Very often, when conducting a diagnostic work-up of both male and female infertility, there may need to be various blood tests in order to verify the presence or absence of various infectious diseases.
The reason for these tests is that if a couple is found to have one of these infections, this very well might be a contributing factor to a couple's infertility. The infection might also affect the outcome of fertility treatments.
Another important reason for these tests that is underestimated, is that the fact that many of these infections can be passed along to the baby, potentially jeopardizing their health and the pregnancy.
Listen today as Dr. Alan Martinez discusses the reasons for infectious disease testing prior to fertility treatments and how they can affect the outcome of treatments.
Selected Podcast
Infectious Disease Testing and How it Relates to Infertility
Featured Speaker:
Learn more about Dr. Alan Martinez
Alan Martinez, MD
Dr. Alan Martinez is a specialist in Reproductive Endocrinology and Infertility. He completed his fellowship training at the University of Cincinnati Medical Center and is a board eligible physician in Obstetrics and Gynecology, and Reproductive Endocrinology. Dr. Martinez has expertise in hysteroscopic and advanced laparoscopic surgery. After graduating with distinction with a B.S in Biology and B.A. in Psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California Los Angeles. He completed his Obstetrics and Gynecology residency training at Saint Barnabas Medical Center, an affiliate teaching institution with Rutgers New Jersey Medical School.Learn more about Dr. Alan Martinez
Transcription:
Infectious Disease Testing and How it Relates to Infertility
Melanie Cole (Host): When conducting a diagnostic work up of both male and female infertility, there may need to be various blood tests in order to verify the presence or absence of various infectious diseases. My guest today is Dr. Allen Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. So, what tests, when you've got a couple in that are talking about fertility treatments, what infectious disease tests do you have to run, or do you typically run?
Dr. Allen Martinez (Guest): For all of our patients who present to our office for an evaluation, the general things that we go over are infectious disease testing that include such things as hepatitis B, hepatitis C, syphilis testing, chlamydia, gonorrhea testing, as well as HIV testing.
Melanie: So, people get these tests and they ask you why are you testing for these?
Dr. Martinez: Yes. I get that question all the time, and most patients are fine with the testing. They kind of recognize they are in a sexual relationship and it's just nice to assess your overall health. So, I say, “Hey, we want to make sure that as we prepare your body for pregnancy that you know the complete status of your health and how some of these infectious diseases can either be transmitted on to the offspring, should we get you pregnant, or some of the effects of these infections on the chances and the likelihood of success with pregnancy.” So, they can directly play a role in both the preconception counselling as well as the treatment approaches based upon any prior history of an infection.
Melanie: And, they might be a contributing factor to their ability to conceive?
Dr. Martinez: That is correct. When we evaluate patients, we always want to look at the infectious disease and their hormonal history, in general. Some of these infectious diseases, particularly a prior chlamydial infection, which some patients may have a remote history of, and they've been treated for it and then they come in here 5 or 10 years later and they want to get pregnant. So, they might have an evaluation to look at the fallopian tubes. And, that particular infection, a prior pelvic infection, undiagnosed or diagnosed can affect the structure of the fallopian tubes--actually block and damage the fallopian tubes--which ultimately affects fertility treatments and may be a consideration for moving towards such treatments as in vitro fertilization.
Melanie: So, what if you find that there is the presence of some of these diseases, may be even varicella or HIV or any of these kinds of things, what do you do with that information?
Dr. Martinez: So, we sit down with the patient and, obviously, have a conversation about the status. The patient may have a remote infection that's been resolved. The patient may actually have an active acute infection. So, we counsel them from the start of the positive test. If they are aware of that, we update them. If they're unaware, then actually we may refer them out to an infectious disease specialist to get subsequent specific tests that better can characterize what kind of condition they have and how it affects them. So we serve as kind of like the mediators of obtaining the information and then ultimately enlisting other physician so that the patient could be best counselled as they prepare for pregnancy.
Melanie: What about if there's somebody that wants to store eggs or the storage of genetic material? What happens when infectious disease is present?
Dr. Martinez: Okay. That's a very good question. The FDA has regulations on these sort of things and so a patient that may be a chronic carrier of something such as hepatitis or HIV or something like that, then anytime our laboratory goes and stores, the genetic material for these patients, whether it be eggs, whether it be embryos, what we actually have to do is we have to store that genetic material separately from any of the other patients, the non-infectious material, because all these patients undergo this testing. So, that may involve extra steps that the patient needs to go through in preparation for their treatment but it also involves kind of a quarantine, so to speak, of their genetic material whether it be the egg or embryos. And then, ultimately those embryos are stored safely to safeguard other patients to make sure there's no mixing and no potential infection of non-infected eggs or embryos.
