Screening standards in assisted reproductive technologies. Is the British Andrology Society recommendation to recruit cytomegalovirus negative semen donors only, a reasonable one?

Abstract

The British Andrology Society recently recommended the exclusion of all cytomegalovirus (CMV) seropositive semen donors to prevent the risk of congenital CMV infection. The recommendation is based on the results of recent studies that identified a high percentage of symptomatic congenital CMV infections in newborns of women with CMV seropositivity pre-existing to pregnancy and on the fact that CMV can be detected in semen of CMV seropositive men. These are not new data. CMV seropositive women can infect their fetuses with their own latent CMV strain that can reactivate, or with an exogenous strain that can be transmitted to them by a sexual partner, but also by contacts, for example with an excreting child. The efficiency of these various ways of transmission to the fetus and the factors that could influence this transmission are for the moment completely unknown. An infectious virus is recovered by culture in the semen of <5% of CMV seropositive men. Exclusion of a large population of donors on the sole criteria of a positive CMV serology introduces the general message that this part of the male population is also not suitable as possible partners in couples who have no fertility problems. The problem of congenital infection in neonates of CMV seropositive women is a complex one that has just begun to be investigated. No data exists concerning this risk in the setting of assisted reproduction. We think that alternatives to the drastic BAS recommendation exist and should be more deeply discussed.