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Bhandari HM, Mitchell T, Duffy J, Mania A, Konsta N, Sarris I, Boyer P, Calhaz-Jorge C, Matik S, Ma Q, Ma F, Siristatidis C, Bosco L, Pomeroy KO, von Byern J, Mocanu E, Drakeley A, Kupka MS, Lara-Molina EE, Le Clef N, Ombelet W, Patrat C, Pennings G, Semprini AE, Tilleman K, Tognon M, Tonch N, Woodward B. ESHRE guideline: medically assisted reproduction in patients with a viral infection/disease. Hum Reprod Open 2021; 2021:hoab037. [PMID: 36733615 PMCID: PMC9887941 DOI: 10.1093/hropen/hoab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Indexed: 02/05/2023] Open
Abstract
STUDY QUESTION What is the recommended management for medically assisted reproduction (MAR) in patients with a viral infection or disease, based on the best available evidence in the literature? SUMMARY ANSWER The ESHRE guideline on MAR in patients with a viral infection/disease makes 78 recommendations on prevention of horizontal and vertical transmission before, during and after MAR, and the impact on its outcomes, and these also include recommendations regarding laboratory safety on the processing and storage of gametes and embryos testing positive for viral infections. WHAT IS KNOWN ALREADY The development of new and improved anti-viral medications has resulted in improved life expectancy and quality of life for patients with viral infections/diseases. Patients of reproductive age are increasingly exploring their options for family creation. STUDY DESIGN SIZE DURATION The guideline was developed according to the structured methodology for the development of ESHRE guidelines. After the formulation of nine key questions for six viruses (hepatitis B virus, hepatitis C virus, human immunodeficiency virus, human papilloma virus, human T-lymphotropic virus I/II and Zika virus) by a group of experts, literature searches and assessments were performed. Papers published up to 2 November 2020 and written in English were included in the review. Evidence was analyzed by female, male or couple testing positive for the virus. PARTICIPANTS/MATERIALS SETTING METHODS Based on the collected evidence, recommendations were formulated and discussed until consensus was reached within the guideline group. There were 61 key questions to be answered by the guideline development group (GDG), of which 12 were answered as narrative questions and 49 as PICO (Patient, Intervention, Comparison, Outcome) questions. A stakeholder review was organized after the finalization of the draft. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help providers meet a growing demand for guidance on the management of patients with a viral infection/disease presenting in the fertility clinic.The guideline makes 78 recommendations on prevention of viral transmission before and during MAR, and interventions to reduce/avoid vertical transmission to the newborn. Preferred MAR treatments and interventions are described together with the effect of viral infections on outcomes. The GDG formulated 44 evidence-based recommendations-of which 37 were formulated as strong recommendations and 7 as weak-33 good practice points (GPP) and one research only recommendation. Of the evidence-based recommendations, none were supported by high-quality evidence, two by moderate-quality evidence, 15 by low-quality evidence and 27 by very low-quality evidence. To support future research in the field of MAR in patients with a viral infection/disease, a list of research recommendations is provided. LIMITATIONS REASONS FOR CAUTION Most interventions included are not well-studied in patients with a viral infection/disease. For a large proportion of interventions, evidence was very limited and of very low quality. More evidence is required for these interventions, especially in the field of human papilloma virus (HPV). Such future studies may require the current recommendations to be revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in MAR for patients with a viral infection/disease, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTERESTS The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, with the literature searches and with the dissemination of the guideline. The guideline group members did not receive any financial incentives, all work was provided voluntarily. A.D. reports research fees from Ferring and Merck, consulting fees from Ferring, outside the submitted work. C.P. reports speakers fees from Merck and MSD outside the submitted work. K.T. reports speakers fees from Cooper Surgical and Ferring and consultancy fees as member of the advisory board BioTeam of Ferring, outside the submitted work. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edgar Mocanu
- Department of Reproductive Medicine, Rotunda Hospital, Royal College of Surgeons in Ireland , Dublin, Ireland
| | - Andrew Drakeley
- Department of Reproductive Medicine, Liverpool Women’s Hospital , Liverpool, UK
| | - Markus S Kupka
- Department Gynaecology and Obstetrics, Gynaekologicum Hamburg , Hamburg, Germany
| | | | - Nathalie Le Clef
- European Society of Human Reproduction and Embryology , Grimbergen, Belgium
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk Faculty of Medicine and Life Sciences, Hasselt University , Hasselt, Belgium
| | - Catherine Patrat
- APHP Centre—University of Paris, Cochin, Service de Biologie de la Reproduction—CECOS , Paris, France
| | - Guido Pennings
- Department of Philosophy and Moral Science, Bioethics Institute Ghent (BIG) Ghent University , Gent, Belgium
| | | | - Kelly Tilleman
- Department for Reproductive Medicine, Ghent University Hospital , Gent, Belgium
| | - Mauro Tognon
- Department of Medical Sciences, University of Ferrara School of Medicine , Ferrara, Italy
| | - Nino Tonch
- Department of Reproductive Medicine, Amsterdam University Medical Centre, Location AMC , Amsterdam, The Netherlands
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Sidler X, Sydler T, Mateos JM, Klausmann S, Brugnera E. Porcine Circovirus Type 2 Pathogenicity Alters Host's Central Tolerance for Propagation. Pathogens 2020; 9:pathogens9100839. [PMID: 33066216 PMCID: PMC7602090 DOI: 10.3390/pathogens9100839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022] Open
Abstract
Porcine circovirus type 2 (PCV2) infections and resulting diseases are a worldwide threat to pig production. PCV2 bears a uniqueness that allows for us to understand more about chronic infections and the immune system in general. The virus can be phylogenetically subdivided into PCV2a to PCV2h genotypes. Although vaccination against PCV2 has been seen to prevent the manifestation of PCV disease, PCV2 still lingers as subclinical infections in all developmental stages of pigs. The “slow and low” tactic gives PCV2 a particular advantage in a host’s immune surveillance. Since the inception of the PCV2 associated panzootic, research scientists have been trying to understand the pathogenicity of PCV2. Different research groups found that one genotype group member was more pathogenic than others. We found, in our weaner infection model with in vivo transfection of different recombinant PCV2 genotype group members that these viruses alter T cell maturation in the thymus, including host’s central tolerance. Here, we extend these original observations by showing that PCV2 infected cells were also found in proximity within the female and male reproductive organs of stillborn pig fetuses. These PCV2 pools were sufficient in infecting three and half-day-old embryos in sows. Furthermore, the dominant PCV2 group member was more pathogenic in our weaner infection model. PCV2 pre-immunocompetence infection makes PCV2 recognized by central immune tolerance as belonging to the host. This also explains why pathogenicity is not a genetically intrinsic characteristic of PCV2; however, the dominance of any one PCV2 genotype group member leads to a more efficient deletion of the T cells against that specific genotype group member in the thymus.
