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Published by American Society for Reproductive Medicine
This ASRM guideline provides updated preconception counseling and clinical protocols for reproductive healthcare providers treating non-pregnant patients with possible Zika virus exposure. It details testing paradigms, required wait times before attempting conception (e.g., 3 months for men, 8 weeks for women), and specific handling procedures for ART, gametes, and embryos to mitigate the risk of congenital Zika virus infection.
Key Takeaways
This revised document updates the August 2018 guidance to reflect changes made by the CDC on its Blood and Tissue Safety webpage, clarifying epidemiological information about Zika infection risk outside the U.S. and adding the most recent information regarding transmission risk within the U.S.
Reproductive healthcare providers should perform preconception counseling that includes a discussion of Zika virus diagnostic challenges and unmitigated risks based on the most current available data and national and regional guidance.
Infertility treatment centers caring for patients at risk of infection during the course of treatment or subsequent pregnancy should develop strategies to mitigate the risk of viral transmission to the patient and the fetus.
Men who have confirmed Zika virus disease should wait at least 3 months after onset of illness to attempt reproduction. For women with confirmed Zika disease, wait 8 weeks (CDC recommendation) or 6 months (WHO recommendation).
Symptomatic women and men attempting pregnancy through ART with possible Zika virus exposure should have testing that includes the Zika virus nucleic acid test (NAT) to rule out active Zika infection, and serologic testing to identify Zika immunity, before proceeding.
Asymptomatic women and men undergoing ART with possible exposure to Zika virus or who have traveled to a zone of possible Zika exposure should wait 8 weeks for women and 3 months for men, or alternatively consider testing for Zika infection.
For males or females with a positive NAT result, treatment of infertility should be halted immediately. It should be deferred until a subsequent NAT is negative on both partners and at least 3 months have passed for the male and 8 weeks to 6 months for the female.
Fertility treatment for sexually intimate couples using their own gametes and embryos should follow the timing recommendations for persons attempting reproduction.
Living donors of human cells, tissues, and cellular and tissue-based products (including sperm, oocytes, and embryos) should be considered ineligible for donation if they have a medical diagnosis of Zika, residence or travel to an increased risk area, or sex with an at-risk person in the past 6 months.
Practitioners providing treatment involving gametes to potentially infected individuals should include language in their consent forms that conveys the gap in knowledge regarding Zika virus transmission and testing.
Clinical Topic
Zika Virus Exposure
Objectives
To address Zika virus infection issues and concerns of individuals and couples undergoing assisted reproductive technologies (ART), including those with frozen gametes and embryos, and mitigate the risk of viral transmission.
Target Patient Population
Women and men of reproductive age with possible Zika virus exposure desiring pregnancy, especially those utilizing assisted reproductive technologies (ART).
Diagnostic Criteria
Zika virus nucleic acid test (NAT) to rule out active infection, followed by serologic testing (Zika IgM) at or beyond 15 days from exposure to identify immunity.
Target Providers
Therapeutic Area
Reproductive MedicineGuideline Scope
Care Settings
Special Populations
Contraindications
Monitoring Guidance
Symptomatic exposed patients and concerned at-risk patients should be referred to Infectious Disease specialists prior to attempting pregnancy.
Difficulty
intermediate
Learning Paths