The recent Zika outbreak began in Brazil last spring, with an estimated 500,000 to 1.5 million people infected. The virus primarily spreads through the bite of the Aedes species mosquito, but it can also be transmitted by sex with a man infected by the virus.
The symptoms include rash, joint pains, eye inflammation (conjunctivitis), and fever. These symptoms are mild and many do not realize that they have been infected. However, Zika infection during pregnancy can cause microcephaly-a condition characterized by abnormally small heads and brain defects. Other problems have been detected in infants with infected mothers, such as hearing and vision deficits. This is obviously a great concern to us and our patients. Another serious condition associated with Zika infection is Guillan-Barre syndrome-a disorder where the body’s immune system attacks nerve cells.
The best way to prevent Zika infection is to prevent mosquito bites. Suggestions include: wearing long sleeve shirts and pants; using insecticides; using mosquito netting; and using condoms to prevent sexual transmission. Unfortunately there is no vaccine to prevent Zika and no treatment for the virus.
The American Society for Reproductive Medicine (ASRM) recently issued a new document “Guidance for Providers Caring for Women and Men of Reproductive Age with Possible Zika Virus Exposure.” The report is intended to help physicians and other health care providers who are treating and counseling patients concerned about Zika’s impact on reproduction.
Developed largely from documents and reports from the Centers and Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) the report focuses on patients planning pregnancy, testing issues and use of gametes in patients undergoing fertility treatments.
Among the key points of the report:
- Women who have Zika disease symptoms should wait at least 8 weeks after symptoms appear, and men should wait 6 months, before attempting reproduction.
- Men and women with possible exposure to, but not showing symptoms of, Zika should also wait 8 weeks.
- These same timelines should be used for sexually intimate couples using their own gametes in fertility treatments.
- For donated reproductive tissue (sperm, eggs, embryos), FDA guidance should be followed. Currently, FDA rules a potential donor ineligible for 6 months following being diagnosed with, or having had a high probability of exposure to, the virus.
- Testing for Zika virus is complicated, not universally available and routine blood testing is not currently recommended. There is no test available to detect Zika in semen.
For our patients who are trying to conceive, it is recommended that they avoid travel to areas known to be affected by Zika. For couples where the male partner is travelling to an area with Zika, he can freeze sperm prior to travel so that the couple can undergo fertility treatment during the 8 week waiting period.
Patients can get the latest information about areas with Zika by checking the CDC website at www.cdc.gov/zika/geo/index.html.