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Screening for Cytomegalovirus Antibody
FERTILITY AND STERILITY
Vol. 53, No.1, January 1990
Copyright <> 1990 The American Fertility Society
Hazards of Electromagnetic Fields to Human Reproduction
To the Editor: As you know, after retirement one reads few medical journals because there is little incentive to learn what you can't use in practice. But one does read, and I am exercised by a series of three articles in the New Yorker (June 12, 19, 26, 1989) on the hazards of radiation by Paul Brodeur. I have talked with several pathologists and several obstetricians and none of these were cognizant of the risks of electromagnetic fields. The portions of Brodeur's work that concern obstetricians is found mainly in the third installment, June 26th, pages 40 to 52. After seeing some of the figures for miscarriage and malformation among women working with video display terminals during early pregnancy, I now believe that electromagnetic fields are hazardous. If you also believe so after reading Brodeur, then I think it worthwhile to write an editorial in our journal to alert obstetricians to this new risk.
Pendleton Tompkins, M.D. San Mateo, California August 20, 1989 Editorial Comment
Dr. Tompkins, editor emeritus of The American Fertility Society journal, has repeatedly expressed to our current Editor-in-Chief his concerns on the hazards of electromagnetic fields to human reproduction. His concerns have been finally vindicated by a nationwide study funded by National Institute of Child Health and Human Development for $2 million to determine the risk, if any, of video display terminals (VDTs) on reproductive outcome. The study, which will be done by Mount Sinai School of Medicine in New York, will survey 8,000 female office workers nationwide and carefully monitor a select BOO subjects for 1 year before and throughout the first months of pregnancy. This study was precipitated partly by a Kaiser Permanente Medical Center (California) study that found increased spontaneous abortion in women who used VDTs over 20 h/wk. 1 Participants will come from four major metropolitan areas. The select 800 females will be carefully moniVol. 53, No.1, January 1990
Printed on acid-free paper in U.S.A.
tared for 1 year with urine human chorionic gonadotropin testing. The study should further enhance our knowledge of the incidence of unrecognized pregnancy loss. I hope a control group will be similarly studied. The completion of the study in 1993 should relieve Dr. Tompkins' anxiety, or realize his worst fears. We are indebted to him for his ability to generate sparks and to encourage scientific inquiry. On second thought, isn't that what editors are supposed to do! Paul G. McDonough, M.D., Editor, Letters REFERENCE 1. Goldhaber MK, Polen MR, Hiatt RA: The risk of miscarriage and birth defects among women who use visual display terminals during pregnancy. Am J Indust Med 13:695, 1988
Screening for Cytomegalovirus Antibody
To the Editor: The article by Chauhan et al. 1 on screening for cytomegalovirus (CMV) antibody in a donor insemination program emphasizes some of the problems semen banks are currently facing in attempting to recruit sufficient numbers of donors for semen freezing. They found that 40% of their semen donors were seropositive for CMV. In certain regions of this country, almost all semen donor applicants are CMV seropositive. 2 Although we agree with Chauhan et al. 1 that it is difficult to recruit sufficient numbers of semen donors who are CMV seronegative and that more information concerning risk of transmission to offspring is needed, we would like to call attention to an inaccurate perception in their report. The authors stated that "the effect of cryobanking of semen on CMV is unknown." We have recently shown that CMV does surviv.e semen cryopreservation and storage in liquid nitrogen for at least 9 months. 3 Cytomegalovirus was isolated in a reproducible manner from one of four donors whose cryopreserved semen was submitted for culture af· ter a positive serological test for CMV. Seminal quality was not adversely affected during the period of time this donor was shedding virus into his semen. Based on these findings, we suggested that only CMV seronegative donors be used, in acLetters to the Editor
185
cordance with the American Fertility Society's recommendations.4 Studies need to be done to evaluate the prevalence of shedding of CMV into the semen of donor applicants who are CMV seropositive. We, as others, are faced with a reduction of our potential donor pool as a result of using only CMV seronegative donors.
