Possible CMV transmission via intrauterine insemination: case report

Maternal cytomegalovirus (CMV) infection at conception can cause congenital CMV (cCMV) infection and substantial morbidity. Although CMV screening is mandated for sperm donors, the risk of acquiring CMV from donor sperm is unknown. Experience with HIV may lead clinicians to expect that standard sperm-washing reduces CMV transmission risk for procedures including intrauterine insemination. However, limited data suggests that CMV may differ importantly from other herpesviruses and from HIV after sperm washing.

A 29-year-old CMV immunoglobulin (Ig)M- and IgG-negative patient underwent intrauterine insemination with a directed donor. The donor was CMV IgM-negative and IgG-positive at the time of donation but had been serum IgM-positive 128 days before donation, and urine CMV PCR-positive 107 days before donation. Following intrauterine insemination, the patient developed clinical evidence of acute CMV infection, CMV viremia, and positive CMV IgM and IgG. The intrauterine insemination did not result in pregnancy. No sources of CMV transmission other than intrauterine insemination could be identified.

Because screening and prevention options for perinatal CMV transmission are limited, a systematic research agenda to understand and reduce CMV transmission risk from seropositive sperm donors is needed to create clear guidelines for fertility treatments and support shared decision-making. Novel approaches to lower risk of transmission from sperm donors with detectable CMV IgG should also be further evaluated. These might include CMV DNA testing of washed sperm samples prior to fertility treatments, antiviral therapy prior to semen collection and/or CMV PCR or IgM screening in pregnant patients who conceived using sperm from antibody-positive donors.