What are the risks for a patient undergoing in vitro fertilization (IVF) who has had varicella and has been exposed to a patient with herpes zoster (Shingles)?

From the Guidelines

The patient who has had varicella (chickenpox) in the past and was exposed to someone with shingles can proceed with their in vitro fertilization (IVF) procedure without delay or special precautions. Since the patient has a history of varicella infection, they already have immunity to the varicella-zoster virus (VZV) and are protected against developing chickenpox from this exposure 1. Shingles occurs when VZV reactivates in someone who previously had chickenpox, but person-to-person transmission from shingles can only cause chickenpox in non-immune individuals, not shingles. The patient's prior varicella infection provides protective antibodies that prevent new infection. This immunity is typically lifelong, so there is no need for varicella-zoster immune globulin (VZIG), antiviral medications, or postponement of the IVF procedure. Some key points to consider:

• The risk of transmission from shingles to a non-immune individual is approximately 20% of the risk for transmission from varicella 1.
• The patient can be reassured that their fertility treatment can continue as scheduled without any increased risk from this exposure.
• If the patient develops any concerning symptoms, they should contact their healthcare provider, but this is unlikely given their immune status. It's worth noting that the most recent study 1 discusses the risk of varicella zoster virus (VZV) reactivation in patients with multiple myeloma, but this is not directly relevant to the patient's situation, as they have a history of varicella infection and are not immunocompromised. However, the study does highlight the importance of vaccination in preventing VZV reactivation, which could be relevant for other patients who are at high risk of VZV reactivation. In general, the patient's prior varicella infection provides sufficient protection against developing chickenpox from this exposure, and they can proceed with their IVF procedure without delay or special precautions.

From the Research

Risk of Varicella Zoster Virus Transmission

• The patient has had varicella, which means they have already been infected with the varicella zoster virus (VZV) and have developed immunity to it 2.
• However, the patient's immunity does not protect against reactivation of the virus, which can cause shingles 2.
• The patient's contact with a patient with shingles does not increase their risk of developing shingles, as they have already been infected with the virus 3.
• The risk of transmission of VZV from the patient with shingles to the patient is low, as VZV is not highly contagious and is usually spread through direct contact with the rash or by airborne transmission 3.

Impact on In Vitro Fertilization

• There is no direct evidence to suggest that contact with a patient with shingles or having had varicella would affect the outcome of in vitro fertilization (IVF) 4.
• However, it is essential to note that IVF patients may be more vulnerable to stress and anxiety, and any potential infection or illness could impact their treatment burden and care delivery 4.
• It is crucial to follow standard infection control protocols and take necessary precautions to minimize the risk of transmission of any infection, including VZV, in an IVF setting 3.

Prevention and Treatment

• The patient has already developed immunity to VZV, so they do not need to take any additional precautions to prevent infection 2.
• However, if the patient is concerned about their risk of developing shingles, they can discuss vaccination options with their healthcare provider 2, 3.
• Antiviral medications, such as acyclovir, valacyclovir, and famciclovir, are available to treat VZV infections, including shingles 3.