Human Reproduction Update, Vol.10, No.2 pp.149-162, 2004
© European Society of Human Reproduction and Embryology 2004; all rights reserved
Medically assisted reproduction in the presence of chronic viral diseases
1 Fertility Clinic, Department of Obstetrics and Gynaecology and Laboratory for Research on Human Reproduction, and IVF Centre of the Université Libre de Bruxelles, 2 Immunodeficiency Treatment Unit and 3 AIDS Reference Laboratory of the Free University of Brussels (ULB) 4 To whom correspondence should be addressed at: Hôpital Erasme and Medicine Faculty, Free University of Brussels (ULB), route de Lennik 808, 1070 Brussels. e-mail: yenglert@ulb.ac.be
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.
Key words: HIV/HCV/HBV/medically assisted reproduction/sexual transmission
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