Englert Yvon, Lesage Benoît, Van Vooren Jean-Paul, Liesnard Corinne, Place Isabelle, Vannin Anne-Sophie, Emiliani Serena, Delbaere Anne
Department of Obstetrics and Gynaecology, IVF Centre of the Université Libre de Bruxelles.
Hum Reprod Update. 2004 Mar-Apr;10(2):149-62. doi: 10.1093/humupd/dmh013.
Teams practising medically assisted reproduction techniques try to avoid viruses as much as possible. Attitudes towards chronic carriers of viruses are rapidly changing, especially for human immunodeficiency virus (HIV) patients. We focus our attention on the legitimacy of systematic screening before assisted reproductive techniques and the need for specialized approaches including an adapted laboratory for viral hazards as well as the need for a multidisciplinary team. Specificities of HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) carriers and the hypothesis of a reduced fertility potential are discussed. Are male HIV carriers a new indication for assisted reproductive techniques in order to prevent virus transmission? It is largely proven that sperm gradient preparation techniques efficiently decrease viral loads and therefore have a protective effect on contamination risk during assisted reproductive techniques. Although a few thousand assisted reproductive technique cycles were performed in the world for this indication without contamination, it is still too early to demonstrate that this technology is fully safe. Two examples of contaminations during insemination are examined. Many questions remain unresolved, such as the lack of standardized techniques for semen preparation or virus detection or the relative merits of intrauterine insemination or ICSI to prevent HIV contamination during assisted reproductive techniques. The authors plead for well-structured, separate programmes of care linked to research objectives.
从事医学辅助生殖技术的团队尽可能避免病毒感染。对病毒慢性携带者的态度正在迅速转变，尤其是对于人类免疫缺陷病毒（HIV）患者。我们将注意力集中在辅助生殖技术前系统筛查的合理性以及采用专门方法的必要性上，这些方法包括一个适应病毒危害的实验室以及多学科团队的需求。讨论了HIV、丙型肝炎病毒（HCV）、乙型肝炎病毒（HBV）携带者的特点以及生育潜力降低的假设。男性HIV携带者是否成为辅助生殖技术的新适应症以预防病毒传播？大量证据表明，精子梯度制备技术能有效降低病毒载量，因此对辅助生殖技术期间的污染风险具有保护作用。尽管全球针对该适应症进行了数千个辅助生殖技术周期且未出现污染情况，但要证明这项技术完全安全仍为时过早。研究了两例授精过程中的污染案例。许多问题仍未解决，例如精液制备或病毒检测缺乏标准化技术，以及在辅助生殖技术期间宫内授精或卵胞浆内单精子注射预防HIV污染的相对优势。作者呼吁制定与研究目标相关的结构完善、独立的护理计划。