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Affiliation(s)
- Xaver Sidler
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
- Correspondence: (X.S.); (E.B.)
| | - Titus Sydler
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - José Maria Mateos
- Center for Microscopy and Image Analysis, University of Zurich, 8057 Zurich, Switzerland;
| | - Stefanie Klausmann
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Enrico Brugnera
- Department of Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
- Correspondence: (X.S.); (E.B.)
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Bujan L, Pasquier C. People living with HIV and procreation: 30 years of progress from prohibition to freedom? Hum Reprod 2016; 31:918-25. [PMID: 26975324 DOI: 10.1093/humrep/dew036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/07/2016] [Indexed: 01/26/2023] Open
Abstract
The emergence of human immunodeficiency virus (HIV) infection in the 1980s drastically changed the prospects of conceiving a child for the man or woman infected with the virus. Advances in treatment then made it possible to envisage pregnancy while decreasing the risk of transmission to the child when the mother was infected. For couples where one partner was HIV-positive and who desired a child, recourse to medical help, notably medically assisted procreation, was discouraged, and very few centres offered such assistance in the 1980s and 1990s. Improved knowledge of viral excretion in the genital tracts, together with more effective treatment, made it possible to envisage medically assisted procreation for these couples, allowing them to have a child while at the same time likely reducing the risk of transmitting HIV to their partner. Several programmes have demonstrated their effectiveness in this domain. Owing to continually increasing knowledge over the past decade, natural conception can now be proposed. Couples where one or both partners are HIV-positive may opt for medically assisted procreation or natural reproduction. Specialists in reproductive medicine and HIV specialists need to provide couples with objective information allowing them to achieve near-optimal conditions that minimize HIV transmission risk. Couples will then be able to choose freely the mode of procreation most appropriate for them.
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Affiliation(s)
- L Bujan
- Université Toulouse-III Paul Sabatier, Groupe de Recherche en Fertilité Humaine (EA 3694, Human Fertility Research Group), Toulouse, France CECOS, Centre Hospitalier Universitaire Paule de Viguier, Toulouse, France
| | - C Pasquier
- INSERM U1043, CPTP, Centre Hospitalier Universitaire Toulouse-Purpan, BP 3028, F-31024 Toulouse, France Université Toulouse-III Paul Sabatier, CPTP, F-31024 Toulouse, France Laboratoire de Virologie, Centre Hospitalier Universitaire Toulouse-Purpan, F-31059 Toulouse, France
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Meseguer M, Garrido N, Simón C, Pellicer A, Remohí J. Concentration of Glutathione and Expression of Glutathione Peroxidases 1 and 4 in Fresh Sperm Provide a Forecast of the Outcome of Cryopreservation of Human Spermatozoa. ACTA ACUST UNITED AC 2013; 25:773-80. [PMID: 15292110 DOI: 10.1002/j.1939-4640.2004.tb02855.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Oxidative stress imbalance potentially leads to damage of the structure of the cell and macromolecules such as plasma membrane components, proteins, and DNA. The plasma membrane of the sperm cell, which has high levels of polyunsaturated fatty acids, renders it particularly sensitive to free radical-mediated attacks. The freezing and subsequent thawing of sperm is a physically stressful process carried out during routine procedures in assisted reproduction techniques, which results in a highly variable and unpredictable reduction in the number of motile sperm cells. Subsequently, oxidative status can positively or negatively affect the motility, viability, and fertilizing capacity of thawed sperm. These effects are counteracted by various oxidative defense enzymes and anti-oxidants such as glutathione peroxidase isoforms GPx1 and GPx4, glutathione reductase (GR), and cellular glutathione (reduced) (GSH). In this way, oxidative status could represent a predictive marker of sperm quality following the freeze-thaw process. This study was based on 56 human sperm samples. We observed direct positive and negative relationships between the postthaw motile sperm recovery rate and GPx1 and GPx4 expression and activity, on the one hand, and GSH concentrations, on the other. No correlation was found between this recovery rate and GR or basic semen parameters. Predictive values clearly demonstrate that, among the molecules analyzed, the most accurate diagnoses result when analyses are conducted for GPx1 and GPx1 messenger RNA expression, GPx1 and GPx4 enzymatic activity, and GSH concentration. In conclusion, a reserve of glutathione, together with GPx expression, is necessary to eliminate free radicals using GSH or a like structural protein and seems to be essential for a good postthaw recovery. These molecules can be employed as indicators of postthaw sperm quality.
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Affiliation(s)
- M Meseguer
- Andrology Laboratory, Instituto Valenciano de Infertilidad, Policía Local 3, Valencia 46015, Spain.
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Report of results obtained in 2,934 women using donor sperm: donor insemination versus in vitro fertilization according to indication. Fertil Steril 2011; 96:1134-7. [PMID: 21917253 DOI: 10.1016/j.fertnstert.2011.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 08/08/2011] [Accepted: 08/10/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To demonstrate that the use of donor sperm leads to varying outcome rates and that its use has evolved. DESIGN Retrospective observational cohort study. SETTING University-affiliated private IVF setting. PATIENT(S) Women (2,934) undergoing donor insemination (DI) or IVF with donor sperm (IVF-D). INTERVENTION(S) None. MAIN OUTCOME MEASUREMENT(S) We evaluated the distribution of the clinical indications for the use of donated sperm, studying the reproductive outcome. RESULT(S) A total of 1,663 DI (57%) and 1,271 IVF-D (43%) were performed. There were significant differences in the indications for the use of donated sperm (DI vs. IVF-D). Regarding pregnancy rates (PR), cases of nonobstructive azoospermia presented the highest rate (29.1%), whereas cases of intracytoplasmic sperm injection (ICSI) failures and single women showed rates of 27.6% and 22.6%, respectively. Meanwhile, patients with ICSI failures achieved the highest PRs in IVF cycles (48.7%), whereas nonobstructive azoospermia and single women showed rates of 42.0% and 38.2%, respectively. There have been significant increases in the use of donated sperm in single women. CONCLUSION(S) Single women, which also represented the oldest group, show a lower probability of achieving pregnancy, and thus represent a subfertile population. Associated factors could include advanced maternal age.
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García-Herrero S, Garrido N, Martínez-Conejero JA, Remohí J, Pellicer A, Meseguer M. Differential transcriptomic profile in spermatozoa achieving pregnancy or not via ICSI. Reprod Biomed Online 2010; 22:25-36. [PMID: 21123116 DOI: 10.1016/j.rbmo.2010.09.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/03/2010] [Accepted: 09/08/2010] [Indexed: 11/28/2022]
Abstract
Basic sperm analysis is limited as a method of estimating pregnancy. This study’s objective was use of microarray technology to differentiate the gene expressions of spermatozoa that achieved pregnancy in an intracytoplasmic sperm injection (ICSI)cycle in an oocyte donation programme with those that did not achieve pregnancy. A study of nested cases and controls was designed to evaluate fresh and frozen spermatozoa from infertile males undergoing ICSI with donor oocytes. The global genome expression of pooled samples from each group (achieving pregnancy versus those that didn’t, from fresh or frozen spermatozoa)was compared using microarray analysis. The level of expression of some of the transcripts from fresh spermatozoa was shown to differ for those that achieved pregnancy versus those that didn’t. Additionally, exclusively expressed transcripts were identified for both outcome groups. Analysis of frozen spermatozoa didn’t reveal differential expression, but exclusively expressed transcripts were detected. Lists of the transcripts were systematically analysed using different databases in order to provide information about them and their relationship with male fertility. The results revealed profound differences between the expression profiles of spermatozoa that resulted in pregnancy versus those that didn’t. These differences may explain ICSI failure associated with male factor infertility.
