Ivf and HSV2

[Flower219]

Hi Terri,

I have had HSV2 for almost 10 years now. I have a couple of recurrences a year, and my last one was about a month and a half ago.

I am beginning IVF this month and am worried about the possibility of transferring herpes to my uterus during the embryo transfer where they insert a catheter through the cervix into the uterus in order to deposit the fertilized embryos there. I also just found out that I will be having a mock transfer on Tuesday. This is where they do a trial run inserting the catheter into the uterus to practice for the real embryo transfer.

I began taking acyclovir 400 mg 2x daily yesterday. This means that I will have only been on it for 3 days when I have my mock transfer on Tuesday. Is that enough to decrease shedding and decrease the chance of infecting my uterus? Should I try to push the mock transfer back to give myself more days on acyclovir?

This is already a hard process and the fact that herpes is complicating things further is so frustrating!

Thanks for your help,

L

[Terri Warren]

Your worry is unfounded. You can relax. But I totally get why you might be worried. The herpes virus is already in the nerves in the entire area innervated by the sacral ganglia and the virus will be be pushing into the uterus with the IVF. Remember that monthly your cervix is open with menses and if virus wanted to move up into the uterus, it would but that’s not how this works. Yes, babies do get herpes sometimes in utero – very uncommon and almost always from women who contract new herpes during the pregnancy. In your case, you are past that risk, having an immune response already in place. Immunity gets passed to your baby later in the pregnancy and women who have established herpes and know it and are looking for outbreaks and are on daily therapy rarely transmit virus to their babies.

I would say go ahead with the practice run and I believe that things will be fine.

Terri

[Flower219]

Thank you Terri.

Do you recommend that I continue the Acyclovir throughout my IVF cycle? If so is 400mg twice daily the dosage you recommend?

You mentioned immunity being passed to the baby later in pregnancy. My doctor has recommended transferring 2 embryos. I am concerned about the possibility of twins given that the chances of delivering early is higher with multiples. I worry that if I delivered prematurely herpes could be more of an issue since my babies would not have my antibodies yet. Do you think I should insist on transferring only one embryo due to the fact that I gave herpes?

Thanks for your help.

[Terri Warren]

I want you to know that I ran your question and my response by a national expert in neonatal herpes. He confirmed that my response was correct. He had never heard of a baby becoming infected via IVF. The antibodies are transferred late in the 20’s week range, I’m quite sure and so I think you would be fine, even with twins. Go for two! And then perhaps you would want to start regular suppression earlier than the usual 34 weeks due to the possibility of an earlier delivery.

It’s fine to stay on suppression now – I think it will help give you some peace of mind.

Terri

[Flower219]

Thank you so much Terri, I really appreciate it. One last question. I am on 400 mg of acyclovir twice daily. My egg retrieval is in 6-7 days and embryo transfer 5 days after. Do you think I should increase my dosage of acyclovir or switch to valtrex for the next 2 weeks to prevent an outbreak? Ovulation can be a trigger for me and since I will be ovulating much more than normal I am getting a little worried.

Thanks for your help!

[Terri Warren]

No, I think your normal dose is OK. We know that Valtrex is no more effective than acyclovir, when both are taken as directed (once a day vs. twice a day).

This is a very exciting but I’m certain stressful time for you. You should ask your doc about the dosing, for sure, and see what they think since this is not something I know a whole lot about (which is why I confirmed with a physician who specializes in these types of question).

Best of luck to you!

This was your final question on this subscription. If you have more questions, feel free to renew your subscription.

Terri

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