Water birth is a valuable and promising alternative to traditional delivery methods. The maternal and fetal outcomes were similar to traditional land births. However, currently there still exist some deficits in the scientific evaluation of its safety. Therefore, the selection of a low-risk collective is essential to minimize the risks with the addition of strictly maintained guidelines and continuous intrapartum observation and fetal monitoring. Based on our results and the literature, water births are justifiable when certain criteria are met and risk factors are excluded.

To investigate the risk of transmission of hepatitis C virus (HCV) via semen in assisted reproduction techniques, semen samples from 32 men chronically infected with HCV attending a center for assisted procreation were tested for HCV RNA by a reverse transcription-PCR protocol by using a modified version of the Cobas AMPLICOR HCV assay (version 2.0; Roche Diagnostics). The sensitivity of the test was 40 copies/ml. Four of 32 seminal plasma samples (12.5%) were found to be positive for the presence of HCV RNA. The median HCV load in blood was significantly higher in patients who were found to be positive for the presence of HCV RNA in semen than in those who tested negative (P ‫؍‬ 0.02). In one man, seven consecutive seminal plasma samples tested positive for HCV RNA, as did two consecutive motile spermatozoon fractions; the corresponding fractions obtained after migration of the spermatozoa remained negative. Despite the absence of the proven infectivity of virus in semen samples that test positive for HCV RNA, these findings highlight the fact that seminal fluid may exhibit prolonged HCV RNA excretion. The usefulness of HCV RNA detection in both seminal plasma and spermatozoon fractions before the start of a program of medically assisted reproduction in couples in whom the male partner is chronically infected with HCV would need to be evaluated prospectively with a larger population of subjects exhibiting HCV RNA in their semen.The risk of transmission of hepatitis C virus (HCV) via seminal fluid is still much debated, especially in assisted reproductive techniques (ART). Even though the rate of HCV transmission by the sexual route has been found to be low (1, 9), the use of spermatozoa from men chronically infected with HCV in ART can lead to a theoretical risk of contamination for the female partner, for the technicians dealing with ART, and perhaps for the artificially conceived embryos of the couple or of other couples treated at the same time or stored in the same container. The management of HCV-infected men enrolled in programs of medically assisted reproduction is highly dependent upon the definition of standardized protocols of detection of HCV RNA in semen. Actually, although previous studies have reported the presence of HCV RNA in seminal plasma of men chronically infected with HCV and coinfected (7, 10, 15) or not coinfected (12, 13) with human immunodeficiency virus (HIV), other investigators have found the opposite pattern (6,8,16). Those contradictory results could be explained, at least in part, by the heterogeneity of the populations studied and by the diversity and the poor standardization of the techniques used for the extraction of RNA from semen and for the reverse transcription (RT)-PCR protocols. Moreover, the cellular fractions of semen, particularly the motile spermatozoa, have been poorly investigated for the presence of HCV.We report herein on the detection of HCV RNA in seminal plasma and, for the first time, in the motile spermatozoon fractions of semen from men chronically infecte...

In France, assisted reproductive technology (ART) for hepatitis C virus (HCV)-infected patients is now subject to strict control after the publication of recent guidelines. Infertile serodiscordant couples (HCV-viraemic men and their seronegative female partners) require special care to carried out in designated 'viral risk' laboratories. Twelve sequential semen samples taken from an HCV chronically infected patient were analysed within 22 months. HCV RNA was detected in all the seminal plasma sampled before antiviral treatment with relatively high viral loads, and in two of the corresponding fractions of motile sperm obtained after a gradient selection, suggesting that a contamination risk by HCV through ART cannot be excluded. When the selection of sperm on a discontinuous gradient was followed by an additional swim-up step, HCV RNA was never detected in the motile sperm suspension that was frozen in highly secure straws. IVF was performed using cryopreserved sperm that tested negative for HCV RNA, resulting in a pregnancy. One month after embryo transfer, testing for HCV RNA and antibodies in the woman gave negative results.

These results emphasize the safety of the semen-processing method. The negligible risk of transmitting HCV reduces the value of the systematic analysis of HCV RNA in seminal fractions prior to ART. Since use of this analytical procedure involves the freezing of semen, its avoidance would result in an increase in sperm quality and reduce the need to perform intracytoplasmic sperm injection techniques.

Regarding GBS colonization of the newborn during water birth there might be a wash out effect, which protects the children during the delivery.