Diane G. Hammitt, Ph.D. Roger A. Williamson, M.D. Department of Obstetrics and Gynecology University of Iowa Hospitals and Clinics Iowa City, Iowa June 16, 1989 REFERENCES
3. There are many essential questions concerning CMV infection that still remained unanswered such as the rate of transmission of CMV by donor insemination, the pathogenicity of the different strains of CMV, and the effect of cryopreservation on the pathogenicity of the virus. We therefore recommend further research to address these questions. Until this research has been conducted we would recommend that whenever possible only CMV negative donors be used but we would still use CMV positive donors for CMV positive recipients where no other suitable donor was available. We would hope that such communications as this help to highlight the important issue of recruiting suitable semen donors.
1. Chauhan M, Barratt CL, Cooke S, Cooke ID: Screening for cytomegalovirus antibody in a donor insemination pro· gram: difficulties in implementing The American Fertility Society guidelines. Fertil Steril51:901, 1989 2. Hayes MF, Magyar DM, Vincent MK: High incidence of cytomegalovirus (CMV) in donor insemination program participants and health care providers. (Abstr. 077) Presented at the Forty-third Annual Meeting of The American Fertility Society, Reno, Nevada, September 28 to 30, 1987. Published by The American Fertility Society, in the program supplement, 1987, p 33 3. Hammitt DG, Aschenbrenner DW, Williamson RA: Culture of cytomegalovirus from frozen-thawed semen. Fertil Steril49:554, 1989 4. The American Fertility Society: New Guidelines for the use of semen for donor insemination. Fertil Steril 46 (Suppl): 95S, 1986
Reply of the Authors: We are very grateful to Hammitt et al. for reminding us of their article1 in which they demonstrated that cytomegalovirus is capable of surviving the freezing process in at least one of their four seropositive donors. Unfortunately because of delays in publication we were unable to incorporate their study into our discussion. 2 We would wish to make three important points. 1. We wholly endorse the view that the recruitment of semen donors who are free from sexually transmissible pathogens is mandatory. We have emphasized this in several recent publications,3- 5 yet surprisingly this has not received universal acceptance in the UK or the USA. 2. The exclusive use of CMV seronegative donors in our clinic would reduce our donor pool by 40%. As we already experience great difficulty in recruiting suitable donors-we accept only 20% of potential donors 5 -this would make running an efficient and effective donor insemination program very difficult. 186
Letters to the Editor
Christopher L. R. Barratt Mayur Chauhan Sheila Cooke lanD. Cooke Harris Birthright Centre for Reproductive Medicine University Department of Obstetrics and Gynaecology Jessop Hospital for Women Sheffield United Kingdom August 22, 1989 REFERENCES 1. Hammitt DG, Aschenbrenner DW, Williamson RA. Culture of cytomegalovirus from frozen-thawed semen. Fertil Steril 49:554, 1989 2. Chauhan M, Barratt CLR, Cooke S, Cooke ID. Screening for cytomegalovirus (CMV) in donor insemination program: difficulties in implementing The American Fertility Society guidelines. Fertil Steril51:901, 1989 3. Barratt CLR, Monteiro EF, Chauhan M, Cooke S, Cooke ID. Screening donors for sexually transmitted disease in donor insemination clinics in the United Kingdom. Br J Obstet Gynaecol 96:461, 1989 4. Barratt CLR, Chauhan M, Cooke ID. Donor Insemination: a look to the future. Fertil Steril (Modern Trends) In press 5. Chauhan MC, Barratt CLR, Cooke S, Cooke ID. A rationalized and objective protocol for the recruitment and screening of semen donors for a AID programme. Hum Reprod 3: 773, 1988
Hyperprolactinemia in In Vitro Fertilization
To the Editor: I read with interest the paper by Gonen and Casper1 on transient hyperprolactinemia during superovulation induction for in vitro fertilization. I think that the conclusion that estradiol (E 2 ) is not involved in the mechanism that is responsible for Fertility and Sterility
Vol. 53, No.1, January 1990
Copyright <> 1990 The American Fertility Society
Hazards of Electromagnetic Fields to Human Reproduction
To the Editor: As you know, after retirement one reads few medical journals because there is little incentive to learn what you can't use in practice. But one does read, and I am exercised by a series of three articles in the New Yorker (June 12, 19, 26, 1989) on the hazards of radiation by Paul Brodeur. I have talked with several pathologists and several obstetricians and none of these were cognizant of the risks of electromagnetic fields. The portions of Brodeur's work that concern obstetricians is found mainly in the third installment, June 26th, pages 40 to 52. After seeing some of the figures for miscarriage and malformation among women working with video display terminals during early pregnancy, I now believe that electromagnetic fields are hazardous. If you also believe so after reading Brodeur, then I think it worthwhile to write an editorial in our journal to alert obstetricians to this new risk.
