Update: August 1, 2016

CDC Guidance for Travel and Testing of Pregnant Women and Women of Reproductive Age for Zika Virus Infection Related to the Investigation for Local Mosquito-borne Zika Virus Transmission in Miami-Dade and Broward Counties, Florida

The Florida Department of Health (FL DOH) has identified an area with local mosquito-borne Zika virus transmission (active Zika virus transmission) in Miami (http://www.cdc.gov/zika/intheus/florida-update.html). Based on the earliest time of symptom onset and a maximal two-week incubation period for Zika virus, this guidance applies to women of reproductive age and their partners who live in or traveled to this area after June 15, 2016.

This is an ongoing investigation, and CDC is rapidly learning more about the extent of active Zika virus transmission in the area identified by the FL DOH. With the recommendations below, CDC is applying existing guidance to the occurrence of Zika virus transmission in this area of Florida. As more information becomes available, we will update these recommendations.

Recommendations:

  1. Pregnant women should avoid non-essential travel to the area with active Zika virus transmission identified by the FL DOH.
  2. Pregnant women and their partners living in or traveling to the area with active Zika virus transmission identified by the FL DOH should follow steps to prevent mosquito bites (http://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html).
  3. Women and men who live in or who have traveled to the area with active Zika virus transmission identified by the FL DOH and who have a pregnant sex partner should consistently and correctly use condoms or other barriers to prevent infection during sex or not have sex for the duration of the pregnancy.
  4. All pregnant women in the United States should be assessed for possible Zika virus exposure during each prenatal care visit. Women with ongoing risk of possible exposure include those who live in or frequently travel to the area with active Zika virus transmission identified by the FL DOH. Women with limited risk include those who traveled to the area with active Zika virus transmission identified by the FL DOH or had sex with a partner who lives in or traveled to the area with active Zika virus transmission without using condoms or other barrier methods to prevent infection. Each evaluation should include an assessment of signs and symptoms of Zika virus disease (acute onset of fever, rash, arthralgia, conjunctivitis), their travel history as well as their sexual partner’s potential exposure to Zika virus and history of any illness consistent with Zika virus disease to determine whether Zika virus testing is indicated.
  5. Pregnant women with possible exposure to Zika virus and signs or symptoms consistent with Zika virus disease should be tested for Zika virus infection based on time of evaluation relative to symptom onset in accordance with CDC guidance (http://www.cdc.gov/mmwr/volumes/65/wr/mm6529e1.htm?s_cid=mm6529e1_e).
  6. Pregnant women with ongoing risk of possible Zika virus exposure and who do not report symptoms of Zika virus disease should be tested in the first and second trimester of pregnancy in accordance with CDC guidance
  7. Pregnant women with limited risk and who do not report symptoms should consult with their healthcare providers to obtain testing for Zika virus infection based on the elapsed interval since their last possible exposure in accordance with CDC guidance.
  8. Women with Zika virus disease should wait at least eight weeks and men with Zika virus disease should wait at least six months after symptom onset to attempt conception.
  9. Women and men with ongoing risk of possible Zika virus exposure who do not have signs or symptoms consistent with Zika virus disease and are considering pregnancy should consult their healthcare provider. Due to the ongoing risk of possible Zika virus exposure, healthcare providers should discuss the risks of Zika, emphasize ways to prevent Zika virus infection, and provide information about safe and effective contraceptive methods. As part of their pregnancy planning and counseling with their health care providers, some women and their partners living in the area with active Zika virus transmission identified by the FL DOH might decide to delay pregnancy.
  10. Women and men with limited risk and who do not report signs or symptoms consistent with Zika virus disease should wait at least eight weeks after last possible exposure to attempt conception.

Previous Update: April 7, 2016

Important Update: American Society for Reproductive Medicine Issues Guidance Document on Zika Virus

The American Society for Reproductive Medicine (ASRM) issued a new document “Guidance for Providers Caring for Women and Men of Reproductive Age with Possible Zika Virus Exposure.” The report is intended to help physicians and other health care providers who are treating and counseling patients concerned about Zika’s impact on reproduction.

