Dr Richa Sharma & Dr Amit Basnotra
Hepatitis is an infective condition in which patient has inflammatory changes in the liver along with other spectrum of varied signs and symptoms depending upon the status and severity of the illness. Irrespective of male or female whosoever is effected, it needs a Multidisciplinary approach and coordination for the benefits of the patient.
Reproduction indicates ability of a person to reproduce As such hepatitis wont cause any directly impact but indirectly it can have through various stages.Here we are collaborating the various key points for the awareness and information of our readers- including common masses to medical and related personnel.
Introduction-
The risk of viral transmissibility in assisted reproduction is heavily debated. Viral screening policies differ in each country and sometimes between infertility centers in the same country. Medical assistance for procreation in couples where one or both parents are infected with hepatitis raises many concerns about transmission of the infection to the baby, and/or possible contamination of the laboratory technicians, medical staff, and other gametes/embryos that are from virus free parents in the same laboratory.
How important it is for a medical personnel to be aware ?
It becomes essential for medical personnel to understand the risk of transmission of hepatitis with assisted reproductive technologies in order to adequately counsel couples who are chronic carriers of viral hepatitis.
Why and What should common people know?
This is a must so that they can see to the concerned doctors dealing with this aspect.Detected early can curb down the transmission risk and the underlying risks of chronicity.
Types of hepatitis-
Viral hepatitis is a term commonly used for several clinically similar, yet etiologically and epidemiologically distinct diseases. Seven human hepatitis viruses have been identified. Hepatitis A, B, C and D are endemic , Hepatitis E is rarely reported , Hepatitis F has not been confirmed as a distinct genotype, and Hepatitis G is a newly described flavivirus. This article will review the various viral etiologies of hepatitis, their mode of transmission and implications for infertile couples, pregnant women, and healthcare workers.
Key points-
Strict adherence to standard precautions and vaccination with Hepatitis B vaccine, commercially available since 1982, is the most effective way to prevent HBV infection. Hepatitis B vaccine is safe and produces a protective antibody response in 95% of young, healthy adults. The Occupational Safety and Health Administration (OSHA) enacted a rule in 1991 that required employers to provide Hepatitis B vaccine free of charge for all employees at risk of exposure to blood.
Data are both limited and controversial on the transmission of hepatitis virus during assisted reproduction.
Transmission of HBV and HCV are the main areas of research and limited information is now available on HDV and HGV.
Concerns over laboratory/nosocomial infection in assisted reproduction clinics has been of great concern since the publication of a case report that described the transmission of HCV from an infected patient undergoing IVF to 2 non-infected patients undergoing IVF within the same clinic during the same time period
Hepatitis and Semen/Embryo Cryopreservation
The occurrence of cross-contamination of HBV during liquid nitrogen storage of biological material and subsequent cross-infection of patients has been demonstrated in a few studies
Recommendations for treating infertile couples
Testing for HBsAg, HBcAb-IgM, HCV, VDRL, HTLV 1 & 2, and HIV 1 & 2 status should be performed on couples prior to cryopreservation of semen or embryos. Since methods are available (vaccination, possibly IUI) to decrease the risk of transmission to the partner or fetus consideration should be given to testing all couples prior to fertility therapy for these infectious diseases. All hepatitis patients need to be counseled about the risks of transmission to their partner, staff, and their children. All office staff should be vaccinated for HBV and universal precautions utilized when handling blood and body fluids for all patients. Until there is a better understanding of the risk of transmission in cryopreserved semen samples and embryos, separate storage tanks for HBV and HCV patients should be established. For specimens with an unknown status, cryopreserved semen should be stored in separate quarantine tanks until the results of infectious disease testing is known. Laboratories should use the company’s guidelines for the brands of equipment they utilize for sealing straws and vials to limit leakage of viral agents to their liquid nitrogen storage tanks. For women with HCV viral titers >106, interferon/Ribaviran therapy should be utilized before attempts at pregnancy to decrease the risk of transmission to the fetus.
Conclusion
Medical assistance for procreation raises many ethical issues with regard to hepatitis transmission. Viral screening and adequate counseling will decrease the risk of transmission of the hepatitis infection to the baby, laboratory/medical staff, and other gametes/embryos in the same lab. Testing infertility patients for HBV and HCV should be offered before starting therapy to decrease the possible risks of transmission of these viral diseases to their sexual partner, to the staff members and to other disease-free embryos/patients in the same laboratory.
Summary
* The risk of transmission of viral hepatitis in assisted reproduction is heavily debated
* Testing for HBsAg, HbcAb-IgM, and HCV should be offered to infertile couples seeking fertility therapy
* Testing for HIV, HBsAg, HbcAb-IgM and HCV status should be performed on the couple prior to cryopreservation of semen or embryos
* Embryos and semen from HCV and HBV patients should be stored in HCV or HBV designated storage tanks
* Infants born to mothers that are HBsAg positive should receive both HBIG and the hepatitis B vaccine within 12 hours of birth
* Women who are HCV positive should be counseled about the risk of transmission of HCV to their fetus with increasing viral loads and positive HIV status. Additionally sexually active women who are HCV positive should be counseled to use condoms when not actively trying to achieve pregnancy until this controversial issue is resolved
* HCV and HBsAg positive patients should be referred to a gastroenterologist/primary care provider to evaluate the patient for chronic liver disease
* HCV patients should be vaccinated for HAV and HBV. Partners of HBsAg positive patients should be vaccinated against HBV.
* Further studies need to be completed to better understand the risk of transmission of hepatitis in cryopreserved semen samples, cryopreserved embryos, or gradient washed semen samples prepared for IUI
(The author are senior IVF and Fertility specialist Delhi, and Senior Gastroentrologist Delhi )
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