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8
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Savasi V, Parrilla B, Ratti M, Oneta M, Clerici M, Ferrazzi E. Hepatitis C virus RNA detection in different semen fractions of HCV/HIV-1 co-infected men by nested PCR. Eur J Obstet Gynecol Reprod Biol 2010; 151:52-5. [DOI: 10.1016/j.ejogrb.2010.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 02/08/2010] [Accepted: 03/11/2010] [Indexed: 11/25/2022]
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Frainais C, Vialard F, Rougier N, Aegerther P, Damond F, Ayel JP, Yazbeck C, Hazout A, Selva J. Impact of freezing/thawing technique on sperm DNA integrity in HIV-1 patients. J Assist Reprod Genet 2010; 27:415-21. [PMID: 20496107 DOI: 10.1007/s10815-010-9417-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 04/08/2010] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION According french legislation, sperm freezing/thawing procedures are used to prevent ART contaminations in couple with HIV-1 infected men. We determined sperm nuclear fragmentation rate before and after selection and freezing/thawing in HIV-1 14 patients. METHODS Two groups of patients were studied: 20 control patients with normal sperm (group 1) and without viral infection and 20 fertile treated HIV-1 patients (group 2). DNA fragmentation was evaluated using terminal uridine nick end labeling, before and after gradient selection, and after cryopreservation and thawing procedures. RESULTS DNA fragmentation rates in fresh semen were increased in HIV patients (6.38% vs 3.39%) (p < 0.05) compared with control patients. After sperm migration, fragmentation rates were significantly lower (p < 0.0001) in the two groups compared with fresh sperm rates. After freezing/thawing, values were similar to those of fresh semen with an increased rate (p < 0.01) for HIV-1 patients, with respectively 3.40% and 5.18% rates in control and infected patients. HIV-1-infected patients treated by antiretroviral therapy showed a significant increase in sperm DNA fragmentation in fresh sperm and also after freezing/thawing procedures, but these two fragmentation rates were not significantly different. CONCLUSION So, freezing/thawing procedures do not seem to impair sperm DNA and preserve probability of conception for couples with HIV-1 infected men.
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GARRIDO N, MESEGUER M, SIMON C, PELLICER A, REMOHÍ J. ASSISTED REPRODUCTION IN HIV AND HCV INFECTED MEN OF SERODISCORDANT COUPLES. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/aan.50.2.105.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Garrido N, Gil-Salom M, Martínez-Jabaloyas JM, Meseguer M. First report of the absence of viral load in testicular sperm samples obtained from men with hepatitis C and HIV after washing and their subsequent use. Fertil Steril 2009; 92:1012-1015. [PMID: 19328477 DOI: 10.1016/j.fertnstert.2009.01.159] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 11/26/2022]
Abstract
Human immunodeficiency virus and hepatitis C infections are sexually transmitted diseases that require sperm samples to be pretreated to eliminate the viral presence before their safe use in assisted reproduction treatments. In this report we describe our experience with sperm washing protocols applied to sperm cells from testicular biopsies as well as the results obtained in subsequent assisted reproduction treatments on seropositive males that are also azoospermic.
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Affiliation(s)
- Nicolás Garrido
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain.
| | - Manuel Gil-Salom
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain; Hospital Universitario Dr. Peset, Valencia, Spain
| | - Jose M Martínez-Jabaloyas
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain; Hospital Clínico Universitario, Valencia, Spain
| | - Marcos Meseguer
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain; Hospital Universitario Dr. Peset, Valencia, Spain
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Hepatitis and reproduction. Fertil Steril 2008; 90:S226-35. [DOI: 10.1016/j.fertnstert.2008.08.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 10/07/2004] [Accepted: 10/07/2004] [Indexed: 11/20/2022]
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13
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Savasi V, Ferrazzi E, Fiore S. Reproductive assistance for infected couples with bloodborne viruses. Placenta 2008; 29 Suppl B:160-5. [PMID: 18790329 DOI: 10.1016/j.placenta.2008.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 08/07/2008] [Accepted: 08/07/2008] [Indexed: 11/25/2022]
Abstract
During the past 15 years Assisted Reproduction has been facing a new demand from patients requiring ART: couples at risk of partner to partner, and mother to child transmission of viral infections, mainly HIV-1, HCV and HIV-HCV co-infected partners. The general conditions and life expectancy of many patients with HIV infection are very good, and three-quarters of these individuals are in their reproductive years. For these reasons, a large number of young couples are expected to make future plans to have children. This desire is not easy to realize for serodiscordant couples, if we consider that, in order to avoid HIV virus transmission, it is necessary to encourage the condom use in vaginal and anal contacts. On the other hand infertile discordant HCV couples need to be included in protocols of controlled assisted reproduction procedures to avoid any risk of HCV transmission to the partner. In this paper we consider assisted reproduction in discordant couples for HIV or HCV-positive men.
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Affiliation(s)
- V Savasi
- Department of Obstetrics and Gynaecology, Sacco Clinical Sciences Institute, University of Milan Medical School, Via GB Grassi 74, 20157 Milan, Italy.
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Abstract
PURPOSE OF REVIEW The total number of people living with HIV has reached 39.5 million. In developed countries, the major risk for HIV transmission is by heterosexual intercourse. The general condition and life expectancy of many patients with HIV infection is very good, and three-quarter of these individuals are in their reproductive years. For these reasons a large number of young couples are expected to make future plans to have children. Assisted reproduction in HIV-1 discordant couples has become important for clinicians in preventing HIV-1 transmission. RECENT FINDINGS The main theme covered in this article is epidemiology of HIV-1 in the world, the biology of the virus present in the sperm, the recently published guidelines from the American Society for Reproductive Medicine and ethics recommendations concerning assisted reproduction in people infected by virus, and all clinical aspects and scientific data published that have been modified to allow assisted reproduction in HIV-serodiscordant couples. SUMMARY To evaluate in clinical practice the safety of HIV-1 assisted reproduction with sperm washing and the outcome of assisted reproductive technologies offered to HIV-1 serodiscordant couples counselled for the prevention of HIV transmission.