Developed largely from documents and reports from the Centers and Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) the report focuses on patients planning pregnancy, testing issues and use of gametes in patients undergoing fertility treatments.

Among the key points of the report:

  • Women who have Zika disease symptoms should wait at least 8 weeks after symptoms appear, and men should wait 6 months, before attempting reproduction.
  • Men and women with possible exposure to, but not showing symptoms of, Zika should also wait 8 weeks.
  • These same timelines should be used for sexually intimate couples using their own gametes in fertility treatments.
  • For donated reproductive tissue, FDA guidance should be followed. Currently, FDA rules a potential donor ineligible for 6 months following being diagnosed with, or having had a high probability of exposure to, the virus.
  • Testing for Zika virus is complicated, not universally available and routine serologic testing is not currently recommended.
  • In areas of active Zika virus transmission, the use of contraceptive methods to prevent unintended pregnancy is essential.
  • Physicians should counsel and educate their patients on Zika and update their informed consent procedures to reflect that counseling.

Owen Davis MD, President of the ASRM said, “We developed this document in order to help educate our members and their patients on the impact of the Zika virus on reproduction and how best to prevent it. As we approach summer in North America, everyone, not just those actively attempting to become pregnant, should educate themselves about Zika virus.”

Dr. Davis also called for more government action on Zika. “It is essential that the public health agencies of the US government be provided the resources they need to help us understand and fight the Zika virus. Our members are prepared to do the work in their labs and their clinics, but they need help from our governmental partners.”

The full guidance can be seen here.


Previous Update: March 31, 2016

CDC Issues New Guidance for Healthcare Providers Caring for Women of Reproductive Age

The centers for Disease Control and Prevention has issued new interim guidance on how to counsel patients about the Zika Virus.

According to the new guidance, “Women who have Zika virus should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus should wait at least 8 weeks after exposure to attempt conception.”

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For any patient or partner that has traveled to a region affected by the Zika virus, fertility treatment will be stopped or postponed for a period of 8 weeks.

To women and their partners who are thinking about pregnancy, please visit the CDC’s Guide for Pregnancy Planning to reference the suggested timeframes for waiting to get pregnant. If you (or your partner) aren’t pregnant, but are thinking about having a baby, here’s what you can do:

  1. Talk with your doctor or healthcare provider
  2. Take steps to prevent mosquito bites
  3. Take steps to prevent getting Zika virus through sex

Women and their partners who are thinking about pregnancy should speak with their doctor or healthcare provider about their plans for having children, the potential risk of getting Zika virus during pregnancy, and their partner’s potential exposure to Zika virus.

Please stay tuned for more updates as they become available


Previous Update: February 19, 2016

Information about Zika Virus and Fertility Treatment

We strive to provide information regarding issues that may affect the health and well-being of our patients. Recently, The World Health Organization (WHO) reported a “very large outbreak” of the Zika virus. The Zika virus, first identified widely in Brazil in May 2015, began spreading across the Americas over the last six months. As of late January 2016, 25 countries have reported locally-transmitted cases of Zika, a virus spread through mosquito bites. Several states in the United States have also reported cases of Zika infection, including Illinois; so far, these have been detected in travelers from other areas. The Zika virus is related to the viruses of dengue and Chikungunya fever. The virus has also been reported to be spread in other ways, such as through sexual intercourse and blood transfusions, as well as by intrauterine and intrapartum (during labor or delivery) transmission. This information confirms that the virus can be spread through body fluid contact with an individual that has been exposed to this virus, and the virus can also be passed to the fetus during pregnancy and delivery. There are no vaccines to prevent the spread of the disease, no anti-virals to treat the infection, and testing can currently only be done through the Centers for Disease Control and Prevention (CDC). Commercial testing may be available soon, and a vaccine may be available in 18 months. The WHO has reported that up to four million people could be infected in the Americas alone.

