Hepatis B Viral infection (HPV) can be transmitted to the conceptus in about 10% of cases. If it does transmit, the consequences can be very serious but this would depends on whether the viral load is high ( <200,000 IU/mL) and whether or not the patient has compromised liver function as evidenced by blood abnormal liver function O(LFT’s and imaging). If a woman of childbearing age presents with chronic HBV infection and is not pregnant, the first objective must be to determine disease severity. This is accomplished by assessing the HBV DNA loadl/HB-Ag status, and by evaluating for the presence and extent of liver dysfunction. Most often women of childbearing age who test positive for HBV do not have active inflammation. Therefore, it is not routinely recommended that antiviral therapy be introduced. However, if there is a high viral load or evidence of liver dysfunction, antiviral therapy with Interferon, for 12 months followed by a 6-month observation, should be considered, before initiating any natural or assisted efforts at conception. This of course means that there would be at least an 18month hiatus before infertility treatment would be initiated. In summary: In the absence of evidence of compromised liver function (LFT’s and clinical evaluation are both normal) and detection of a HYBV load of <200,000/ml, antiviral treatment is not recommended. Such HBV+ patients need to be informed of the 10% risk of transmission to the conceptus and told that the choice before them is either: a) to not have children at all or, b) to assume the 10% risk and the realization that should they conceive, the baby(ies) could be seriously affected and careful medical surveillance of the viral load during pregnancy… leading to antiviral therapy being required to try and reduce risk to the developing baby. Once this information is provided, it is then up to the patient to decide on whether to proceed or not proceed.
Fertility Topics Explained from the Experts at SFS