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Chama C, Morrupa J, Gashau W. Sex and reproduction among HIV-infected people in Maiduguri, Nigeria. J OBSTET GYNAECOL 2008; 27:812-5. [PMID: 18097901 DOI: 10.1080/01443610701711706] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
For HIV-infected people, prevention of transmission of the virus to their spouses and other sexual partners can only be achieved through abstinence and safer sex practices using condoms. New drugs and technologies are now available that can prevent vertical transmission of the virus. A total of 262 people living with HIV/AIDS (PLWHA) were interviewed to explore their sexual and reproductive desires and practices. About 75.6% of them were sexually active and 62.2% never used condoms. Although only 26.3% had no living child, the majority of these (71.4%) wanted to have children. Their knowledge of mother-to-child transmission of HIV and how to prevent it was good. PLWHA engage in unprotected sexual intercourse with the desire to have more children. It is expected that more paediatric HIV infections will be seen in the future in a poor-resource setting like ours.
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Affiliation(s)
- C Chama
- Departments of Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.
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Melo MAB, Meseguer M, Bellver J, Remohí J, Pellicer A, Garrido N. Human immunodeficiency type-1 virus (HIV-1) infection in serodiscordant couples (SDCs) does not have an impact on embryo quality or intracytoplasmic sperm injection (ICSI) outcome. Fertil Steril 2008; 89:141-50. [PMID: 17669407 DOI: 10.1016/j.fertnstert.2007.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 02/02/2007] [Accepted: 02/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the embryo quality in our program for human immunodeficiency type-1 virus (HIV-1) serodiscordant couples (SDCs) with the male infected in comparison with a tubal-factor infertility control group. DESIGN Retrospective case-control study. SETTING Instituto Valenciano de Infertilidad, Valencia, Spain. PATIENT(S) Thirty SDC and 79 control couples without HIV-1 infection attending for intracytoplasmic sperm injection (ICSI). Only first cycles were considered. INTERVENTION(S) Controlled ovarian hyperstimulation and ICSI in both groups; sperm wash, nested polymerase chain reaction (PCR) in semen sample, and capacitation by swim-up after thawing the semen sample in the SDC group; and sperm capacitation by swim-up after thawing the semen sample in the control group. MAIN OUTCOME MEASURE(S) ICSI procedure and embryo characteristics (fertilization, cleavage, embryo morphology, and development) and cycle outcome (ongoing pregnancy and miscarriage rates). RESULT(S) Fertilization and cleavage rates were similar between the groups. On days 2 and 3 of embryo development, very similar embryo features were found between the groups. There was no difference in mean number of optimal embryos on day 3. When embryos were cultured up to 5-6 days, a significant increase in embryo blockage was found in the SDC group compared with the control group. The mean number of optimal blastocysts on day 6 was comparable in both groups. No difference was found regarding the number of cryopreserved and transferred embryos or implantation, pregnancy, multiple pregnancy, or miscarriage rates between the groups. CONCLUSION(S) HIV-1 infection in SDCs with infected males does not appear to have a significantly negative impact on embryo development or ICSI outcome.
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Bujan L, Sergerie M, Kiffer N, Moinard N, Seguela G, Mercadier B, Rhone P, Pasquier C, Daudin M. Good efficiency of intrauterine insemination programme for serodiscordant couples with HIV-1 infected male partner: A retrospective comparative study. Eur J Obstet Gynecol Reprod Biol 2007; 135:76-82. [PMID: 17544201 DOI: 10.1016/j.ejogrb.2007.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 02/08/2007] [Accepted: 04/23/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted reproduction techniques can minimize the risk of HIV female contamination when the male partner is HIV-infected. The aim of this study was to investigate the efficiency of sperm washing and intrauterine insemination (IUI) in these couples. STUDY DESIGN Retrospective comparative study. Eighty-four HIV-1 serodicordant couples underwent 294 IUI. The control group was composed of 90 couples (320 IUI cycles) with donor sperm. Spermatozoa from HIV-1 infected male partner were prepared and tested for HIV-1 according to sperm washing method. Spermatozoa from HIV-1 and donor male were frozen before IUI. IUI were performed after ovarian stimulation. Main outcomes measures were pregnancy rate per cycle and baby take-home rate per couples. RESULTS Although the pregnancy rate and baby take-home rate were higher in IUI with sperm washing than in IUI using donor sperm (18.0 versus 14.7 and 52.4 versus 41.1, respectively), the differences were not statistically significant. In serodiscordant couples, blood estradiol levels under ovarian stimulation and total motile sperm inseminated were a determining factor in achieving pregnancy. No female HIV-1 contamination occurred. CONCLUSION This study demonstrates that sperm washing and IUI are highly effective in enabling serodiscordant couples with an HIV-1 infected male partner to have a child.
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Affiliation(s)
- Louis Bujan
- Université Toulouse-III Paul Sabatier, EA 3694, Research Group on Human Fertility, France.
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Garrido N, Meseguer M. Reply of the Authors. Fertil Steril 2007. [DOI: 10.1016/j.fertnstert.2007.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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van Leeuwen E, Prins JM, Jurriaans S, Boer K, Reiss P, Repping S, van der Veen F. Reproduction and fertility in human immunodeficiency virus type-1 infection. Hum Reprod Update 2006; 13:197-206. [PMID: 17099206 DOI: 10.1093/humupd/dml052] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Human immunodeficiency virus type-1 (HIV-1) affects mostly men and women in their reproductive years. For those who have access to highly active antiretroviral therapy (HAART), the course of HIV-1 infection has shifted from a lethal to a chronic disease. As a result of this, many patients with HIV-1 consider having offspring, as do other patients of reproductive age with chronic illnesses. This article summarizes the current knowledge on the presence of HIV in the male and female genital tract, the effects of HIV-1 infection and HAART on male and female fertility and the results of various assisted reproduction techniques (ART) in HIV-1-infected men and women who wish to have offspring.
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Affiliation(s)
- E van Leeuwen
- Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
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Garrido N, Remohí J, Pellicer A, Meseguer M. The effectiveness of modified sperm washes in severely oligoasthenozoospermic men infected with human immunodeficiency and hepatitis C viruses. Fertil Steril 2006; 86:1544-6. [PMID: 16996509 DOI: 10.1016/j.fertnstert.2006.03.061] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Revised: 03/29/2006] [Accepted: 03/29/2006] [Indexed: 11/17/2022]
Abstract
Men who are seropositive for human immunodeficiency virus (HIV) or hepatitis C virus now can father children safely, thanks to sperm washing and nested polymerase chain-reaction techniques, followed by intracytoplasmic sperm injection. However, in a small percentage of such patients, it is impossible to recover spermatozoa after said procedures because of their highly impaired spermatogenesis. We have established that less rigorous methods, such as repeated centrifugation, yield nested polymerase chain-reaction HIV- and hepatitis C virus-negative specimens, even in sperm samples from men with severe oligoasthenozoospermia.
