November 11, 2010
Running repeat tests for HIV and hepatitis B and C on couples before each cycle of in-vitro fertilization treatment is unnecessary, a new study suggests. The initial screening is enough if the couple reports no new risk factors, according to Drs. Mary Wingfield and Evelyn Cottell of the Merrion Fertility Clinic in Dublin.
A European Union directive in 2006 states that IVF couples using their own sperm and egg cells should be tested "at the time of donation," but member states vary in their interpretation. In Ireland, couples are retested before each IVF treatment and intracytoplasmic sperm injection. For some couples, that could equate to three to four testing rounds. In the United Kingdom, most couples are tested annually during fertility treatment. EU regulatory authorities and fertility associations are debating the issue.
In the new study, Wingfield and Cottell analyzed the testing results of 13,700 people seen at seven Irish fertility clinics between 2007 and 2009. Initial tests found no HIV infections, about 200 people positive for hepatitis B antibodies, and 16 positive for hepatitis C antibodies. Of those who continued treatments, repeat testing found no new infections.
"The evidence presented in our paper certainly shows that repeat screening is not necessary," Wingfield said. Some couples were tested six times over two years, "which has to be excessive and a waste of resources," she said.
A review of the literature for fertility treatment-related viral transmission to the fetus, or to stored frozen embryos, found no documented cases. Of the small number of reported viral transmissions to an uninfected partner during fertility treatment, nearly all occurred prior to routine viral screening. Virtually all would be prevented with current fertility practices, said Wingfield and Cottell.
A better strategy would be to conduct initial viral screening and follow up at later sessions by asking couples if their risk factors for HIV or hepatitis have changed since their last test, said Wingfield. At €100 (US $137) per test, the annual cost of testing all IVF couples in Ireland for each treatment cycle is about €1 million (US $1.38 million), she noted.
The full report, "Viral Screening of Couples Undergoing Partner Donation in Assisted Reproduction With Regard to EU Directives 2004/23/EC, 2006/17/EC and 2006/86/EC: What Is the Evidence for Repeated Screening?" was published in Human Reproduction (doi:10.1093/humrep/deq261).