Human immunodeficiency virus (HIV)
Any person can carry an HIV infection over any period without showing symptoms. Such a person can transmit the infection to another person through sexual intercourse, in pregnancy, and during delivery or breastfeeding. In addition, such an individual carrying the virus can contaminate the laboratory and transmit the infection to members of the treating staff for assisted reproduction, thereby potentially causing a threat to other couples receiving treatment. Therefore, in order to prevent any contamination and transmission, all patients are requested to undergo an HIV screening test during their diagnostic work‐up. In cases where a new infection with HIV is detected during the infertility diagnostic work‐up, we will refer such a person to specialized centres or institutions for further management.
Presently, there is no vaccine for HIV prevention and neither is there a cure. Nowadays, it is possible to manage the progression of HIV with various antiretroviral medications. Modern-assisted reproductive technology offers the possibility of pregnancy in cases in which the condition of the infection is well under control. It is important to know that there is a reduced chance of pregnancy; prenatal diagnostic procedures such as amniocentesis cannot be performed because of the risk of infecting the amniotic fluid; and there is an increased risk of complications such as miscarriage and preterm delivery. Unfortunately, we are unable to store gametes and embryos of HIV-infected couples now.
Hepatitis B virus
Chronic infections with the virus causing hepatitis B constitute a serious health hazard, potentially leading to liver cirrhosis and liver cancer though in a small proportion of people who are infected with the virus. Infertility treatment can be performed despite the presence of the hepatitis B infection in one or both partners. In most cases, this virus does not affect the course of the pregnancy. The healthy partner and the new‐born baby can be vaccinated in order to prevent the transmission of the virus and delivery does not have to be through caesarean section. However, the presence of the virus carries the risk of contaminating both the personnel and the laboratory of the treatment center, particularly in those cases in which a high concentration of the hepatitis B virus is found in the blood or in the seminal fluid. Like in HIV, the hepatitis B virus can be washed away from the spermatozoa through the usual semen preparation.
Hepatitis C virus
An infection with hepatitis C has been associated with liver cancer. The course of the pregnancy is unaffected by a hepatitis C virus infection. However, depending on the concentration of the virus in the blood of the mother, in approximately 3 to 5 % of all cases the virus is transmitted to the newborn during mid- to late-pregnancy or during delivery. However, unlike the hepatitis B virus infection, vaccination of the new‐born is not possible, and delivery through caesarean section is not considered to be necessary. Like the hepatitis B and HIV viruses, the virus causing hepatitis C can be eliminated effectively from the spermatozoa through sperm washing.
Rubella (German measles) is an infection caused by the rubella virus, but it is usually a mild and self‐limiting infection. This infection in early pregnancy has a very significant damaging effect on the foetus. It can cause either miscarriage or what is known as congenital rubella syndrome. The risk of the baby developing congenital rubella syndrome is greatest in the first 12 weeks of pregnancy. The risk is much lower when the pregnancy is more than 20 weeks. Symptoms include:
Sensorineural deafness ‐ rubella is the most common cause of congenital deafness in the developed world.
Congenital heart disease, commonly patent ductus arteriosus or peripheral pulmonary artery stenosis.
Eye defects including cataracts, congenital glaucoma, pigmentary retinopathy (50% ‐ so‐ called ‘salt and pepper’), severe myopia, microphthalmia (abnormally small eyes).
Microcephaly (an abnormally small head).
General learning disability.
Insulin‐dependent diabetes, which is often delayed to adolescence or adulthood.
Every woman is screened for immunity against rubella by checking the presence and level of the rubella IgG antibody (body defense) in the blood. We advise any woman who does not have immunity – no antibody – to rubella to take the Measles, Mumps and Rubella (MMR) vaccine and avoid pregnancy for two months.