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Meseguer M, de los Santos MJ, Simón C, Pellicer A, Remohí J, Garrido N. Effect of sperm glutathione peroxidases 1 and 4 on embryo asymmetry and blastocyst quality in oocyte donation cycles. Fertil Steril 2006; 86:1376-85. [PMID: 16979635 DOI: 10.1016/j.fertnstert.2006.03.053] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 03/22/2006] [Accepted: 03/22/2006] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To prospectively determine the impact of concrete components of the sperm oxidative glutathione stress system in terms of enzymatic activity and mitochondrial RNA (mRNA) expression on embryo quality and reproductive outcome. Human spermatozoa use the glutathione system to inactivate reactive oxygen metabolites, and there is a close correlation between some components of the glutathione system and male fertility. However, very few data are published regarding this system in sperm cells and its effect on fertilization ability and embryo development in human beings. DESIGN An oocyte-donation model, used to homogenize the female factor. SETTING University-affiliated private IVF setting. PATIENT(S) Semen samples from infertile males (n = 43) of couples undergoing oocyte-donation cycles (n = 43). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Gene expression and activity of glutathione peroxidases (GPXs) 1 and 4, glutathione reductase, and intracellular glutathione (GSH) by fluorescent quantitative polymerase chain reaction and spectrophotometry, respectively. RESULT(S) Fertilization rate, pronuclear number, asymmetry, and pronuclear body distribution were not correlated with any sperm glutathione parameters that were considered. When day 3 embryo parameters were evaluated, only GPX4 mRNA expression in sperm cells was statistically significantly lower when asymmetric embryos were observed. Also, worst embryo development and morphology on day 5 was statistically significantly correlated with lower sperm GPX1 activity (101.07 vs. 258.8 IU/mg protein). Glutathione system analysis in fresh sperm was not statistically significantly different in patients achieving pregnancy compared with those who not, and we did not find any correlation with implantation rate. CONCLUSION(S) We have been able to correlate embryo morphology on day 3 with the sperm expression of GPX family members. The results indicate that sperm-derived mRNA may condition human embryo quality and persist even to blastocyst stage. The correlation of the sperm GPX family mRNA expression with embryo health appears quite promising for discovery of molecular causes of male infertility.
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Affiliation(s)
- Marcos Meseguer
- Instituto Valenciano de Infertilidad Valencia, Universidad de Valencia, Valencia, Spain.
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Hepatitis and reproduction. Fertil Steril 2006; 86:S131-41. [PMID: 17055810 DOI: 10.1016/j.fertnstert.2006.08.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2004] [Revised: 10/07/2004] [Accepted: 10/07/2004] [Indexed: 10/24/2022]
Abstract
This bulletin will review the various viral etiologies of hepatitis, their mode of transmission, and implications for infertile couples, pregnant women, and health care workers.
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Pasquier C, Souyris C, Moinard N, Bujan L, Izopet J. Validation of an automated real-time PCR protocol for detection and quantitation of HIV and HCV genomes in semen. J Virol Methods 2006; 137:156-9. [PMID: 16844236 DOI: 10.1016/j.jviromet.2006.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 05/23/2006] [Accepted: 05/25/2006] [Indexed: 11/18/2022]
Abstract
The ability to detect and quantify HIV and HCV genomes is important for checking spermatozoid preparation protocols also known as "sperm washing". But no commercial assay is available. A method was developed for detecting HIV and HCV in semen fractions using the COBAS Ampliprep and COBAS Taqman instruments. It will detect fewer than 200 copies of HIV RNA per ml of semen plasma and fewer than 200 copies/3 x 10(6) semen cells. The sensitivity for HCV is similar at more than 200 IU/ml and below 200 IU/3 x 10(6) semen cells. No inhibitor of PCR amplification was detected. This automated protocol permits a convenient, standardized testing for HIV and HCV in semen. The performance is the same as that of the previous generation of automated assays but the cost and operating time are both reduced.
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Affiliation(s)
- Christophe Pasquier
- Laboratoire de Virologie, EA2046-IFR30, Hôpital Purpan, 31059 Toulouse, France.
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Lesage B, Vannin AS, Emiliani S, Debaisieux L, Englert Y, Liesnard C. Development and evaluation of a qualitative reverse-transcriptase nested polymerase chain reaction protocol for same-day viral validation of human immunodeficiency virus type 1 ribonucleic acid in processed semen. Fertil Steril 2006; 86:121-8. [PMID: 16756977 DOI: 10.1016/j.fertnstert.2005.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To develop a method for same-day validation of processed semen in the setting of assisted reproductive techniques (ART) with patients who are seropositive for human immunodeficiency virus, type 1 (HIV-1). DESIGN Laboratory experiments. SETTING University hospital. PATIENT(S) Volunteers who are HIV-1 seronegative and seropositive. INTERVENTION(S) Evaluation of the sensitivity of a reverse-transcriptase (RT)-nested polymerase chain reaction (PCR) in HIV-1 RNA-positive blood plasma, in artificially infected blood plasma and semen, and in 85 semen samples of 29 HIV-1-seropositive volunteers. Semen was submitted to gradient separation, followed by swim-up. MAIN OUTCOME MEASURE(S) Qualitative detection of HIV-1 RNA in blood plasma and in different parts of semen preparation by using RT-nested PCR, PCR inhibition control by dilution of samples, and an internal control. RESULT(S) The detection limit of our PCR was 20 HIV-1 RNA copies per milliliter. Among seropositive patients, RNA was detected in 25% of fresh semen, 36.5% of seminal plasma, 27.5% of gradient supernatants, and 7.1% of final preparations before the migration-sedimentation stage. Positive final preparations were observed in patients who had blood viral loads of >/=20,000 HIV-1 RNA copies per milliliter. Inhibition was present in 17.6% of seminal plasma and in 20% gradient supernatants and in 2 final preparations among 69 tested. Among 25 preparations tested after the migration-sedimentation stage, 2 were positive (1 patient; 70,000 HIV-1 RNA copies per milliliter). CONCLUSION(S) The RT-nested PCR detects low viral load and allows the validation of semen preparations of HIV-1-seropositive patients for ART on the day of sampling. For this purpose, the validation is performed on spermatozoa that are obtained after gradient separation before swim-up. Inhibition of the PCR must be controlled by using an internal control that is well-designed to explore the detection limit of the method.
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Affiliation(s)
- Benoît Lesage
- Fertility Clinic, Department of Obstetrics and Gynaecology and Laboratory for Research on Human Reproduction, Campus Erasme, Universite Libre de Bruxelles (ULB), Brussels, Belgium
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Cardona-Maya W, López-Herrera A, Velilla-Hernández P, Rugeles MT, Cadavid AP. The role of mannose receptor on HIV-1 entry into human spermatozoa. ACTA ACUST UNITED AC 2006; 55:241-5. [PMID: 16533334 DOI: 10.1111/j.1600-0897.2005.00340.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this opinion article we consider the possibility that human spermatozoa have receptors for human immunodeficiency virus-1 (HIV-1). It is clear that sperm cells have the potential for transmitting HIV-1, but the mechanisms responsible for spreading or the virus by this vector are not known. In contrast to the traditional HIV-1 target cells, spermatozoa do not express CD4 receptors or the CCR5/CXCR4 co-receptors. Recent evidence indicates that astrocytes, which also do not express these molecules, can be infected with HIV-1 through the mannose receptor. Furthermore, a 160-kDa sperm receptor that interacts with the HIV gp 120 has been described. Therefore, we hypothesize that the mannose receptor, of 165-175 kDa, is the receptor that HIV-1 uses to invade spermatozoa, which could lead to both vertical and horizontal transmission of HIV-1.
