Zika Virus: What should infertility patients do?

January 31, 2016Carole 2 Comments »

NEW UPDATE FROM ASRM REGARDING ZIKA VIRUS AND REPRODUCTION (as of 4/6/2016):

Open pdf from this link: https://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/News_and_Research/ASRM_Bulletins/2016-04/Zika%20Guidance%2004-06-16%20%282%29.pdf

The guidance  in the pdf is for providers but I think patients should be aware of the recommendations that professional societies are giving to medical providers so that they can be sure they are getting the best treatment and know what questions to ask.

Original post: The Zika virus has been in the press recently. It is a virus that is carried by a type of mosquito (Aedes aegypti )  that is found in much of the Americas. The CDC has posted a map of active infections areas here.

Currently, the most active zones are in South and Central America. For most persons infected with the virus, it’s not a big deal. The virus is usually cleared from the blood by the body within a week after infection and the person may have either no symptoms or may have some fever, rash, conjunctivitis that might be associated with a mild flu or cold.

Infection with the Zika virus may be of much greater concern to pregnant women because there may be a connection between being infected with the virus and an increased risk of having a child born with a birth defect called  microcephaly (small head).  This birth defect is particularly scary because it causes life-long issues with brain function including :

  • Seizures
  • Developmental delay, such as problems with speech or other developmental milestones (like sitting, standing, and walking)
  • Intellectual disability (decreased ability to learn and function in daily life)
  • Problems with movement and balance
  • Feeding problems, such as difficulty swallowing
  • Hearing loss
  • Vision problems

Currently, because there is no vaccine to prevent infection or medicine to treat Zika virus infection– the best option is to take steps to prevent exposure to the virus.

Until more is known, CDC recommends special precautions for pregnant women and women trying to become pregnant (copied below from the CDC website) :

Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing. Pregnant women who do travel to one of these areas should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bites during the trip.

Women trying to become pregnant or who are thinking about becoming pregnant should consult with their healthcare provider before traveling to these areas and strictly follow steps to prevent mosquito bites during the trip.

Because specific areas where Zika virus transmission is ongoing are difficult to determine and likely to change over time, CDC will update this travel notice as information becomes available. Check CDC’s Zika Travel Information website frequently for the most up-to-date recommendations.

Q: I am pregnant. How will Zika virus affect me or my unborn baby?

A: CDC has issued a travel notice (Level 2-Practice Enhanced Precautions) for people traveling to regions and certain countries where Zika virus transmission is ongoing.

This notice follows reports in Brazil of microcephaly and other poor pregnancy outcomes in babies of mothers who were infected with Zika virus while pregnant. However, additional studies are needed to further characterize this relationship. More studies are planned to learn more about the risks of Zika virus infection during pregnancy.

Q: Is it safe to use an insect repellent if I am pregnant or nursing?

A: Yes. Using an insect repellent is safe and effective. Pregnant women and women who are breastfeeding can and should choose an EPA-registered insect repellents and use it according to the product label.

Q: If a woman who is not pregnant is bitten by a mosquito and infected with Zika virus, will her future pregnancies be at risk?

We do not know the risk to the infant if a woman is infected with Zika virus while she is pregnant. Zika virus usually remains in the blood of an infected person for only a few days to a week. The virus will not cause infections in an infant that is conceived after the virus is cleared from the blood. There is currently no evidence that Zika virus infection poses a risk of birth defects in future pregnancies. A women contemplating pregnancy, who has recently recovered from Zika virus infection, should consult her healthcare provider after recovering.

Q: Should a pregnant woman who traveled to an area with Zika virus be tested for the virus?

A: See your healthcare provider if you are pregnant and develop a fever, rash, joint pain, or red eyes within 2 weeks after traveling to a country where Zika virus cases have been reported. Be sure to tell your health care provider where you traveled.

Q: Can a previous Zika virus infection cause someone who later becomes pregnant to have an infant with microcephaly?

A: We do not know the risk to the baby if a woman is infected with Zika virus while she is pregnant. However, Zika virus infection does not pose a risk of birth defects for future pregnancies.

Q:Is it safe to get pregnant after traveling to a country with Zika virus?

A: If infected, Zika virus usually remains in the blood of an infected person for about a week. The virus will not cause infections in a baby that is conceived after the virus is cleared from the blood. (CW Note: That is true if the virus is not harbored in the semen, but there are a couple of cases which suggest that it may linger in the semen after being cleared from the blood- see the bottom of the post for more information).

Q: Can a pregnant woman be tested for Zika weeks or months after being in a country with Zika?

A: At this time, and for several reasons, we do not recommend routine Zika virus testing in pregnant women who have traveled to a country with known transmission. First, there can be false-positive results due to antibodies that are made against other related viruses. Second, we do not know the risk to the fetus if the mother tests positive for Zika virus antibodies. We also do not know if the risk is different in mothers who do or do not have symptoms due to Zika virus infection.

Q: If a woman who has traveled to an area with Zika virus transmission, should she wait to get pregnant?

A: We do not know the risk to an infant if a woman is infected with Zika virus while she is pregnant. Zika virus usually remains in the blood of an infected person for only a few days to a week. The virus will not cause infections in an infant that is conceived after the virus is cleared from the blood. There is currently no evidence that Zika virus infection poses a risk of birth defects in future pregnancies. A women contemplating pregnancy, who has recently traveled to an area with local Zika transmission, should consult her healthcare provider after returning.

Perhaps most troubling for couples trying to conceive is that there have been several cases in which the Zika virus was found in the semen of men infected with the virus. Most troubling, the virus persisted in the semen long after it was cleared from the blood so a blood test would have shown negative for Zika. This New York Times article, Zika Virus: Two cases suggest it could be spread through sex; raise the specter of a much longer time of caution – perhaps several months- to allow the infected sperm to be cleared from the body, before conception should be attempted.

Bottom Line for couples trying to get pregnant:

  • Avoid traveling to areas that have active areas of infection, if possible. Note that the mosquito that carries the Zika virus is currently very active in South and Central America,  but the same mosquito is found in some more tropical regions of the southern US, but so far the spread of infected mosquitoes has not become a public health issue in the US- due to aggressive mosquito control measures.
  • If you must travel to hotspot areas, use preventive measures (DEET sprays, mosquito netting etc.)  to avoid exposure to mosquito bites.
  • Check the CDC site for updates at  http://www.cdc.gov/zika/index.html ; and consult with your physicians before traveling to these areas, or after your return if you think you may have been infected.
  • If you are a man who has traveled to these hotspots, and you know you have been infected with the virus, or have been bitten by mosquitos, it may be advisable to have only protected sex with your partner for a couple of months after your return. Alternatively, you might consider having your semen cryopreserved in advance of your travel, if you anticipate travel to highly infectious regions and plan to conceive a child soon after your return using IVF/IUI.

Other articles about the Zika virus:

Scientists are Using Genetically Modified Mosquitoes to Fight the Mosquito-Borne Zika Virus

Zika Virus “spreading explosively” in the Americas, WHO says

© 2016, Carole. All rights reserved.

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