Hepatitis and fertility

28th of July is designated as World Hepatitis Day, a day where we are getting informed about this infectious disease, its types, and how we can prevent/treat it. In this article aside from learning more about the disease, we will also examine the correlation between the different types of hepatitis and fertility. How can male/female hepatitis affect fertility, how can ART help, and other important questions will be answered. 

What is hepatitis?

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When it is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. When we refer to hepatitis, we usually mean viral hepatitis. This form of the disease can be caused by one of five viruses, called hepatitis A through E. The most common ones- hepatitis B and C, often shortened to HBV and HCV – affect millions of Americans, with thousands of new cases each year. 

Hepatitis A: It is an acute type of hepatitis that is caused by the hepatitis A virus (HAV). This virus is typically transmitted by consuming contaminated food or water, and it is a highly contagious infection with approximately 1.4 million people infected every year. Fortunately, there are no known long-term side effects of contracting hepatitis A, and most infections will clear up on their own. The average recovery time is one week after symptoms appear.

Hepatitis B: It is usually transmitted through contact with bodily fluid, like blood, vaginal secretions, or semen — containing the hepatitis B virus (HBV). This means hepatitis B can be spread by having sex with an infected partner, or sharing razors or needles with an infected person. In most cases, the hepatitis B infection will clear up on its own after several weeks. In rare cases, some adults with hepatitis B may become long-term carriers of the virus with a chronic infection. 

Hepatitis C: HCV is usually transmitted through direct contact with infected bodily fluids, much like the hepatitis B virus. Hepatitis C is one of the most common types of hepatitis, with approximately 2.7–3.9 million people in the US living with a chronic form of it. Although most people believe that HCV is transmitted through kissing, or sharing food with an infected person, it is most commonly transmitted by sharing needles, razors, or toothbrushes, or via sexual contact. In some cases, people can contract hepatitis C by getting a tattoo or piercing with non-sterile equipment. Hepatitis C can also be passed from a gestational parent to their baby during childbirth.

Hepatitis D: The hepatitis D virus (HDV), also known as delta hepatitis, is a “satellite virus” of HBV, meaning it’s only transmitted in conjunction with the hepatitis B virus. HDC is contracted through direct contact with infected blood and is very rare. 

Hepatitis E: is very rare in the US; most cases of it occur in still-developing areas in the Middle East, Asia, Central America, and Africa with inadequate water supply and poor sanitation. If fecal matter finds its way into the water supply, ingesting that contaminated water can cause hepatitis E.

Alcoholic Hepatitis: As the name suggests, alcoholic hepatitis is caused by excessive consumption of alcohol. One of the primary jobs of the liver is to filter toxins and waste from your body, and one of those substances it filters and breaks down is alcohol. If someone drinks more alcohol than their liver can process, they could develop alcoholic hepatitis, which can eventually lead to liver failure. Although the development of alcoholic hepatitis usually occurs over the course of years of over-drinking, it is possible to develop a case of acute alcoholic hepatitis. 

Autoimmune Hepatitis: It occurs when your body’s immune system begins mistakenly attacking your liver cells. The cause of this type is unknown. Some research shows that autoimmune hepatitis is more likely to occur in people with ovaries instead of people with testes, and it’s also more likely to occur in people with other autoimmune conditions, such as thyroiditis. 

Symptoms of hepatitis include fatigue, yellow skin and eyes, dark urine, abdominal pain, weight loss, and symptoms that are similar to the flu ones. 

Hepatitis and fertility

Among the seven types of the disease only HBV is associated with impaired infertility. There is significant evidence that HBV affects mostly male fertility, but research suggests that it also has an impact on female fertility as well. Overall, individuals with hepatitis B are 1.59 times more likely to experience infertility than individuals who are not infected. The primary factor in HBV is the virus’ S protein – HBs – which according to studies lowers sperm motility and reduces the fertilization rate of sperm by more than half. The protein attacks the cell membrane in sperm, killing them or significantly degrading their normal function. One study found that semen volume, sperm concentration, sperm survival rate, and rate of normal sperm morphology in infertile males with hepatitis B were significantly lower than infertile males without hepatitis infection. People with hepatitis B have also been found to have an increased risk of sperm DNA fragmentation, or damage to the DNA inside sperm, which can contribute to infertility and miscarriage. In women, HBV mostly increases the risk of tubal and uterine infertility. Ηepatitis infection may indicate an increased risk of other sexually transmitted infections that can affect fertility. Individuals and couples who are experiencing fertility problems in the context of hepatitis infection should discuss that with their doctor.

AΡΤ may need to be altered to reduce the risk of viral transmission between the partners. If only one partner is infected with a hepatitis virus (known as a serodiscordant couple), vaccination may also be an option to reduce the risk of sexual transmission.

Hepatitis and pregnancy.

Acute HBV occurs in one to two of every 1,000 pregnancies, with 1.5% of pregnant women being chronic carriers of HBV. There is no evidence that HBV infection is any more common in pregnancy though. The incidence of spontaneous abortion during the first trimester in patients with acute viral hepatitis is increased. Similarly, when viral hepatitis occurs during the third trimester, there is an increased incidence of preterm labor.

Very little is known about the effect of HCV on pregnancy; however, it appears that most women are asymptomatic, and fewer than 10% will have elevated transaminases. Although few women have been studied, there does not appear to be an increase in adverse pregnancy outcomes in HCV-infected pregnant women.

Hepatitis A is a vaccine-preventable illness. New infections with hepatitis A are associated with an increased risk of preterm birth, placental abruption, and premature rupture of membranes. In rare cases, hepatitis A can cause liver damage to the fetus.

Hepatitis E during pregnancy is extremely serious. In addition to pregnant people being at increased risk of it, it is very dangerous for the fetus. There is an elevated risk of stillbirth and preterm birth and it can cause acute liver failure in infants. The risk of transmission from mother to fetus is estimated to range from 33% to 100%. 

In contrast, hepatitis D transmission during pregnancy is quite rare, and there is relatively little data on it during pregnancy. It is not known if pregnancy increases the progression of liver disease in people with hepatitis D, but liver health should be monitored during pregnancy.

Hepatitis and ART.

Infertility treatment in couples where one or both parents are infected with hepatitis raises many concerns about transmission of the infection to the baby, laboratory technicians, and medical staff, and contamination of other gametes/embryos that are from virus-free parents in the same laboratory. Testing for HBsAg and HCV should be offered to high-risk infertile couples seeking fertility therapy to reduce the potential risk of transmission and prior to cryopreservation of semen or embryos. Ideally, semen and embryos from HCV and HBV patients should be stored in HCV- or HBV-designated storage tanks. Methods suggested for reducing the potential risk of virus transmission among cryopreserved sperm and embryos include: storage of sample in the nitrogen vapor state instead of the liquid state; use of sperm washing techniques to reduce viral load prior to freezing semen samples; and use of a double-sealing technique for cryo containers. 

So, the need for testing is essential for people infected with hepatitis, and yet again your fertility specialist is the one responsible for guiding you through the process safely. Stay informed, explore your options and trust the professionals. 

And if you decide on performing a fertility treatment in Greece, trust MEDIPASS to create the ideal fertility journey for you. By cooperating with top-notch clinics, we guarantee you’ll have all the right guidance you deserve. 

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