Wednesday, November 23, 2011

Surrogate Worried She May Contract Hep B From Transferred Embryo



Hello Dr. Ramirez,

I'm currently signed up with an agency as a gestational carrier (surrogate). I have been matched with an international couple and was set to have their fertilized embryo transfered into my uterus this month. However I was just informed that the intended father tested positive for Hepatitis B core antigens. So he has a positive total antibody level but is negative for IgM. I'm told this means the results indicate either a false positve or that he had a past infection but there is NO current infection. Furthermore I'm told that the chances of me contracting hepatitis B is negligible to non-existent since the hepatitis virus lives in the fluid surrounding the sperm but not in the sperm itself and the fluid is always discarded prior to IVF procedures.

Do you have any expereince with or know if this is safe for me to go forward with this transfer via in vitro fertilization using just the sperm from the intended father as mention above and the intended mother's egg which I'm also told does not have recepters for the hepatitis virus?At this point I'm inclined to not take the risk but I feel obligated to find out as much information as possible before I make my descion.Thanks in advance for your time and help. J. from the U.S.

Answer:

Hello J. from the U.S.,

You have submitted a very interesting and difficult question. I think that it is unknown territory, and not being an infectious disease expert, I had to do some research myself to try and answer your question. There is an infectious disease (hepatitis) expert on the All Experts site on About.com, whom you might want to submit this question to as well.

From my research, based mainly via the CDC recommendations, hepatitis B or C are not transmissible via sperm but can be transmitted via semen, if the person is a chronic carrier If the sperm was prepped via thorough washing, there should be little risk of transmission of the virus to the egg, and in most IVF programs, that is the proper method. Transferring that embryo in to your uterus, would have a very small risk of hepatitis B. If you have been immunized for hepatitis B, which many many persons have been, then the chances of transmission are even less.

Based on the information regarding the sperm donor's testing, I cannot draw a conclusion as to his carrier status, except to say that he does not have an active infection. A carrier would have a positive hepatitis surface antigen, hepatitis core antibody but negative IgM. If he had Hep B in the past and recovered and is now naturally immune, he would also have a positive core antibody but also would have a positive surface antibody. This person would not be at risk for transmission of the virus, as no live virus would be present.

So, as a surrogate your chances would be very low, but it is ultimately your choice as to whether or not to take any form a risk. Even a low risk is a risk.

Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.

2 comments:

  1. I am going through the SAME situation right now!!!! Did you go through with the surrogacy???? I am very interested to know what your decision was!

    Thank you!

    ReplyDelete
  2. My situation is a bit different. I am a GC and was recently advised by the clinic that the sperm and oocyte were HBcAb reactive, and the OOCYTE is HBsAg reactive. So, the egg is infected. I am told it is a chronic infection. I did not receive any information about the IgG and IgM. According to the interpretation of Hep B serologic test results if the IgG and IgM are negative the infection is chronic, not acute. I am being told by the IVF clinic that my risk is extremely negligible, like "almost none". I'm also told (or understood) that it does not exist at the cellular level which coincides with the issue of the sperm (seminal fluid vs the sperm cell) however, I feel like I may have misheard. Finally, they advised that transmission is low for chronic infection as opposed to acute infection. As you so rightly pointed out Dr. Ramirez, any risk is a risk... but what are your thoughts on an infected egg as opposed to the sperm?

    ReplyDelete

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