Fran Lowry

November 06, 2017

Many couples with infertility issues are unwilling to delay attempts at conception when faced with a public health crisis, such as the Zika virus epidemic, despite knowing the risks, results from a new survey show.

We need to understand this population a little better, and then find more ways to educate and intervene, said Ashley Tiegs, MD, from Reproductive Medicine Associates of New Jersey in Basking Ridge.

"Identifying opportunities for patient education and discussing these with our infertile patients is crucial," she said at the American Society for Reproductive Medicine 2017 Scientific Congress in San Antonio.

"For example, we found that most couples don't know that freezing sperm before traveling is an option," she told Medscape Medical News.

The Centers for Disease Control and Prevention recommends that women do not conceive for 8 weeks after traveling to a Zika-affected region — which now comprises more than 70 countries — and that men delay impregnating a partner for 6 months.

This poses a problem because infertile couples "are often not willing to put their attempts at conception on hold," said Dr Tiegs. Six months can be "a very long time, especially if couples are older and time is of the essence."

In their survey of infertile women, Dr Tiegs and her colleagues assessed patient knowledge of Zika and whether it had any influence on reproductive planning.

This very important study illustrates the difficulties in preventing the transmission of Zika, despite attempts at education.

Patients seen at the NYU Fertility Center in New York City from January 2016 to March 2017 were invited to complete an anonymous, online survey in April 2017.

Of the 153 respondents, 68% identified as white, 80% were married, 64% were at least 35 years of age, 47% were nulliparous, 93% demonstrated adequate health literacy, and 75% had been trying to conceive for more than 1 year.

All respondents knew about the Zika virus, and 81% reported that they learned about it from the media. Mode of transmission was correctly identified by 92%, and associated symptoms and prevention measures were identified by 80%.

However, only 14% knew that Zika infection could be asymptomatic, and 71% did not know the recommended time delay between potential exposure and conception.

And despite counseling, 64% did not know that men could freeze sperm for future pregnancy attempts.

Although 85% of survey respondents reported that they had changed travel plans because of concern about Zika exposure, 91% did not alter their reproductive plans. Just 6% said they delayed attempts at conception, and only 3% said they completely deferred.

Of the 28 respondents who reported travel to a Zika-affected region, 61% did not change sexual practices, 21% used condoms, and just 18% were abstinent.

Age and years of infertility did not predict the likelihood that a woman would delay pregnancy.

The women in our population — "who were actually very knowledgeable about how the Zika virus is contracted, what they can do to prevent infection, and even the time period during which men and women need to abstain from attempting conception to prevent consequences to the fetus — still wanted to move forward with attempting conception," said Dr Tiegs.

"This very important study illustrates the difficulties in preventing the transmission of Zika, despite attempts at education," Kevin Doody, MD, director of CARE Fertility in Bedford, Texas, and immediate past president of the Society for Assisted Reproductive Technology (SART), told Medscape Medical News.

Dr Tiegs and Dr Doody have disclosed no relevant financial relationships.

American Society for Reproductive Medicine (ASRM) 2017 Scientific Congress: Abstract P-582. Presented November 1, 2017.

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