HCV-positive intended parents may be safely used for gestational carrier cycles using RT-PCR testing and extended embryo culture

Abstract

OBJECTIVE: To minimize a gestational carrier's risk of contracting hepatitis C virus (HCV) from a Hepatitis C-positive intended mother. DESIGN: Case report. MATERIALS AND METHODS: A 30-year old nulligravida woman was referred for a gestational carrier cycle. FDA screening revealed she was Hepatitis C antibody positive and plasma viral load testing showed 3.5 million copies of HCV/ml. A gastroenterologist recommended a 48-week course of Interferon/Ribavirin. Due to diminished ovarian reserve the patient desired to proceed with IVF prior to initiating treatment. On the day of TVOR, follicular fluid was tested for HCV by RT-PCR. Maternal plasma and collection/culture media served as the positive and negative controls, respectively. Routine insemination was undertaken and each oocyte was cultured separately. Every morning the zygote's surrounding media was collected and tested for virus. The zygote(s) were then washed and cultured in fresh media. Zygote(s) cultured in media testing HCV negative (<50 IU/ml) on day 3 were cryopreserved. RESULTS: Three oocytes were retrieved following a microdose-flare protocol. Follicular fluid collected on the day of oocyte retrieval tested positive for HCV RNA. Subsequent flushes of the collection tubing from each ovary also tested positive but with a decreased viral load (88,600 IU/ml and 13,350 IU/ml). Of the 3 oocytes obtained, 1 fertilized normally and was cultured further. The media surrounding this zygote showed decreasing amounts of HCV RNA with days of culture. On culture day 3, the media tested negative for HCV and the embryo was cryopreserved at the 8-cell stage.Tabled 1Days of CultureHepatitis C Viral RNA (IU/ml)Day 0 (follicular fluid)284,000Day 1 (2PN stage)7Day 2 (cleavage stage)<50Day 3 (cleavage stage)<50 Open table in a new tab CONCLUSION: The number of HCV RNA copies decreases with the number of zygote rinses and days of embryo culture. Thus, extended culture and testing by RT-PCR may help reduce the theoretical risk of viral transmission to a gestational carrier.