Q: I am a 25 years old housewife who has been advised a TORCH test. The sample of blood was collected four months back after I delivered a dead child. After a week, the doctor told me that the report is fine - toxoplasma IgG was 3.35 and IgM 0.37 whereas rubella IgG and IgM was 14.45 and 0.07, respectively. Cytomegalovirus IgG and IgM was 19.78 and 0.42 and cytomegalovirus avidity - 95. Will there be any problem in conceiving again?

A:It appears from the Toxoplasma, Rubella and Cytomegalovirus serological reports that you had previous exposure to these infections. The exact time when these infections may have occurred is difficult to discern because the period of gestation at which the delivery had occurred is not mentioned. Generally IgG reactive serology in the absence of IgM means past infection (months and years). It is likely that if the infection had been fairly recent some traces of the IgM should have been found. The high avidity of CMV IgG (a test which measures the strength of antigen-antibody interaction; the greater the avidity index the older the infection) also suggests that these infections are not recent, but is likely to have occurred several months or years earlier. There is no suggestion from these reports that you have any active disease by either CMV, rubella or toxoplasma. Most individuals in India at your age are likely to be serologically positive for these agents because of the common prevalence of such infections. It cannot be concluded from these results that these infections could have contributed to the unfortunate still birth. There might be other causes for the still birth which your obstetrician may wish to exclude. In many cases it is very difficult to establish the exact cause because of the long list of possible causes, and facilities for screening all causes (infectious or non-infectious) are not readily available (a complete screen for all possible causes if also likely to be expensive). Although some infections such as CMV and toxoplasma can reactivate, the chances of subsequent babies being affected by reactivated infections is low.