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Chu MC, Pena JE, Nakhuda GS, Thornton MH, Sauer MV. Assessing the reproductive performance of men co-infected with HIV-1 and hepatitis C undergoing assisted reproduction. Arch Gynecol Obstet 2006; 274:155-9. [PMID: 16715288 DOI: 10.1007/s00404-006-0164-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2004] [Accepted: 08/22/2004] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the reproductive performance of men co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) undergoing assisted reproduction. DESIGN A retrospective analysis. SETTING University-based assisted reproductive technology (ART) center. PATIENTS We reviewed 217 consecutive ART cycles performed on 106 HIV-1 serodiscordant couples between August 1997 and March 2004, in which 28 men (26%) were seropositive for HCV and HIV-1 (group 1). MAIN OUTCOME MEASURES Patient demographics and laboratory testing were compared to reproductive outcomes of men undergoing similar treatment but infected only with HIV-1 (group 2). RESULTS Co-infected men and their partners were of similar age as men infected only with HIV-1. Comparing group 1 to group 2, like values were noted for HIV-1 viral loads [1,993 +/- 1,140 copies/ml (mean +/- SE) vs. 1,659 +/- 487 copies/ml]; CD4 counts (520 +/- 98 vs. 604 +/- 38 mm(-3)); and semen parameters. IVF performance and outcomes were similar, with fertilization rate (0.68 +/- 0.03 vs. 0.71 +/- 0.02); number of normally cleaving embryos (6.0 +/- 0.5 vs. 5.3 +/- 0.3); embryo implantation rate (0.27 +/- 0.04 vs. 0.2 +/- 0.02); and clinical pregnancy rate (40 vs. 29%). Although the male mortality rate was low in both groups, morbidity among co-infected men was significantly higher. Seven of 28 men (25%) had detectable HCV viral loads, and 14 (50%) had elevated liver function tests. CONCLUSION Men co-infected with HCV and HIV-1 do reasonably well undergoing ART to prevent transmission of viruses to their partners and children.
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Affiliation(s)
- Micheline C Chu
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, 1790 Broadway, 2nd Floor, New York, NY 10019, USA
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Bujan L, Daudin M, Pasquier C. Choice of ART programme for serodiscordant couples with an HIV infected male partner. Hum Reprod 2006; 21:1332-3; author reply 1333-4. [PMID: 16611978 DOI: 10.1093/humrep/dei472] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kato S, Hanabusa H, Kaneko S, Takakuwa K, Suzuki M, Kuji N, Jinno M, Tanaka R, Kojima K, Iwashita M, Yoshimura Y, Tanaka K. Complete removal of HIV-1 RNA and proviral DNA from semen by the swim-up method: assisted reproduction technique using spermatozoa free from HIV-1. AIDS 2006; 20:967-73. [PMID: 16603847 DOI: 10.1097/01.aids.0000222067.07255.2d] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Use of antiretroviral drugs has reduced the mortality rate for HIV infection and many HIV-discordant couples wish to have children. It is possible for an HIV-infected man to father children without risk of HIV transmission if HIV-free spermatozoa can be obtained from his semen. METHODS An improved swim-up method was used to collect HIV-free spermatozoa from the semen of HIV-positive males. Diluted semen was layered over a Percoll solution with a continuous density gradient of 30-98%, and then centrifuged. The bottom layer was collected by cutting the end from the tube and the sperm suspension was collected using the swim-up method. Spermatozoa were tested by nested polymerase chain reaction (PCR) for HIV-1 RNA and DNA, with a detection limit of one copy. Spermatozoa were used for assisted reproduction in 43 couples. RESULTS HIV-1 RNA and proviral DNA were not detected by nested-PCR assay in all 73 of the collected spermatozoa samples from 52 patients. The HIV-1-negative sperm was used for in vitro fertilization in 12 couples and for intracytoplasmic sperm injection in 31 couples. No detection of HIV-1 RNA or proviral DNA in the culture medium of the fertilized eggs was confirmed again before embryo transfer. Of the 43 female partners, 20 conceived and 27 babies were born. HIV antibodies, HIV RNA and proviral DNA were negative in all of the females and babies. CONCLUSIONS HIV-negative spermatozoa could be obtained from semen of HIV-positive men. The method involves no risk of HIV transmission to female partners and their children.
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Affiliation(s)
- Shingo Kato
- Department of Microbiology, Keio University School of Medicine, Tokyo, Japan
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Persico T, Savasi V, Ferrazzi E, Oneta M, Semprini AE, Simoni G. Detection of human immunodeficiency virus-1 RNA and DNA by extractive and in situ PCR in unprocessed semen and seminal fractions isolated by semen-washing procedure. Hum Reprod 2006; 21:1525-30. [PMID: 16476677 DOI: 10.1093/humrep/del004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To determine the presence of human immunodeficiency virus-1 (HIV-1) viral RNA/DNA in whole semen, in properly isolated seminal fractions and in spermatozoa after swim-up, by extractive nested PCR and to compare the detection of HIV DNA by in situ PCR (IS-PCR) with the results of nested PCR. METHODS We tested HIV-1 RNA and DNA by nested PCR in semen and in seminal fractions from 55 patients. Non-spermatic cells and spermatozoa pellet fractions from 10 HIV-1-positive and five HIV-1-negative men were tested for proviral DNA by IS-PCR. RESULTS All samples of spermatozoa recovered after sperm washing were free of HIV RNA. HIV RNA tested positive in seven (13%) seminal plasma samples and only in two (4.2%) whole semen of these same samples. Of the seven seminal plasma samples testing positive for HIV RNA, four men had elevated blood viral load and three an undetectable viraemia. HIV DNA by IS-PCR turned positive in three of five samples in semen of HIV-noninfected men. CONCLUSION HIV RNA/DNA detection in the semen of HIV-infected men proves the efficacy of sperm washing with swim-up of spermatozoa. It is recommended that nested PCR be conducted on purified seminal compartments. IS-PCR is inadequate for detecting HIV in semen.
