Medically assisted reproduction in the presence of chronic viral diseases

Abstract

Teams practising medically assisted reproduction techniques try to avoid viruses as much as possible. Attitudes towards chronic carriers of viruses are rapidly changing, especially for human immunodeficiency virus (HIV) patients. We focus our attention on the legitimacy of systematic screening before assisted reproductive techniques and the need for specialized approaches including an adapted laboratory for viral hazards as well as the need for a multidisciplinary team. Specificities of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) carriers and the hypothesis of a reduced fertility potential are discussed. Are male HIV carriers a new indication for assisted reproductive techniques in order to prevent virus transmission? It is largely proven that sperm gradient preparation techniques efficiently decrease viral loads and therefore have a protective effect on contamination risk during assisted reproductive techniques. Although a few thousand assisted reproductive technique cycles were performed in the world for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Two examples of contaminations during insemination are examined. Many questions remain unresolved, such as the lack of standardized techniques for semen preparation or virus detection or the relative merits of intrauterine insemination or ICSI to prevent HIV contamination during assisted reproductive techniques. The authors plead for well-structured, separate programmes of care linked to research objectives.

Efficacy and safety of nucleoside analogs on blocking father-to-infant vertical transmission of hepatitis B virus

“…The integration between HBV DNA and the sperm chromosome was random and at multiple loci, which further increases the instability of the chromosomes, indicating that HBV infection may have a widespread impact by altering the genetic composition generation after generation. In 2004, Englert et al (17) reported that with assisted reproductive technology (ART), washed gradient centrifugation can be used to reduce the HBV load and avoid transmission to embryos. The sperm underwent washing and ART, and subsequently the spread of HBV was reduced.…”

Artificial Insemination: Current and Future Trends

“…centrifugation on a density gradient followed by a "swim-up" (reviewed by Englert et al, 2004). Spermatozoa from virally infected men prepared by this method have been used in assisted reproduction attempts, apparently without sero-conversion of mothers or children.…”

Semen decontamination for the elimination of seminal HIV-1

“…However, concerns regarding the treatment of patients with potential seminal pathogens during ART include: i) the probability of vertical and horizontal transmission of the specific pathogen, ii) the welfare of children with infected parents that may pass away due to the infection (Lyerly and Anderson, 2001) and iii) the possibility of nosocomial transfer of pathogens in an ART laboratory (Englert et al, 2004).…”