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Should I Delay Pregnancy or IVF Because of The Zika Virus?

Originally published February 12, 2016, and continually updated

Zika virus and your fertility and pregnancy planning, logoGiven the recent explosion of media coverage of the Zika virus, I have had more than one patient ask this question. I’d like to offer some perspective.

While Zika sounds like the name of a new pop singer, it is actually a virus striking fear into hearts and minds worldwide.

According to health officials in Brazil, where the outbreak originated, the Zika virus is the suspected culprit in more than 4,100 cases of microcephaly, a rare birth defect in which a baby is born with a small brain and head. By comparison, in 2014, fewer than 200 cases of microcephaly were reported in Brazil. Here is what we know right now.

  • The Centers for Disease Control and Prevention (CDC) has now confirmed the link between the Zika virus and the occurrence of microcephaly as well as other birth defects.
  • Only 1 in 5 people infected with Zika ever display symptoms. This makes it hard to know if your baby is at risk.
  • There is no vaccine yet for Zika, although the vaccine is currently in phase 1 trials and being tested on humans.
  • There is no cure.
  • The mosquito that carries Zika inhabits the United States, mainly in Florida and South Texas. There have been confirmed cases of local Zika virus in Florida.
  • A second kind of mosquito, aedes albopictus, is widely prevalent in the South and may also carry the virus.
  • The virus can be transmitted sexually from both males and females.
  • The only ways to avoid Zika is to avoid bites by mosquitos carrying the virus, and to avoid sexual intercourse with an infected person.
  • So little is known about Zika that doctors and scientists don’t even know if people who contracted Zika are immune to new infections.
  • In the fall of 2016, the World Health Organization strengthened its guidelines that state anyone traveling in a Zika-affected area should practice protected sex for at least six months.
  • The CDC frequently updates its travel guidelines to show where Zika is actively spreading, and patients are advised to check the CDC travel guidelines page before planning travel to see if the region is affected by Zika.

Let’s be vigilant, not panicked

Before wrapping your house in mosquito netting or trading all your lamps for bug-zappers, let’s pause to see if the medical pendulum swings the other way.

Less developed nations are considered to be much more vulnerable to this disease than United States residents. In Central and South America, for example, rampant poverty, lack of windows that close securely, and cramped living spaces all contribute to the risk of disease transmission.

None of this is to say that Zika does not cause microcephaly and other birth defects. Recently, the Journal of the American Medical Association identified a number of birth defects directly caused by the Zika virus. This group of defects is now being referred to as congenital Zika syndrome, and it includes:

  • Severe microcephaly (abnormally small head size)
  • Decreased brain tissue with a specific pattern of calcium deposits indicating brain damage
  • Damage to the back of the eye with a specific pattern of scarring and increased pigment
  • Joints with limited range of motion, such as clubfoot
  • Too much muscle tone, restricting movement soon after birth.

In response to this information, women considering in vitro fertilization (IVF) are likely to be among the most concerned. Psychologically, this group has already been traumatized by infertility. They frequently get devastating news just when they were hoping against hope for good news. News like this tends to put IVF patients even more on edge. Fortunately, there seems little reason for extreme concern provided the appropriate precautions are taken.

Should I delay having a baby?

For now for the majority of American women, the short answer to this question is no: Do not let fear of contracting the Zika virus delay pregnancy. There are multiple reasons.
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First, there has not been a major outbreak in the United States.

This is not to say it can’t happen, but we are likely a long ways from the same risk as in the foreign countries where outbreaks have occurred. Due to our standard of living, Zika and similarly transmitted diseases are much less likely in the U.S. as in more tropical climates. So far, Zika cases in the U.S. have been isolated and contained.

Further, keep in mind that Zika, which has been known to epidemiologists for decades, is hardly the first virus known to cause birth defects.

The much more prevalent airborne varicella virus (chicken pox), the rubella virus (German measles), parvovirus – in addition to organisms such as toxoplasmosis and syphilis – have been safely avoided by most mothers-to-be for years.

By comparison, for some women, the risks of Zika associated birth defects may be far outweighed by the odds of having a baby with Down syndrome or another genetic disorder. For example, a woman who gives birth at age 35 has an approximate 1 in 350 chance of delivering a baby with Down syndrome. If she waits just one year, that risk increases to 1 in 275. By age 38, the risk is approximately 1 in 175.

For the above reasons, we at TRM do not currently recommend delaying pregnancy for women who have had no exposure. This is not to say that we should not be cautious. If there is no need to travel to a region where Zika has been reported, you should avoid it. And you should not have sex with someone who has recently travelled to an affected area for at least six months.

If you have traveled to an affected area, we recommend avoiding unprotected intercourse and foregoing fertility treatment for at least eight weeks after your trip.

If your partner has traveled to an affected area, we recommend avoiding unprotected intercourse and postponing fertility treatment for six months following the travel.

What precautions can I take against Zika?

If a pregnant or soon-to-be pregnant woman is worried about infection, she lessens her chances of being bitten by an infected mosquito through the following measures.

  • Do not travel to countries where Zika outbreaks have been reported.
  • Stay indoors as much as possible. While you should maintain your activity and exercise regimen, it’s best to try to contain your workouts to gyms and other indoor facilities.
  • Wear protective clothing, including long pants and long-sleeve shirts and blouses, as well as clothing treated with the repellent permethrin.
  • Use pregnancy-safe insect repellent.
  • Avoid anyone who might be infected.

Unless you suspect an active infection or unless you were in an affected area, you generally should not be tested for exposure to the virus. The testing for prior exposure can be difficult to interpret, as other prior virus exposures can interfere with Zika testing.

This blog is continually updated as new information warrants.