Melanie: And, if a woman is found to have one of these infectious diseases that you've mentioned and they could be passed along to the baby, potentially jeopardizing the health or the pregnancy, what do you tell them about continuing with fertility treatments?
Dr. Martinez: Yes. That's a very good point and one that we commonly get from our patients. If it's a new infection or if it's an infection that is active, then this obviously increases the potential risk of transfer to their offspring. If, however, they're chronic carriers or they have low viral titers, then their chances of actually passing on the infectious agent to their offspring can actually be decreased to a very low level to where the chances are very low that they will actually pass it on to their son or their daughter. So, it involves careful counselling. I'll give an example. Sometime we have patients that come through with HIV and you can have an HIV infection or you can have an undetectable viral load which means that you're being treated and since we don't have any virus particles--small numbers that are fooling around in your bloodstream. We can undergo IVF and there are procedures where we may inject sperm into the egg through ICSI (intracytoplasmic sperm injection). In these cases, if it's actually a controlled infection, even with HIV, and we undergo these advanced treatments, their likelihood of transmission to the offspring can be less than 1-2%. So, in most cases, finding the infection early, treating it, can really maximize the health of their future offspring.
Melanie: Is there anything with vaccines and the presence of some of these infectious diseases, like I mentioned varicella or chickenpox. If they've had the vaccine, do you then see the presence of this virus in their system?
Dr. Martinez: Yes. So, we essentially do titers for their vaccination and for their immune system. We look at varicella, we look at rubella, and, in some cases, we look at something called cytomegalovirus, depending upon the situation. We take an extensive history and see if they've had chicken pox but even if they have it, which is varicella or if they've had a rubella infection, we will test their titers and we will be able to see whether or not they are immune or not immune. Just because somebody had a prior infection doesn't mean that they retain their immunity to this infection. So then, in that case, we may counsel them and say, “You may benefit, you will benefit, by receiving a varicella or rubella vaccine, completing that course before we try to get you pregnant.” Because, ultimately, the way that I talk to my patients is that we want to take care of you, we want to optimize your health so that your future offspring can be healthy as well.
Melanie: Then, wrap it up for us, Dr. Martinez. Such great information. What do you want couples to know about the presence of infectious disease or the testing thereof that you conduct at the Reproductive Science Center of New Jersey?
Dr. Martinez: Well, first of all, I do not want the patients to become overwhelmed and at Reproductive Science Center of New Jersey, we sit down with you, we take your whole medical history, we discuss all these things and we walk you through the process. We operate on an individualized basis and we make decisions based on your personal medical history. You don't have to feel like you're overwhelmed but when you come into our office, we're going to lead you through, educate you so that you can become a part of your treatment plan. It's the same with infectious disease testing or any testing that we do. You're going to become a part of that and we'd love to help you through your journey.
Melanie: Thank you so much for being with us today. You're listening to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That's www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.
Infectious Disease Testing and How it Relates to Infertility
Melanie Cole (Host): When conducting a diagnostic work up of both male and female infertility, there may need to be various blood tests in order to verify the presence or absence of various infectious diseases. My guest today is Dr. Allen Martinez. He's a specialist in reproductive endocrinology and infertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. So, what tests, when you've got a couple in that are talking about fertility treatments, what infectious disease tests do you have to run, or do you typically run?
Dr. Allen Martinez (Guest): For all of our patients who present to our office for an evaluation, the general things that we go over are infectious disease testing that include such things as hepatitis B, hepatitis C, syphilis testing, chlamydia, gonorrhea testing, as well as HIV testing.
Melanie: So, people get these tests and they ask you why are you testing for these?
Dr. Martinez: Yes. I get that question all the time, and most patients are fine with the testing. They kind of recognize they are in a sexual relationship and it's just nice to assess your overall health. So, I say, “Hey, we want to make sure that as we prepare your body for pregnancy that you know the complete status of your health and how some of these infectious diseases can either be transmitted on to the offspring, should we get you pregnant, or some of the effects of these infections on the chances and the likelihood of success with pregnancy.” So, they can directly play a role in both the preconception counselling as well as the treatment approaches based upon any prior history of an infection.
Melanie: And, they might be a contributing factor to their ability to conceive?
Dr. Martinez: That is correct. When we evaluate patients, we always want to look at the infectious disease and their hormonal history, in general. Some of these infectious diseases, particularly a prior chlamydial infection, which some patients may have a remote history of, and they've been treated for it and then they come in here 5 or 10 years later and they want to get pregnant. So, they might have an evaluation to look at the fallopian tubes. And, that particular infection, a prior pelvic infection, undiagnosed or diagnosed can affect the structure of the fallopian tubes--actually block and damage the fallopian tubes--which ultimately affects fertility treatments and may be a consideration for moving towards such treatments as in vitro fertilization.
