Zika Pregnancy Dilemma: Tips for trying to couples trying to conceive

Zika Pregnancy Dilemma

What is Zika?

Zika is a disease caused by the Zika virus, which is spread to people primarily through the bite of an infected mosquito. The most common symptoms of Zika are fever, rash, joint pain, and conjunctivitis (red eyes). The illness is usually mild with symptoms lasting for several days to a week after being bitten by an infected mosquito. Zika can be contracted with a single mosquito bite. According to the CDC, people usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected. Once a person has been infected, he or she is likely to be protected from future infections, that is, they are immune. A Zika pregnancy can result in miscarriage and birth defects.  Currently, there is no vaccine to prevent Zika infection. There is no treatment for people who are infected with Zika.

Zika transmission through sexual contact

There is documented evidence of sexual transmission of Zika from male-to-female, male-to-male, and female-to-male sex partners. Female-to-female sexual transmission has not yet been reported but is biologically plausible. Zika can be passed from a person with Zika before their symptoms start, while they have symptoms, and after their symptoms end. It may also be passed by a person who has been infected with the virus but never develops symptoms.

Sex includes vaginal, anal, oral sex, and the sharing of sex toys. Sexual exposure includes sex without a condom with a person who traveled to or lives in an area with Zika.

Studies are underway to find out how long Zika stays in the semen and vaginal fluids of people who have Zika, and how long it can be passed to sex partners. Current research shows that Zika can remain in semen longer than in other body fluids, including vaginal fluids, urine, and blood. One way that is used to detect Zika virus is to look for Zika virus RNA. Zika virus RNA was detected in semen of five men more than 90 days after symptom onset, with the longest period of reported detection 188 days after symptom onset. Although this doesn’t prove that those men remain infectious for that duration, it does indicate that it is possible.

Although the Zika virus has been found in saliva, we don’t know yet if Zika can be passed through saliva during kissing.

Zika Virus testing

One of the methods that has been used to see if a person has been exposed to the Zika virus is blood testing to look for Zika antibodies. There are different types of antibodies. IgM antibodies are generally used to try to identify a recent exposure.

The CDC recommends that a woman who is considering pregnancy and has visited or resides in an area with active Zika transmission should have blood testing for Zika IgM antibodies before pregnancy. This is recommended because the IgM antibodies might stay in the body for a long period of time, even after the virus is gone. So if a pregnant woman as found to have Zika IgM antibodies during pregnancy, it doesn’t necessarily mean that she contracted the infection during the pregnancy. Having the test done before hand will help to clarify the timeline.

Zika and Fertility

A September 2016 study in mice found that the Zika virus caused damage to testicular cells responsible for hormone and sperm production. The result included lower testosterone levels and a reduction in sperm concentration. It is not known whether the same impact occurs in human beings.

Zika and Miscarriage

If a pregnant woman contracts the Zika infection, the virus can pass through the placenta and affect the developing fetus. Reports from Brazil and the United States have found the Zika virus in the fetal tissue recovered after a woman had a miscarriage. This does not yet prove that Zika caused these miscarriages but it does make it very suspicious. It is also known that the Zika virus can stay in a woman’s body for several weeks.

Zika pregnancy complications

Transmission of Zika to the fetus has been documented in all trimesters. Zika virus has been identified in amniotic fluid, the placenta, and in full term babies. However, much is not yet known about the problems the Zika virus can cause in pregnancy.  The problems that Zika is suspected to cause in pregnancy include stillbirth, poor fetal growth and microcephaly (a birth defect affecting the brain). Other abnormalities have been found in fetuses who were infected with Zika.

Recommendations for avoiding Zika pregnancy complications

For those couples who are actively trying to become pregnant, the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO) recommend

  • Avoid travel to areas where active Zika transmission is occurring
  • As of August 27, 2016 – Active transmission had been documented in Florida. The Florida Zika outbreak has now been found in multiple areas in and around Miami including the Miami airport. The CDC recommendations about travel to Florida can be found here
  • As of December 9, 2016, the CDC added Brownsville, Cameron County, Texas as the 2nd area in the United States with local transmission of Zika
  • If you do find yourself in an area with active Zika transmission, take these steps to avoid getting bitten by mosquitoes
  • Women who’ve been in areas where Zika is found should practice safe sex (correct and consistent use of condoms or barrier methods of contraception) or abstain from intercourse for at least eight weeks – NOTE: YOU DO NOT NEED TO EXHIBIT SYMPTOMS. THE RECOMMENDATION IS TO WAIT 8 WEEKS FROM JUST VISITING AN AREA OF ZIKA TRANSMISSION. The World Health Organization (WHO) advises waiting 6 months
  • Women who showed Zika symptoms or with confirmed Zika diagnosis are advised to wait 8 weeks before trying to conceive with their partners according to the CDC. The World Health Organization (WHO) advises waiting 6 months
  • Men who’ve been in areas where Zika is found or who showed Zika symptoms or with confirmed Zika diagnosis are advised to wait six months before trying to conceive with their partners.
  • Couples in which a woman is pregnant and either partner has been in an area with Zika should use barrier methods against infection consistently and correctly during sex (including vaginal, oral, anal sex, and sharing of sex toys), or abstain from sex for the duration of the pregnancy.

Zika and Fertility Treatment

The American Society for Reproductive Medicine (ASRM) advises waiting the same length of time noted above before initiating fertility treatments. For donated reproductive tissue, FDA guidance should be followed. Currently, FDA rules mandate that a potential egg or sperm donor be ineligible for 6 months following being diagnosed with, or having had a high probability of exposure to, the Zika virus.  Specifically, the FDA states that living donors of sperm, eggs, and embryos will be deemed ineligible for anonymous donation if they have any of the following risk factors:

  • medical diagnosis of Zika virus infection in the past 6 months
  • residence in or travel to an area with active Zika virus transmission within the past 6 months or
  • within the past 6 months had sex with a male partner who, during the 6 months before this sexual contact, received a diagnosis of or experienced an illness consistent with Zika virus disease, or had traveled to an area of active Zika virus transmission