient is not pregnant, not potentially pregnant, and using contraception. We advise withholding fertility treatment until the patient is back from the region, and at least two weeks pass from the latest time of exposure to allow for clearance of the virus. The current recommendation is avoiding conception for at least 8 weeks from last possible exposure to Zika.

Due to the critical health implications for offspring, Fertility Centers of Illinois is following the recommendations regarding suspected exposure to the Zika virus. For any patient or partner that has traveled to a region affected by the Zika virus, fertility treatment will be stopped or postponed for a period of 8 weeks. Once the virus is absent, it is safe to conceive without fear of the fetus being infected.

However, the virus may persist up to two months in semen. This fact has led to recommendations of avoiding intercourse during pregnancy if the man has been infected. The WHO, CDC, and The American Congress of Obstetricians and Gynecologists (ACOG) all support this approach. Avoidance of other travelers who may have been exposed is also critical, since a sexually transmitted infection may again take weeks to resolve. More information becomes available daily and may be obtained at the CDC website.