American Society for Reproductive Medicine
Caring for Women and Men Of Reproductive Age with Possible Zika Virus Exposure
This guideline holds 17 recommendations, 19 references and 1 table.
Summary
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.
Attempting pregnancy via ART requires active medical intervention and discretionary timing. Consequently, intentional measures can be taken to minimize the risk of a Zika virus-infected pregnancy for individuals and couples undergoing ART who live in or travel to active Zika transmission areas.
Key takeaways
Men with confirmed or possible Zika virus exposure should wait 3 months, and women should wait 8 weeks, before attempting pregnancy.
ART patients with possible exposure must have a negative NAT test before proceeding if they do not wish to wait out the delay period.
Living donors of gametes and embryos are ineligible if diagnosed with Zika or exposed to increased risk areas within the last 6 months.
Zika RNA may persist in semen for longer durations than in serum, and sperm washing or cryopreservation is not proven to eliminate the virus.
What is new in this version
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.
Recommendations
Planning Pregnancy for Infected, Exposed, or Possibly Exposed Individuals
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.
Population: Women and men of reproductive age with possible Zika virus exposureWhen: Possible Zika virus exposure
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.
Population: Patients at risk of Zika virus infectionWhen: Infertility treatment
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).
Population: Men and women with confirmed Zika virus diseaseWhen: Confirmed Zika virus infection
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.
Population: Symptomatic women and men attempting pregnancy through ARTWhen: Possible Zika virus exposure
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.
Population: Asymptomatic women and men undergoing ARTWhen: Possible Zika virus exposure or travel to risk zone
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.
Population: Males or females with a positive Zika NAT resultWhen: Active Zika virus infection
Fertility Treatments Using Autologous or Donated Gametes
Fertility treatment for sexually intimate couples using their own gametes and embryos should follow the timing recommendations for persons attempting reproduction.
Population: Sexually intimate couples undergoing fertility treatmentWhen: Possible Zika virus exposure
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.
Population: Living donors of human cells, tissues, and embryosWhen: Donor eligibility screening
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