Can CMV infection lead to repeated abortions?
Q: I am 30 years old and married for 6 years. I have yet not been blessed with a child, though, I have been able to conceive. The first time I conceived was 6 years ago but we aborted it in 45 days because of certain family problems. I was able to conceive only 4 years after that. But this pregnancy too did not last long and I suffered a missed abortion within 6 weeks. I tested +positive for Rubella antibodies and CMV (both IgG), but I did not take any medication. I am at present under treatment for infertility and under medication for CMV. I underwent an IUI last month and was tested +positive for pregnancy in 31 days after LMP, but this also did not last. In both the cases I underwent a D&C. I again tested +positive for CMV. Is CMV the cause for both my missed abortions? I read on the Internet that CMV cannot be treated. Does that mean that I will never have a child since I do have CMV which cannot be cured? Please help.
A:It is unlikely that the CMV infection is the cause of your 2 missed abortions at or less than 6 weeks of pregnancy. First time infection with CMV(Primary infection) during pregnancy has a 20- 50% chance of transmission to the fetus(baby), and of these infected fetuses, about 1-2 % have obvious disease at birth. Women once infected with CMV, and who have latent infection, can have reactivation during pregnancy. Rates of reactivation are not known and differ from population to population. Prevention is by observing clean practices and avoiding being near people, usually children who have colds. Usually one gets infected with CMV from naso-pharyngeal secretions, infected urine and of course, sexually also. Infection is commonest amongst children aged 5 years or less. I guess you are not teaching in a nursery school or working in a creche. In such women(with reactivation during pregnancy), chances of transmission to the fetus is ~ 1%. So, the chance of your fetus getting infected next time you get pregnant are extremely low. However, you need to be properly monitored during your next pregnancy for reactivation of infection. If this is proved, you need to undergo tests :usually ultrasound is done as it is noninvasive to see for signs of infection in fetus. Cordocenetsis (drawing blood from umbilical cord when baby is still in the uterus) is a highly specialized technique that can be done only by trained doctors (can also be done in India). Blood so drawn can be tested for CMV. In case baby is proven to be infected, he should be followed and examined closely at birth and later to see if he develops signs of being infected. If diagnosing infection of baby before birth is not done, this should be done immediately at birth. In short, the CMV infection you have cannot result in missed abortion at 6 weeks. I would advise you to be tested for other causes- endocrinological, immunological and genetic causes. I suggest you be under the care of an experienced obstetrician in your city. Next time you conceive, you should be registered under someone who is working in a major hospital where all test facilities are available.