Guidelines for risk reduction when handling gametes from infectious patients seeking assisted reproductive technologies

Abstract

According to the Americans with Disabilities Act (1990), couples with blood-borne viruses that lead to infectious disease cannot be denied fertility treatment as long as the direct threat to the health and safety of others can be reduced or eliminated by a modification of policies or procedures. Three types of infectious patients are commonly discussed in the context of fertility treatment: those with human immunodeficiency virus (HIV), hepatitis C or hepatitis B. Seventy-five per cent of hepatitis C or HIV positive men and women are in their reproductive years, and these couples look to assisted reproductive techniques for risk reduction in conceiving a pregnancy. In many cases, only one partner is infected. Legal and ethical questions about treatment of infectious patients aside, the question most asked by clinical embryologists and andrologists is: "What are the laboratory protocols for working with gametes and embryos from patients with infectious disease?" The serostatus of each patient is the key that informs appropriate treatments. This guidance document describes protocols for handling gametes from seroconcordant and serodiscordant couples with infectious disease. With minor modifications, infectious patients with stable disease status and undetectable or low viral load can be accommodated in the IVF laboratory.

Renin Angiotensin System, COVID-19 and Male Fertility: Any Risk for Conceiving?

“…When processing semen in virus-positive patients, the viral titer should be kept at the lowest possible level. Special washing refers to an additional swim-up step for sperm from the pellet, which results from the density gradient [ 163 ].…”

Croatian Society of Clinical Embryologists – guidelines on the epidemiological framework for the implementation of medically assisted reproduction (MAR) procedures during the COVID-19 pandemic regarding the safety of patients and medical health workers

“…14 This kind of the semen preparation of the HIV positive patients has been shown to remove more than 99% of viral particles from the sample. 15 The samples can be processed by a simple wash technique in the cases where a small number of sperm is present in the sample (severe oligoasthenozoospermia, testicular tissue) as they are not suitable for purification on a density gradient. 16 No cases of viral transmission have been reported in the literature following the use of prepared semen in the IVF treatment.…”

Sperm Preparation Methods for IUI and IVF

“…Yıkama işlemi ejekülasyonu takip eden 1 saat içerisinde yapıldığı takdirde seminal plazmada bulunan diğer hücreler, ölü sperm hücreleri, çözünmüş halde bulunan prostoglandinler ve çinko gibi çeşitli maddeler, bakteri ve virüs-ler gibi enfektif ajanlardan kaynaklanabilecek zararlı etkiler en aza indirilmiş olur. 6,7 Uygulanacak sperm hazırlama protokolünün seçiminde semen analizi kritik önem taşır. Örneğin; normozoospermik hastalarda hem SU, hem de DGS yön-temiyle yeterli sayıda ileri hızlı hareketli sperm elde edilirken, oligoastenozoospermi vakalarında dansite-gradiyent yöntemiyle elde edilen hareketli sperm sayısı daha yüksektir.…”

“…Çalışmalar uygun şekilde yapılan DGS uygulamasının bu hastaların ejakülatlarındaki viral yükü ortadan kaldıracak kadar başarılı olduğu yönündedir ve gerek IUI gerekse de ICSI/IVF siklusları için kullanılabilir. 7 Bu vakalarda gradiyent sütunlarının 3 katmanlı şe-kilde hazırlanması önerilmektedir. Hafif erkek faktörü olarak kabul edilen, toplam motil sperm sayısının 5-15 milyon aralığında ve ileri hareketliliğin düşük olduğu vakalarda katmanlar 0,5 mL hacimle sınırlandırılmalıdır (mini gradiyent olarak da isimlendirilir).…”