Rethinking cytomegalovirus screening in gamete donation: a critical appraisal of practices and risks

In the context of gamete donation, cytomegalovirus (CMV) serological screening was originally implemented to mitigate concerns about viral transmission, particularly following the HIV epidemic. Although emerging evidence questions the reliability of serological markers in accurately reflecting the presence of the virus in genital secretions, current North American practices still heavily rely on CMV serological testing to identify sperm donors at risk of transmitting CMV during fertility treatments. This review explores the complexities of CMV transmission in assisted reproductive technologies (ART), underscoring the unpredictable nature of viral shedding in semen and the inherent limitations of relying solely on serostatus for risk assessment. Additionally, the available data suggest that the risk of congenital CMV (cCMV) following ART appears low, although significant gaps in the literature highlight the need for more comprehensive studies to better evaluate transmission risks. Finally, this review advocates for the revision of CMV screening societies' guidelines, emphasizing the need for broader, evidence-based preventive strategies. Preventing CMV risk in fertility treatments may include more significant action such as patient education on simple hygiene measures to prevent infection during pregnancy-instead of current, potentially unnecessary measures such as CMV serostatus matching.