Pendleton Tompkins, M.D. San Mateo, California August 20, 1989 Editorial Comment
Dr. Tompkins, editor emeritus of The American Fertility Society journal, has repeatedly expressed to our current Editor-in-Chief his concerns on the hazards of electromagnetic fields to human reproduction. His concerns have been finally vindicated by a nationwide study funded by National Institute of Child Health and Human Development for $2 million to determine the risk, if any, of video display terminals (VDTs) on reproductive outcome. The study, which will be done by Mount Sinai School of Medicine in New York, will survey 8,000 female office workers nationwide and carefully monitor a select BOO subjects for 1 year before and throughout the first months of pregnancy. This study was precipitated partly by a Kaiser Permanente Medical Center (California) study that found increased spontaneous abortion in women who used VDTs over 20 h/wk. 1 Participants will come from four major metropolitan areas. The select 800 females will be carefully moniVol. 53, No.1, January 1990
Printed on acid-free paper in U.S.A.
tared for 1 year with urine human chorionic gonadotropin testing. The study should further enhance our knowledge of the incidence of unrecognized pregnancy loss. I hope a control group will be similarly studied. The completion of the study in 1993 should relieve Dr. Tompkins' anxiety, or realize his worst fears. We are indebted to him for his ability to generate sparks and to encourage scientific inquiry. On second thought, isn't that what editors are supposed to do! Paul G. McDonough, M.D., Editor, Letters REFERENCE 1. Goldhaber MK, Polen MR, Hiatt RA: The risk of miscarriage and birth defects among women who use visual display terminals during pregnancy. Am J Indust Med 13:695, 1988
Screening for Cytomegalovirus Antibody
To the Editor: The article by Chauhan et al. 1 on screening for cytomegalovirus (CMV) antibody in a donor insemination program emphasizes some of the problems semen banks are currently facing in attempting to recruit sufficient numbers of donors for semen freezing. They found that 40% of their semen donors were seropositive for CMV. In certain regions of this country, almost all semen donor applicants are CMV seropositive. 2 Although we agree with Chauhan et al. 1 that it is difficult to recruit sufficient numbers of semen donors who are CMV seronegative and that more information concerning risk of transmission to offspring is needed, we would like to call attention to an inaccurate perception in their report. The authors stated that "the effect of cryobanking of semen on CMV is unknown." We have recently shown that CMV does surviv.e semen cryopreservation and storage in liquid nitrogen for at least 9 months. 3 Cytomegalovirus was isolated in a reproducible manner from one of four donors whose cryopreserved semen was submitted for culture af· ter a positive serological test for CMV. Seminal quality was not adversely affected during the period of time this donor was shedding virus into his semen. Based on these findings, we suggested that only CMV seronegative donors be used, in acLetters to the Editor
185
cordance with the American Fertility Society's recommendations.4 Studies need to be done to evaluate the prevalence of shedding of CMV into the semen of donor applicants who are CMV seropositive. We, as others, are faced with a reduction of our potential donor pool as a result of using only CMV seronegative donors.