Melanie: So, what if you find that there is the presence of some of these diseases, may be even varicella or HIV or any of these kinds of things, what do you do with that information?
Dr. Martinez: So, we sit down with the patient and, obviously, have a conversation about the status. The patient may have a remote infection that's been resolved. The patient may actually have an active acute infection. So, we counsel them from the start of the positive test. If they are aware of that, we update them. If they're unaware, then actually we may refer them out to an infectious disease specialist to get subsequent specific tests that better can characterize what kind of condition they have and how it affects them. So we serve as kind of like the mediators of obtaining the information and then ultimately enlisting other physician so that the patient could be best counselled as they prepare for pregnancy.
Melanie: What about if there's somebody that wants to store eggs or the storage of genetic material? What happens when infectious disease is present?
Dr. Martinez: Okay. That's a very good question. The FDA has regulations on these sort of things and so a patient that may be a chronic carrier of something such as hepatitis or HIV or something like that, then anytime our laboratory goes and stores, the genetic material for these patients, whether it be eggs, whether it be embryos, what we actually have to do is we have to store that genetic material separately from any of the other patients, the non-infectious material, because all these patients undergo this testing. So, that may involve extra steps that the patient needs to go through in preparation for their treatment but it also involves kind of a quarantine, so to speak, of their genetic material whether it be the egg or embryos. And then, ultimately those embryos are stored safely to safeguard other patients to make sure there's no mixing and no potential infection of non-infected eggs or embryos.
Melanie: And, if a woman is found to have one of these infectious diseases that you've mentioned and they could be passed along to the baby, potentially jeopardizing the health or the pregnancy, what do you tell them about continuing with fertility treatments?
Dr. Martinez: Yes. That's a very good point and one that we commonly get from our patients. If it's a new infection or if it's an infection that is active, then this obviously increases the potential risk of transfer to their offspring. If, however, they're chronic carriers or they have low viral titers, then their chances of actually passing on the infectious agent to their offspring can actually be decreased to a very low level to where the chances are very low that they will actually pass it on to their son or their daughter. So, it involves careful counselling. I'll give an example. Sometime we have patients that come through with HIV and you can have an HIV infection or you can have an undetectable viral load which means that you're being treated and since we don't have any virus particles--small numbers that are fooling around in your bloodstream. We can undergo IVF and there are procedures where we may inject sperm into the egg through ICSI (intracytoplasmic sperm injection). In these cases, if it's actually a controlled infection, even with HIV, and we undergo these advanced treatments, their likelihood of transmission to the offspring can be less than 1-2%. So, in most cases, finding the infection early, treating it, can really maximize the health of their future offspring.
Melanie: Is there anything with vaccines and the presence of some of these infectious diseases, like I mentioned varicella or chickenpox. If they've had the vaccine, do you then see the presence of this virus in their system?
Dr. Martinez: Yes. So, we essentially do titers for their vaccination and for their immune system. We look at varicella, we look at rubella, and, in some cases, we look at something called cytomegalovirus, depending upon the situation. We take an extensive history and see if they've had chicken pox but even if they have it, which is varicella or if they've had a rubella infection, we will test their titers and we will be able to see whether or not they are immune or not immune. Just because somebody had a prior infection doesn't mean that they retain their immunity to this infection. So then, in that case, we may counsel them and say, “You may benefit, you will benefit, by receiving a varicella or rubella vaccine, completing that course before we try to get you pregnant.” Because, ultimately, the way that I talk to my patients is that we want to take care of you, we want to optimize your health so that your future offspring can be healthy as well.
Melanie: Then, wrap it up for us, Dr. Martinez. Such great information. What do you want couples to know about the presence of infectious disease or the testing thereof that you conduct at the Reproductive Science Center of New Jersey?
Dr. Martinez: Well, first of all, I do not want the patients to become overwhelmed and at Reproductive Science Center of New Jersey, we sit down with you, we take your whole medical history, we discuss all these things and we walk you through the process. We operate on an individualized basis and we make decisions based on your personal medical history. You don't have to feel like you're overwhelmed but when you come into our office, we're going to lead you through, educate you so that you can become a part of your treatment plan. It's the same with infectious disease testing or any testing that we do. You're going to become a part of that and we'd love to help you through your journey.
Melanie: Thank you so much for being with us today. You're listening to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. For more information, you can go to www.fertilitynj.com. That's www.fertilitynj.com. This is Melanie Cole. Thanks so much for listening.