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Affiliation(s)
- Tiziana Persico
- Department of Obstetrics and Gynaecology, Sacco Clinical Sciences Institute, University of Milan Medical School, Milan, Italy
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Garrido N, Meseguer M. Use of washed sperm for assisted reproduction in HIV-positive males without checking viral absence. A risky business? Hum Reprod 2006; 21:567-8; author reply 568. [PMID: 16423837 DOI: 10.1093/humrep/dei337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pasquier C, Anderson D, Andreutti-Zaugg C, Baume-Berkenbosch R, Damond F, Devaux A, Englert Y, Galimand J, Gilling-Smith C, Guist'hau O, Hollander L, Leruez-Ville M, Lesage B, Maillard A, Marcelin AG, Schmitt MP, Semprini A, Vourliotis M, Xu C, Bujan L. Multicenter quality control of the detection of HIV-1 genome in semen before medically assisted procreation. J Med Virol 2006; 78:877-82. [PMID: 16721844 DOI: 10.1002/jmv.20636] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Couples in whom the man is HIV-1-positive may use medically assisted procreation in order to conceive a child without contaminating the female partner. But, before medically assisted procreation, the semen has to be processed to exclude HIV and tested for HIV nucleic acid before and after processing. The performance was evaluated of the technical protocols used to detect and quantify HIV-1 in 11 centers providing medically assisted procreation for couples with HIV-1 infected men by testing panels of seminal plasma and cells containing HIV-1 RNA and/or DNA. The performance of these tests varied due to the different assays used. False positive results were obtained in 14-19% of cases. The sensitivity for RNA detection in seminal plasma was 500-1,000 RNA copies/ml, over 500 RNA copies/10(6) cells in semen cells, and for DNA detection in semen cells 50-500 DNA copies/10(6) cells. The use of silica-based extraction seemed to increase the assay performance, whereas the use of internal controls to detect PCR inhibitor did not. This first quality control highlights the need for technical improvements of the assays to detect and quantify HIV in semen fractions and for regular evaluation of their performance.
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Affiliation(s)
- Christophe Pasquier
- Laboratoire de Virologie, laboratoire de Spermiologie et CECOS Midi-Pyrénées, Toulouse University Hospital, Toulouse, France.
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Mencaglia L, Falcone P, Lentini GM, Consigli S, Pisoni M, Lofiego V, Guidetti R, Piomboni P, De Leo V. ICSI for treatment of human immunodeficiency virus and hepatitis C virus-serodiscordant couples with infected male partner. Hum Reprod 2005; 20:2242-6. [PMID: 15946998 DOI: 10.1093/humrep/dei031] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Assisted reproductive technology with semen washing can offer a significant reduction in risk of sexual and vertical transmission of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) in serodiscordant couples with infected male partner. METHODS Among couples coming to our centre for reproductive problems from January 2001 to December 2003, we selected 43 couples with seropositive male and seronegative female: 25 couples with HIV-seropositive males, 10 couples with HIV/hepatitis C virus (HCV)-seropositive males and eight couples with HCV-seropositive males. Sperm samples were washed and used for ICSI. RESULTS Seventy-eight cycles of ICSI were performed. The mean fertilization rate was 70.34 +/- 20.14% (mean +/- SD). A mean number of 3.55 +/- 1.11 (range: 1-5) embryos of good quality was transferred for each patient. We obtained 22 pregnancies (21 singletons and one twin), with a pregnancy rate per transfer of 28.2% and an implantation rate per transfer of 15.2%. The cumulative pregnancy rate was 51.2%. At follow-up, no seroconversion was detected in any patient. CONCLUSIONS Our data suggest that sperm wash and ICSI could be useful for reducing the risk of HIV and/or HCV transmission in serodiscordant couples with infected male wishing to have a child, irrespective of their fertility status.
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Affiliation(s)
- Luca Mencaglia
- Centro di Chirurgia Ambulatoriale SrL, Via Toselle 178, 50144, Florence, Italy
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Garrido N, Meseguer M, Remohí J, Simón C, Pellicer A. Semen characteristics in human immunodeficiency virus (HIV)- and hepatitis C (HCV)-seropositive males: predictors of the success of viral removal after sperm washing. Hum Reprod 2005; 20:1028-34. [PMID: 15608027 DOI: 10.1093/humrep/deh699] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-seropositive males can now father children safely, avoiding transmission risks to the mother and the children using sperm washing and nested PCR (nPCR) techniques. Nevertheless, we still lack enough data to determine the reasons why approximately 10% of the performed sperm washes remain positive, thus forcing the repetition of the treatment. Semen quality in infected males is also essential to these procedures. We aimed to determine the predictive value of the semen parameters, sperm washing procedure and the infection status for the post-wash viral positivity, as well as the correlation between the semen and the disease features. METHODS Semen characteristics were evaluated in 136 samples provided from 125 males. We also included a control group of 125 males matched by age and length of sexual abstinence. At the time of semen retrieval, 70 of them were infected with HIV (45 also with HCV, 64.3%), and 55 of them with HCV alone. nPCR for viral detection was performed in each sample. RESULTS Thirteen out of 136 (9.5%) of the samples were positive for one or more viral detections (HIV RNA, HIV DNA and HCV RNA, when needed). From a total of 240 nPCR viral analyses, 16 were positive (6.6%). None of the seminal parameters were adequate to predict post-wash results, nor was a positive result dependent on the volumes used in the semen wash. A positive correlation was found between post-wash progressive motility and CD4 blood levels, as well as a negative correlation between progressive motility and time of evolution of the disease in HIV-infected males. CONCLUSIONS Semen analysis, according to the World Health Organization criteria, of HIV- and HCV-affected patients showed no differences from that of non-infected males. Moreover, low CD4 blood levels, and a long evolution of the disease do not negatively affect sperm motility.
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Affiliation(s)
- Nicolás Garrido
- IVI Valencia, Valencia University School of Medicine, Valencia, Spain. nicolas.
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Zuzuarregui JL, Meseguer M, Garrido N, Simón C, Pellicer A, Remohí J. Parameters affecting the results in a program of artificial insemination with donor sperm. A 12-year retrospective review of more than 1800 cycles. J Assist Reprod Genet 2005; 21:109-18. [PMID: 15270209 PMCID: PMC3455611 DOI: 10.1023/b:jarg.0000029494.55273.a2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We aimed to establish the influence of the parameters affecting artificial insemination (AI) results in order to describe the ideal situations to achieve the best results as well as to adequately counsel the patients undergoing these treatments about their pregnancy chances. METHODS We performed a controlled retrospective clinical study over more than one decade in a total of 1858 cycles in 710 patients. Clinical histories and computer registers were systematically reviewed between January 1990 and June 2002. We analyzed the influence of diverse factors affecting AI results such as patient's age, ovarian stimulation, and seminal characteristics to offer a detailed description of the technique. RESULTS Less than 35-years-old, smooth ovarian stimulation and 5 million of progressive motile sperm inseminated two consecutive days are the optimum conditions for achieving good results. Also, period of time that sperm remained frozen do not affect the result. Furthermore, we present the likely or expected outcomes of these treatments depending on the male and female etiologies. CONCLUSIONS We discourage AI in aged patients, and strongly recommend undergoing ovarian stimulation. Nonetheless, we must reach an adequate amount of sperm with good motility in order to inseminate with maximum guaranties of success.
