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Laboratory Safety During Assisted Reproduction in Patients with a Bloodborne Virus

par Sassi, Asma ;Devreker, Fabienne ;Englert, Yvon
Référence Assisted Reproductive Technologies and Infectious Diseases: A Guide to Management, Springer Science+Business Media, page (157-178)
Publication Publié, 2016-01

Partie d'ouvrage collectif

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Résumé :

Access to fertility care for chronic carriers of viruses, especially human immunodeficiency virus (HIV) was widely debated around the year 2000 (Englert et al., Hum Reprod 16:1309–15, 2001; Gilling-Smith et al., BMJ 322:566–7, 2001; Shenfield et al., Hum Reprod 19:2454–6, 2004). Nowadays, these patients have access to assisted procreation in many European and North American states (Gilling-Smith et al., BMJ 322:566–7, 2001; Sifer et al., Gynecol Obstet Fertil 31: 410–21, 2003; Ohl et al., Hum Reprod 18:1244–9, 2003; Ethics Committee of American Society for Reproductive Medicine, Fertil Steril 77, 2002, Fertil Steril 94:11–5, 2010). Some specific precautions are recommended for the management of these patients, particularly to treat them in fertility centres that have adapted facilities, procedures and a multidisciplinary team experienced in treating couples with blood-borne viral infections to ensure minimal risks for the future child, in addition to minimising the risk of cross-contamination to patients, members of staff or to uninfected gametes and embryos. (Englert et al., Hum Reprod Update 10:149–62, 2004; Gilling-Smith et al., Hum Reprod 20:1433–8, 2005; Savasi et al., Placenta 29:160–5, 2008; Practice Committee of American Society for Reproductive Medicine, Fertil Steril 99:340–6, 2013). The objectives of these centres are to counsel couples, select the optimal condition before initiating assisted reproduction technologies (ARTs) to prevent vertical and horizontal transmission of blood-borne viruses (BBVs)ensuring the safety of the future child, and of the staff and of other patients during ARTs. This implies that it is necessary to identify these patients and raises the debate on the safety of ARTs when treating carriers of BBV, and thus legitimate systematic screening before assisted reproduction. This chapter evaluates the risk of cross-contamination and nosocomial transmission of BBV in assisted reproduction centres, the safety measurements that should be undertaken, and discusses the legitimacy of BBV screening before infertility treatment. The focus is on hepatitis B (HBV) and C (HCV) viruses, in addition to HIV.