title: Medically assisted reproduction in the presence of chronic viral diseases.
abstract: Teams practising medically assisted reproduction techniques try to avoid viruses as much as possible. Attitudes towards chronic carriers of viruses are rapidly changing, especially for human immunodeficiency virus (HIV) patients. We focus our attention on the legitimacy of systematic screening before assisted reproductive techniques and the need for specialized approaches including an adapted laboratory for viral hazards as well as the need for a multidisciplinary team. Specificities of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) carriers and the hypothesis of a reduced fertility potential are discussed. Are male HIV carriers a new indication for assisted reproductive techniques in order to prevent virus transmission? It is largely proven that sperm gradient preparation techniques efficiently decrease viral loads and therefore have a protective effect on contamination risk during assisted reproductive techniques. Although a few thousand assisted reproductive technique cycles were performed in the world for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Two examples of contaminations during insemination are examined. Many questions remain unresolved, such as the lack of standardized techniques for semen preparation or virus detection or the relative merits of intrauterine insemination or ICSI to prevent HIV contamination during assisted reproductive techniques. The authors plead for well-structured, separate programmes of care linked to research objectives.
authors.affiliation: Department of Obstetrics and Gynaecology, IVF Centre of the Université Libre de Bruxelles. yenglert@ulb.ac.be
authors.forename: Yvon
authors.initials: Y
authors.lastname: Englert
authors.forename: Benoît
authors.initials: B
authors.lastname: Lesage
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Van Vooren
authors.forename: Corinne
authors.initials: C
authors.lastname: Liesnard
authors.forename: Isabelle
authors.initials: I
authors.lastname: Place
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Vannin
authors.forename: Serena
authors.initials: S
authors.lastname: Emiliani
authors.forename: Anne
authors.initials: A
authors.lastname: Delbaere
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000635:transmission; D002908:Chronic Disease; D005260:Female; D006679:HIV Seropositivity; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission; D006526:Hepatitis C / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D018580:Mandatory Testing; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000941:ethics / Q000639:trends; D015229:Sexually Transmitted Diseases, Viral / Q000517:prevention & control; D014777:Virus Diseases / Q000635:transmission*