The recent concerns about Zika virus infection and the probable association with microcephaly require an urgent review of couples undergoing fertility treatment and gamete donation procedures. Whilst the virus is principally transmitted by mosquito there is evidence for the potential for transmission by blood and organ donation. There also appears to be a risk of sexual transmission. The situation is still evolving and might change but given the potential disastrous consequences for a pregnancy if Zika is transmitted via the sperm, you should specifically ask donors about recent travel. In addition it would be prudent to enquire of couples embarking upon fertility treatment if they have recently travelled from infected areas. We advise recording this clearly in the clinical notes.

The relevant issues are summarised as follows:

1. There is evidence that the Zika virus can be found in semen and that it may persist in semen after the acute infection has resolved.

2. There have been recorded incidences of sexually transmitted infection.

3. The Zika virus is likely to survive freeze/thaw.

The following actions are therefore recommended. These are consistent with the advice being given to potential blood, organ and tissue donors and by Public Health England to travellers from affected areas.

1. A person who has travelled to an area where the Zika virus is present should not try to conceive naturally, donate gametes or proceed with fertility treatment for 2 months.

Given the evolving situation, up to date information about these areas can be found on https://www.gov.uk/guidance/zika-virus

2. A person who has had a known Zika virus infection should not try to conceive naturally, donate gametes or proceed with fertility treatment for 6 months. Sperm donors who have been infected with Zika virus should be deferred from donation for six months unless the semen tests negative for Zika virus RNA by nucleic acid testing (NAT). Asymptomatic sperm donors should be deferred for six months after return unless the semen tests negative for Zika virus by NAT.

Further information can be found at the following sites.

http://www.who.int/mediacentre/factsheets/zika/en/

http://ecdc.europa.eu/en/healthtopics/zika_virus_infection/Pages/index.aspx

http://www.cdc.gov/zika/index.html

Professor Adam Balen MD, DSc, FRCOG
Chair of The British Fertility Society

References:
1. Besnard M, Lastere S, Teissier A, Cao-Lormeau V, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, December 2013 and February 2014. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2014;19.
2. Brian DF, Kevin CK, Joy LCF, et al. Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA. Emerging Infectious Disease journal 2011;17:880.
3. Lanciotti RS, Kosoy OL, Laven JJ, et al. Genetic and serologic properties of Zika virus associated with an epidemic, Yap State, Micronesia, 2007. Emerg Infect Dis 2008;14:1232-9.
4. Ventura CV, Maia M, Bravo-Filho V, Gois AL, Belfort R, Jr. Zika virus in Brazil and macular atrophy in a child with microcephaly. Lancet 2016.
5. Oehler E, Watrin L, Larre P, et al. Zika virus infection complicated by Guillain-Barre syndrome–case report, French Polynesia, December 2013. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 2014;19.
6. Laura A-O, Arnulfo P, Giamina P-T, et al. Fatal Zika Virus Infection in Girl with Sickle Cell Disease, Colombia. Emerging Infectious Disease journal 2016;22.