What’s up with Zika?
Sandy beaches, all-inclusive resorts and never-ending cocktails. While this might sound like paradise to most of us, for those of us who are thinking of conceiving or are in the process of undergoing fertility treatment, it means one thing: Zika!
By now, everyone has heard of the Zika virus, and most people think twice before travelling while trying to conceive or while pregnant, due to the serious risks associated with Zika. But what are the true risks? Is anywhere safe? Or should you stay home for nine months straight in order to avoid exposure and keep your baby “safe”?
Here is the latest information, pared down to the basics, and what you really need to know.
What is Zika?
The Zika virus is transmitted by mosquitos that live in warm climates (such as the Caribbean). These mosquitos bite during the night and day. Most infected people do not have symptoms. In pregnant women who have acquired Zika, birth defects have been reported, the most prominent and serious being microcephaly (small head and incomplete brain development) and neurologic (brain) damage.
Zika transmission has been reported in over 30 countries — many which are popular holiday destinations! Although the mosquito is not found in Canada, travelers and their partners returning from areas where Zika is present can transmit the virus.
Zika can also be transmitted through sexual contact, in addition to mosquito bites. Hence, if your partner has travelled to a Zika-endemic place (even if you didn’t go with them) and you were intimate upon their return, you could contract the virus.
What precautions should be taken?
According to the Society of Obstetricians and Gynecologists of Canada (SOGC):
- Women and men wishing to become pregnant should wait two to three months after their return from a Zika-affected area before trying to conceive.
- For men who are travelling to an area with Zika and whose partners are trying to conceive, the recommendation is to use condoms for two to three months and to consider condom use for the entire duration of the pregnancy, because the Zika virus can last for months in the semen. Obviously, this can present a problem for couples who are trying to conceive with infertility treatment. If your partner is going to be away in a Zika-infected area, consider having him freeze a few samples of sperm before he leaves on his trip. In most cases, with both IUI (intrauterine insemination) and IVF (in vitro fertilization), frozen sperm can be as effective as fresh sperm and will allow you to continue your treatment process.
- For couples who do not wish to wait the recommended two to three months after possible exposure, one option is to do IVF and freeze embryos prior to travel, then transferring embryos once the waiting period (two to three months post-travel) is over. This is a viable option for those who are doing IVF anyway for other reasons, or for women who want to avoid delay because they are older and are worried about losing time before starting fertility treatment.
Can you test for Zika?
Testing for Zika virus is complicated and not universally available, and routine blood testing is currently not recommended.
However, women who have travelled to high-risk areas and have viral symptoms consistent with possible infection (fevers, muscle pain, eye symptoms, or rash), especially if they are within the first 10 days of symptom development, should be offered Zika blood testing. The test could look for the presence of the virus in the blood using a technique called PCR or look for the formation of antibodies to the Zika virus. This can be offered to men, too.
Antibody testing can be offered to women and men who have exposure without symptoms or with symptoms that were present but resolved. However, this testing can have false positives and negatives, and it is not very accurate.
Women who are pregnant and found to have tested positive for either the Zika virus or antibodies should be offered referral to a high-risk centre that specializes in treating these patients. These high-risk maternal-fetal medicine (MFM) specialists might recommend specialized testing to determine whether the baby has been infected with Zika. This could involve amniocenteses and detailed ultrasounds.
Ultimately, careful planning and avoidance of travel to infected areas are the best protection, and if travel is necessary, then take good precautions to avoid infection.
Where has Zika been reported?
It seems like Zika has been reported everywhere, according to the following [list compiled by](https://wwwnc.cdc.gov/travel/page/world-map-areas-with-zika) the Centers for Disease Control and Prevention (CDC), updated June 2017:
Zika travel notices:
- Zika Virus in Cape Verde
- Zika Virus in Mexico
- Africa: Angola, Guinea-Bissau
- Asia: Maldives, Singapore
- The Caribbean: Anguilla; Antigua and Barbuda; Aruba; The Bahamas; Barbados; Bonaire; British Virgin Islands; Cayman Islands; Cuba; Curaçao; Dominica; Dominican Republic; Grenada; Jamaica; Montserrat; the Commonwealth of Puerto Rico, a US territory; Saba; Saint Kitts and Nevis; Saint Lucia; Saint Martin; Saint Vincent and the Grenadines; Sint Eustatius; Sint Maarten; Trinidad and Tobago; Turks and Caicos Islands; US Virgin Islands
- Central America: Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama
- The Pacific Islands: Fiji, Marshall Islands, Micronesia, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga
- South America: Currently includes: Argentina, Bolivia, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Peru, Suriname, Venezuela
Other areas with Zika risk:
- Africa: Benin, Burkina-Faso, Burundi, Cameroon, Central African Republic, Chad, Congo (Congo-Brazzaville), Côte d’Ivoire, Democratic Republic of the Congo (Congo-Kinshasa), Equatorial Guinea, Gabon, Gambia, Ghana, Guinea, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, South Sudan, Sudan, Tanzania, Togo, Uganda
- Asia: Bangladesh, Burma (Myanmar), Cambodia, India, Indonesia, Laos, Malaysia, Pakistan, Philippines, Timor-Leste (East Timor), Thailand, Vietnam
- The Caribbean: Haiti
- South America: Brazil
“I’m pregnant and have a trip booked!”
Don’t worry. Your doctor can provide a letter to you indicating that you are at risk for Zika infection to assist you with cancelling or avoiding travel to areas where Zika is prevalent. Always consider purchasing additional travel insurance when planning a trip (even if Zika isn’t an issue) while you’re conceiving or pregnant, in order to avoid losing money if necessity or complications prevent you from travelling.
“I have to travel for work!”
Sometimes travel can’t be avoided. In this case, the recommendation is to use protective measures against mosquito bites for your entire trip, including wearing long clothing that covers the majority of exposed skin, using mosquito nets, and applying insect repellants and DEET (diethyltoluamide). DEET for personal use and permethrin for pre-treatment of clothing have both been tested and have been found to be safe for pregnant and breastfeeding women.
The best advice is to be prepared and to talk to your doctor about any travel plans, well in advance, so that alternative arrangements — a refund, trip-cancellation insurance, a medical letter — can be made. Especially when you’re undergoing fertility treatment, remember that any cycle could end up working and you could become pregnant, so consider taking the necessary precautions when travelling.