Most people who are infected with the Zika virus have no symptoms; only 1 in 5 experience mild symptoms, such as headache, fever, conjunctivitis, rash, and coryza. Rare cases of Guillain-Barre, an ascending polyneuritis, have been ascribed to Zika. Most concerning is the association of Zika infection with fetal anomalies. The virus is known to cause microcephaly in the fetus, as a result of forebrain shrinkage caused by the virus. Visual impairment is also commonly seen. The physical and developmental results of this condition are devastating. The fetus is most susceptible to the infection in the first trimester, but miscarriage does not necessarily occur. The condition may be detectable by ultrasound examination in the late first trimester, but not as reliably as later in gestation.

This outbreak has prompted the Centers for Disease Control to issue a travel advisory to the affected countries, particularly among pregnant women at risk of passing the virus to their baby. The CDC’s general recommendations include postponing travel to countries where the Zika virus has been documented recently.

Physician Recommendations to Our Patients

Our advice to our patients is to cancel any trip to a region where Zika is present unless you are not pregnant, not potentially pregnant, and using contraception. The current recommendation is avoiding conception for at least 28 days from last possible exposure to Zika. Due to the critical health implications for offspring, we are following the recommendations regarding suspected exposure to the Zika virus. For any patient or partner that has traveled to a region affected by the Zika virus, fertility treatment will be stopped or postponed for a period of 28 days. Once the virus is absent, it is safe to conceive without fear of the fetus being infected. This fact has led to recommendations of avoiding intercourse during pregnancy if the man has been infected. The WHO, CDC, and The American Congress of Obstetricians and Gynecologists (ACOG) all support this approach. Avoidance of other travelers who may have been exposed is also critical, since a sexually transmitted infection may again take weeks to resolve. More information becomes available daily and may be obtained at the CDC website, www.cdc.gov/zika.

If you have any questions or concerns please contact your Fertility Centers of Illinois office.


Original (February 1, 2016)

At Fertility Centers of Illinois, we strive to provide information regarding issues that may affect the health and well-being of our patients. Recently, The World Health Organization (WHO) reported a “very large outbreak” of the Zika virus. The Zika virus, first identified in Brazil in May 2015, began spreading across the Americas over the last six months. As of late January 2016, 25 countries have reported locally-transmitted cases of Zika, a virus spread through mosquito bites. The virus has also been reported to be spread in other ways, such as through sexual intercourse, blood transfusions, intrauterine, and intrapartum (during labor or delivery) transmission. This information confirms that the virus can be spread through body fluid contact with an individual that has been exposed to this virus, and the virus can also be passed to the fetus during pregnancy and delivery. There are no vaccines to prevent the spread of the virus, and there are no drugs to treat individuals once affected. The WHO has reported that as many as four million people could be infected this year in the Americas alone. Most people who are infected with the Zika virus have no symptoms. Only one-in-five experience mild symptoms, including flu, headache, fever, conjunctivitis (red eyes), and rash. The virus has been especially concerning for pregnant women. The virus is known to cause microcephaly, a disabling birth defect in which babies are born with abnormally small heads and underdeveloped brains. The first trimester is considered the highest-risk period during pregnancy. In many cases, the babies do not survive. If you are currently attempting conception, or are pregnant, please be aware of this risk. This outbreak has prompted the Centers of Disease Control ( CDC) to issue a travel advisory to the affected countries, particularly among pregnant women at risk of passing the virus to their baby. The CDC’s general recommendations include postponing travel to countries where the Zika virus has been documented recently.

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Our advice is to cancel any trip to a region where Zika is present unless she is not pregnant, is not potentially pregnant, or is using contraception. Treatment should be withheld until the patient is back from such a region and several weeks pass to allow for the clearance of the virus. WHO, CDC, and ACOG support this approach.
- Edward L. Marut, MD

If you or your partner have recently traveled, or have upcoming plans to travel, please refer to the CDC website and this American Society for Reproductive Medicine (ASRM) statement for more information. If you or your partner have recently traveled to any of the affected areas, please inform your fertility physician and contact your medical doctor for evaluation.

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