Infections in IVF: review and guidelines

Abstract

Since the inception of in-vitro fertilization (IVF), questions about contamination and the transmission of infection have been raised. In this review, screening for Chlamydia trachomatis, as well as medical and ethical considerations on IVF in couples infected with hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV), are discussed. IVF is not contraindicated in case of HBV or HCV infection, but the decision is far more delicate in case of HIV infection. If donor gametes or embryos are used, prevention of infectious disease transmission resides in accurate donor selection, including screening for C. trachomatis, HIV, HBV, cytomegalovirus and Treponema pallidum. In the embryology laboratory, microbial contamination of the IVF system deserves attention, and can be prevented by using sterile technique and supplementing culture media with screened sera or serum substitutes and antibiotics. Persons whose biological material is to be cryopreserved should be screened for HBV, HCV and HIV, and separate containers should be used for infected and non-infected material. Finally, transmission of infectious diseases to laboratory personnel can be prevented by adherence to strict safety guidelines, wearing of protective clothing, HBV vaccination, prohibition of mouth pipetting, and developing a plan for the disposal of bio-hazardous material.

Reproductive Performance of Couples Discordant for Hepatitis B and C Following IVF Treatment

“…Pregnancy does not appear to influence the course of the disease nor does the disease have an adverse effect on pregnancy outcome (3). Given the acceptability of a spontaneous pregnancy in patients chronically infected with HBV or HCV, there is no ethically sound reason for declining IVF treatment in these patients (4). Knowledge of the serostatus of the couple however, allows firstly for immunoprophylactic measures to be taken to reduce the risk of transmission to the partner, fetus, or newborn baby, and secondly, for precautions to be taken against cross-contamination during sample handing and embryo cryostorage.…”

Actinomyces urogenitalis Bacteremia and Tubo-Ovarian Abscess after an In Vitro Fertilization (IVF) Procedure

“…However, the incidence is generally low and varies between 0.03% and 1.3% (7,(21)(22)(23)(24)(25)(26)(27). Transvaginal inoculation of bacteria into the peritoneal cavity or ovary by the collecting needle is the most apparent source of these infections (23,28,29). Furthermore, reactivation of a latent PID or direct colonic injury is also a possible, but less likely, mechanism of a post-TVOR pelvic infection (28,30).…”

“…Our patient received neither of the two. Preoperative disinfection of the vagina with topical antiseptics, such as povidone iodine, has been questioned because of potential embryotoxic effects of disinfectants, resulting in a lower pregnancy rate (29,32,33). However, this has recently been contradicted (34).…”

Viral Hepatitis and Assisted Reproduction

“…Transmission of HBV and HCV is the main areas of research, and limited information is now available on HDV and HGV. Concerns over laboratory/nosocomial infection in assisted reproduction clinics have been of great concern since the publication of a case report that described the transmission of HCV from an infected patient undergoing IVF to two non-infected patients undergoing IVF within the same clinic during the same time period [4][5][6]. These cases led to the development of additional regulations for ART in hepatitis patients in 2001 and the emergence of ''viral risk'' laboratories in France where serodiscordant couples (HCVpositive men and HCV-negative women) undergo ART.…”