B型肝炎~~可不可以做~~~`試管嬰兒？

To do or not to do: IVF and ICSI in chronic hepatitis B virus carriers

Suzanne P.M. Lutgens1,, Ewka C.M. Nelissen2,4,, Inge H.M. van Loo1, Ger H. Koek3, Josien G. Derhaag2 and Gerard A.J. Dunselman2
1 Department of Medical Microbiology, Research Institute Growth & Development (GROW), Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands 2 Department of Obstetrics and Gynaecology, Research Institute Growth & Development (GROW), Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht,, The Netherlands 3 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Research Institute Growth & Development (GROW), Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands

4 Correspondence address. Tel: +31-43-3876764; Fax: +31-43-3874765; E-mail: e.nelissen@mumc.nl

Several assisted reproduction procedures, such as IVF and ICSI, are available for a variety of infertility problems. In fertility clinics, patients are screened for blood-borne viral infections, including hepatitis B virus (HBV). Reasons for screening are prevention of vertical transmission and laboratory safety. We present the case of a 26-year-old female patient with a chronic HBV infection, whose husband tested negative for hepatitis B. She and her husband were referred to our fertility clinic because of subfertility. Analysis of the husband's semen indicated the necessity of an ICSI procedure. The current Dutch guidelines advise against ICSI in chronic HBV carriers, since the risks and effects of chromosomal integration of HBV DNA in the fetus are not well-known. In this article, we review the scientific evidence for the risk of introducing HBV virus into the oocyte and subsequent integration of HBV DNA into the human genome, and debate the question of whether to do, or not to do, IVF and ICSI.

Key words: hepatitis B/IVF/ICSI/quality control/vertical The chance of a chronically infected mother is 2-15% to pass it to the child when she is only HBsAg positive and 80%-90% HBsAg positive and HBeAg positive with HBV DNA positive (3). Immunoprophylaxis should be given within 24 hours of birth to decreases by 85 % the chance of the child being infected. A future mother that is HBsAg positive should be counseled about the risks in pregnancy. It is best to perform ART when the viral load is low.

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