Diane G. Hammitt, Ph.D. Roger A. Williamson, M.D. Department of Obstetrics and Gynecology University of Iowa Hospitals and Clinics Iowa City, Iowa June 16, 1989 REFERENCES
3. There are many essential questions concerning CMV infection that still remained unanswered such as the rate of transmission of CMV by donor insemination, the pathogenicity of the different strains of CMV, and the effect of cryopreservation on the pathogenicity of the virus. We therefore recommend further research to address these questions. Until this research has been conducted we would recommend that whenever possible only CMV negative donors be used but we would still use CMV positive donors for CMV positive recipients where no other suitable donor was available. We would hope that such communications as this help to highlight the important issue of recruiting suitable semen donors.
1. Chauhan M, Barratt CL, Cooke S, Cooke ID: Screening for cytomegalovirus antibody in a donor insemination pro· gram: difficulties in implementing The American Fertility Society guidelines. Fertil Steril51:901, 1989 2. Hayes MF, Magyar DM, Vincent MK: High incidence of cytomegalovirus (CMV) in donor insemination program participants and health care providers. (Abstr. 077) Presented at the Forty-third Annual Meeting of The American Fertility Society, Reno, Nevada, September 28 to 30, 1987. Published by The American Fertility Society, in the program supplement, 1987, p 33 3. Hammitt DG, Aschenbrenner DW, Williamson RA: Culture of cytomegalovirus from frozen-thawed semen. Fertil Steril49:554, 1989 4. The American Fertility Society: New Guidelines for the use of semen for donor insemination. Fertil Steril 46 (Suppl): 95S, 1986
Reply of the Authors: We are very grateful to Hammitt et al. for reminding us of their article1 in which they demonstrated that cytomegalovirus is capable of surviving the freezing process in at least one of their four seropositive donors. Unfortunately because of delays in publication we were unable to incorporate their study into our discussion. 2 We would wish to make three important points. 1. We wholly endorse the view that the recruitment of semen donors who are free from sexually transmissible pathogens is mandatory. We have emphasized this in several recent publications,3- 5 yet surprisingly this has not received universal acceptance in the UK or the USA. 2. The exclusive use of CMV seronegative donors in our clinic would reduce our donor pool by 40%. As we already experience great difficulty in recruiting suitable donors-we accept only 20% of potential donors 5 -this would make running an efficient and effective donor insemination program very difficult. 186
Letters to the Editor
Christopher L. R. Barratt Mayur Chauhan Sheila Cooke lanD. Cooke Harris Birthright Centre for Reproductive Medicine University Department of Obstetrics and Gynaecology Jessop Hospital for Women Sheffield United Kingdom August 22, 1989 REFERENCES 1. Hammitt DG, Aschenbrenner DW, Williamson RA. Culture of cytomegalovirus from frozen-thawed semen. Fertil Steril 49:554, 1989 2. Chauhan M, Barratt CLR, Cooke S, Cooke ID. Screening for cytomegalovirus (CMV) in donor insemination program: difficulties in implementing The American Fertility Society guidelines. Fertil Steril51:901, 1989 3. Barratt CLR, Monteiro EF, Chauhan M, Cooke S, Cooke ID. Screening donors for sexually transmitted disease in donor insemination clinics in the United Kingdom. Br J Obstet Gynaecol 96:461, 1989 4. Barratt CLR, Chauhan M, Cooke ID. Donor Insemination: a look to the future. Fertil Steril (Modern Trends) In press 5. Chauhan MC, Barratt CLR, Cooke S, Cooke ID. A rationalized and objective protocol for the recruitment and screening of semen donors for a AID programme. Hum Reprod 3: 773, 1988
Hyperprolactinemia in In Vitro Fertilization
To the Editor: I read with interest the paper by Gonen and Casper1 on transient hyperprolactinemia during superovulation induction for in vitro fertilization. I think that the conclusion that estradiol (E 2 ) is not involved in the mechanism that is responsible for Fertility and Sterility