Cytomegalovirus (CMV) infection during conception can lead to congenital CMV (cCMV) infection, a condition associated with significant morbidity. While sperm donor screening for CMV is a standard practice, the risk of transmitting CMV through donor sperm remains unclear. Drawing on past experiences with HIV, there is an assumption that sperm washing reduces the risk of viral transmission in fertility procedures such as intrauterine insemination (IUI). However, emerging evidence suggests that CMV may behave differently from other herpesviruses and HIV in relation to sperm washing.
Case Report
A 29-year-old patient, with no prior CMV immunoglobulin (Ig)M or IgG antibodies, underwent IUI using sperm from a directed donor. The donor was CMV IgM-negative and IgG-positive at the time of donation but had previously tested positive for CMV IgM 128 days before donation and CMV in urine via PCR 107 days before donation. After the IUI procedure, the patient developed acute symptoms of CMV infection, including CMV viremia, and tested positive for both CMV IgM and IgG antibodies. Despite the infection, the insemination did not result in pregnancy, and no other sources of CMV transmission were identified.
Conclusions
Given the limited screening and prevention methods available for perinatal CMV transmission, this case highlights the need for further research to evaluate and minimize the risk of CMV transmission from seropositive sperm donors. A comprehensive research agenda is necessary to establish clearer guidelines for fertility practices, facilitating informed decision-making between healthcare providers and patients. Innovative strategies to reduce transmission risks from CMV IgG-positive sperm donors should be explored. These could include testing sperm for CMV DNA post-washing, implementing antiviral treatments prior to semen collection, and conducting CMV PCR or IgM screening for patients who conceive using sperm from antibody-positive donors.
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