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Garrido N, Meseguer M, Bellver J, Remohí J, Simón C, Pellicer A. Report of the results of a 2 year programme of sperm wash and ICSI treatment for human immunodeficiency virus and hepatitis C virus serodiscordant couples. Hum Reprod 2004; 19:2581-6. [PMID: 15319386 DOI: 10.1093/humrep/deh460] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) serodiscordant couples with the male infected can be helped to have children minimizing the transmission risk. Our aim was to evaluate the results of our assisted reproduction programme for these couples and to develop adequate strategies for their management. METHODS Members of serodiscordant couples: (i) HIV positive males attending our centre for sperm wash and assisted reproduction and (ii) HCV positive males needing assisted reproduction for infertility provided 134 semen samples for sperm wash. Before ICSI treatment, semen was confirmed to be negative for viral presence by reverse transcription and nested PCR after the sperm wash. RESULTS Sperm washes were effective in 90% of the samples. Regardless of the type of infection, no differences were found in semen quality, embryos obtained and pregnancy rates (40-48% per cycle). To date, 41 pregnancies and 23 newborns were obtained. Fertilization rates were lower in HCV than in HIV serodiscordant couples (59.3+/-5.3% versus 72.0+/-8.1%), probably because they were infertile couples for whom we recommended sperm wash and PCR. No seroconversion was detected in the patients' follow-up. CONCLUSIONS To date, sperm wash, nested PCR and ICSI is a safe and effective procedure that avoids HIV and HCV transmission with reasonable pregnancy rates, and is cost-effective.
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Affiliation(s)
- Nicolás Garrido
- IVI Valencia, Valencia, Valencia University School of Medicine, Valencia, Spain.
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Abou-Setta AM. Transmission risk of hepatitis C virus via semen during assisted reproduction: how real is it? Hum Reprod 2004; 19:2711-7. [PMID: 15489242 DOI: 10.1093/humrep/deh509] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The risk of viral transmissibility in assisted reproduction is still a much-debated issue, especially for hepatitis C virus (HCV). HCV is a common causative agent for parenterally transmitted viral hepatitis. In addition, it has been incriminated in other routes of transmission, including sexual transmission and nosocomial infections. The management of infertility, in association with HCV, has sparked debates about the potential risk of spread of infection to virus-free individuals, embryos and/or semen. The lack of worldwide-accepted screening policies has helped to fuel this debate. Today, it is evident that there is a potential risk of spread of HCV through biological fluids, including semen, to other individuals. This risk can only be marginalized by the use of well-established criteria for safety in infertility centres, and by the use of proper initial detection and segregation of potentially hazardous materials. Techniques and protocols have been established to help the andrologist and embryologist to safeguard patients against such dangers, and should be imposed in all centres, allowing HCV-positive males to enter their assisted reproduction programmes.
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Affiliation(s)
- Ahmed M Abou-Setta
- The Egyptian IVF-ET Center, 3, Street 161, Hadayek El Maadi, Cairo 11431, Egypt.
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Politch JA, Xu C, Tucker L, Anderson DJ. Separation of human immunodeficiency virus type 1 from motile sperm by the double tube gradient method versus other methods. Fertil Steril 2004; 81:440-7. [PMID: 14967387 DOI: 10.1016/j.fertnstert.2003.06.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Revised: 06/27/2003] [Accepted: 06/27/2003] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare a new sperm-processing device, utilizing a double tube and gradient, with other commonly used sperm-processing methods for their abilities to exclude human immunodeficiency virus type 1 (HIV-1) from the motile sperm fraction while retaining maximum sperm yield. DESIGN Laboratory experiments. SETTING Academic research environment. PATIENT(S) Healthy HIV-1 seronegative men between the ages of 25 and 55. INTERVENTION(S) Semen samples were spiked with HIV-1 (MN HIV-1 strain; range of concentrations: 10(-1)-10(6) TCID(50)) and subjected to one of the following sperm-processing methods: double sperm tube with discontinuous gradient of sperm separation medium formed inside (double tube gradient), conventional single tube gradient, swim-up or single tube gradient followed by swim-up (gradient/swim-up), which is the method currently used to minimize HIV-1 in semen used for assisted reproductive technology (ART) procedures. For the gradient techniques, Percoll, ISolate, and PureSperm sperm separation media were compared for efficacy of HIV-1 removal. The amount of HIV-1 remaining in the motile sperm pellet after processing was measured by reverse transcription-polymerase chain reaction (RT-PCR), NucliSens assay, or quantitative HIV-1 culture. A hemacytometer was used to microscopically assess motile sperm count. MAIN OUTCOME MEASURE(S) HIV-1 RNA copy number, decrease in HIV-1 TCID(50), motile sperm yield. RESULT(S) The double tube gradient technique was significantly better than all other methods in the removal of HIV-1 from the motile sperm fraction, and produced significantly higher sperm yields in comparison with the gradient/swim-up method. CONCLUSION(S) The double tube gradient technique is a relatively simple and effective method that reduces the risk of infection by HIV-1 while producing good sperm recovery.
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Affiliation(s)
- Joseph A Politch
- Fearing Research Laboratory, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
This article focuses on a range of issues that are of current concern to those working in human sperm cryobanking and considers them within a general framework of risk analysis and management, taking into account the available evidence and perceptions of 'best practice' from both the medical and legal perspectives. In particular, issues arising from concerns over the risk of cross-contamination between samples during storage immersed in liquid nitrogen have been analysed in detail. Even though such an occurrence has never been reported for spermatozoa or embryos, and the risk is generally accepted to be vanishingly small, it does represent a finite risk and all reasonable measures should be taken to reduce the chance of its occurring. It is concluded that all methods used to collect, cryopreserve, store, thaw and use cryobanked human spermatozoa must address the risk of contamination from any source throughout the entire process. To assist workers in this area, a series of recommendations as to current best practice are made, based upon conclusions from risk analyses using currently available information.
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Affiliation(s)
- D Mortimer
- Oozoa Biomedical, Box 93012, Caulfeild Village RPO, West Vancouver, BC, Canada V7W 3G4.
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Brady M. Preventing Sexually Transmitted Infections and Unintended Pregnancy, and Safeguarding Fertility: Triple Protection Needs of Young Women. REPRODUCTIVE HEALTH MATTERS 2003; 11:134-41. [PMID: 14708404 DOI: 10.1016/s0968-8080(03)02289-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The problems and risks of unprotected sex, unintended pregnancy and sexually transmitted infections are inextricably linked. In this context, the critical yet overlooked problem of infertility also needs to be addressed. Dual protection means concurrent protection against unintended pregnancy and STI/HIV. This paper argues for a more comprehensive notion of "triple protection" to include the safeguarding of fertility. This is intended explicitly to draw out the connection between infertility and STIs--using the "visibility" of fertility and infertility and people's immediate connection with them--and in so doing to bolster STI prevention and control efforts. It could also serve to highlight the connections between infertility and unsafe abortion and delivery practices, which still exist in many developing countries. Understanding differences in perception and weighting of protection concerns by young women and men, whether they wish to start, postpone or avoid pregnancy, is essential for the creation of effective programmes. Building on efforts to promote dual protection, a strategic opportunity exists to include prevention of infertility into safer sex messages and to address the fragmentation of reproductive health and HIV/AIDS programmes.
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Affiliation(s)
- Martha Brady
- Family and Development Program, Population Council, New York, NY, USA.
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