As a specialist in male fertility and owner/director of a sperm bank (http://NYCryo.com) , I have been increasingly asked this question by my colleagues and patients over the past several weeks. Interest in the Zika has been ignited recently by news coverage of celebrities including Pau Gasol of the Chicago Bulls talking about freezing his sperm in the Washington post (http://wapo.st/293BkUP) ….if he even decides to go to the Olympic games. In fact, golf greats like Jason Day, Dustin Johnson, Shane Lowry and Rory McIlroy together with Basketball legends LeBron James and Stephen Curry have pulled out of the games entirely (http://wapo.st/293Cob5, http://wapo.st/29g036u) while others like Jordan Spieth are weighing their options (http://wapo.st/293DG5U). To add to this concern, the Center for Disease Control (CDC) had issued warnings earlier this year on travel for pregnant women and continue to monitor/update their recommendations (http://bit.ly/29ewocX) . In this brief blog I will try to provide a well referenced overview of what is known about the Zika virus to help you decide what is best for you and your future family. A great review article on Zika virus in pregnancy can be found at http://bit.ly/29dWhfn .
First the facts provided by the CDC (http://1.usa.gov/294JyZ0) .
- A man with Zika virus can pass it to his female or male sex partners through their semen….even if they have never had symptoms. In addition, Zika viral RNA level were higher in semen samples then in blood urine or saliva (http://bit.ly/29dkujA) .
- Using condoms or delaying sex can reduce the risk of getting Zika from sex…however it is not known where saliva or vaginal fluids can pass the virus on.
- Zika virus RNA has been detected in semen up to 62 days after the onset of symptoms (http://bit.ly/299BJBd) . CDC therefore recommends that men who have been diagnosed with Zika should consider using condoms or not having sex for at least 6 months.
It is clear from these statements that we need to know much more about how the Zika virus. In particular, how the virus is transmitted and even more about the longevity of the virus in the human host. So how should men interested in their future fertility protect themselves? Should they bank their sperm as Pau Gasol believes one should? That question is not a simple one to answer given the paucity of data presently available on the Zika virus. Many questions remain before a definitive answer can be given. In fact, there are more questions then there are answers.
- Should all pregnant couples be screened for the Zika virus and what exactly should be tested? One problem is that not also tests are as sensitive and many correctly performed tests yield incorrect results (http://n.pr/299L93j) .
- What are the best methods to test for the ZiKa virus (http://bit.ly/29kyR9s) ? There are most sensitive test is the Reverse Transcription-Polymerase Chain Reaction which tests for the presence of a piece of the virus. However, it is only positive for 1 to at most 4 weeks after the virus is in the host. The Zika MAC-ELISA is a better test which detects the virus for up to 12 weeks after exposure. However, the possibility still exists that the virus is present after this time but just not detectable.
- Should pregnant women have screening during pregnancy and if so at what frequency? Although there are recommendations for screening during pregnancy (http://bit.ly/29kyyeT) who to handle positive results is still evolving.
- Does screening guarantee the absence of virus RNA (http://bit.ly/29kyR9s) ? The answer is no. In addition, since screening is usually done on symptomatic individuals and the Zika virus can be asymptomatic in a large number of men, we would need to screen all men considering conceiving with their partner…which is not practical or even possible.
- What fluid type should be screened? Cerebrospinal fluid, blood, urine, saliva and semen all seem to have the virus in them…however, which is the best to test is not yet known.
- Does the virus directly affect the sperm or egg cell or the genetic material in these cells is also not yet known. However the FDA has imposed restrictions (http://bit.ly/29p4fAF) on the freezing of sperm and eggs (oocytes) from men and/or women that have had:
- A diagnosis of Zika in the past 6 months
- A residence, in or travel to, an area with active Zika transmission within the past 6 months
- Sex within the past 6 months with a partner who is known to have lived, traveled, or has been diagnosed with Zika in the past 6 months?
Men have been banking sperm prior to therapy that might affect their fertility as well as a protection form hazards to their reproductive health from their occupation. It is therefore entirely appropriate for them to bank sperm prior to travel to an area known to have the Zika virus. However, as discussed above, even if they undergo testing for the Zika virus prior to freezing sperm there is no guarantee that the specimen stored is free of the virus from possible prior exposure. In addition, sexual relations with their partner anytime during the 6 months after their return from an area endemic for the Zika virus might predispose their partner to the infection. No easy answers at this time…..just more questions.