It's completely normal to have concerns about getting pregnant when you or your partner has genital herpes. But herpes doesn't have to stop you from having a healthy pregnancy and baby. In fact, by keeping a few considerations in mind, you can make things much comfortable and reduce the risk of spreading the infection.
Because herpes spreads through skin-to-skin contact, conceiving a baby presents a risk for transmission. There are several ways to make getting pregnant with genital herpes safer, and there are also alternative methods for having a baby that make spreading the virus much less likely. No matter what situation you are facing, knowing how the virus behaves and how it sheds and spreads can help you plan how to time unprotected sex to get pregnant.
How to Get Pregnant With Genital Herpes
If you have a history of genital herpes and you want to conceive naturally, the challenge is to time unprotected intercourse at your most fertile time, yet not infect your partner. The same applies if your partner is the one infected and you are not.
As with everything in life, there is no guarantee when it comes to spreading herpes while conceiving. Taking the best approach together may limit the risk while you are trying to get pregnant.
Avoid Unprotected Sex When Herpes Spread Is Likely
Genital herpes, caused by the herpes simplex virus, is transmitted through sexual contact - either genital to genital or anal, or oral to genital, according to the American College of Obstetricians and Gynecologists. Take note that even when you don't have open herpes sores or other symptoms of infection, you can still shed the virus and infect your partner or vice versa.
To decrease your chance of passing the virus to your non-infected partner, follow these guidelines:
- Avoid unprotected sex if you have symptoms, such as tingling or soreness around your genitals, that suggest a herpes outbreak is near.
- Have unprotected intercourse only if you don't have any active, open sores (herpes outbreak), even if you are at the most fertile time of your cycle.
- If your partner is the one who is infected, they should take the same precautions while you are trying to get pregnant.
- Use latex condoms up to your most fertile days and limit unprotected sex to only your most fertile days.
If you both have a history of genital herpes, then unprotected sex between you is not an issue. However, if either of you have open lesions, you should still avoid unprotected sex, even if you are at the best time in your cycle to get pregnant. Keep in mind, there are other routes of sharing the virus, including fluid in a herpes blister, contact with the mucus lining of the mouth or vagina, and through secretions from the mouth, vagina, or penis.
Time Intercourse to Your Most Fertile Days
To limit unprotected intercourse to only your most fertile days, and therefore decrease the chance of sharing the virus, it is helpful to know a few things about your body and your signs of fertility. One of the best ways to do this is by monitoring your most fertile days by using an ovulation predictor kit (OPK). An OPK (or LH kit) is up to 99% accurate as a predictor of when ovulation is likely to occur. The at-home urine test measures the pituitary luteinizing hormone (LH), which increases as you approach ovulation.
- The day you see your strongly positive result is the day of the biggest increase in your LH secretion from your pituitary gland. This "LH surge" is what triggers release of an egg from your ovary (ovulation).
- In the average 28-day menstrual cycle, you will see this result around day 12 or 13. It will be easier to figure out your fertile window if your cycles are regular.
- The LH surge predicts that ovulation will likely occur 24 to 36 hours later - around day 13 to 14 of a 28-day cycle.
Have intercourse the day of the surge and about 36 hours later. This is your best fertile window for live sperm to catch the egg while it is still fertilizable. The timing takes into account the lifespan of the sperm and the egg. According to Clinical Gynecologic Endocrinology and Infertility, sperm can survive in a woman's reproductive track for three to five days. The egg is only viable for fertilization from 12 to 24 hours.
Ask Your Doctor About Antiviral Medications
There is no cure for herpes, but medicines can modify the pattern of the disease process. Taking an antiviral herpes medicine daily (suppressive therapy) might make it less worrisome and stressful to get pregnant with genital herpes. Daily treatment can:
- Decrease the frequency of herpes outbreaks
- Reduce the chance of passing the virus to your partner or the other way around
- Suppress the virus and decrease viral shedding and transmission
Acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) are the choices of medicines used for herpes suppressive therapy, according to the CDC guidelines. Ask your doctor about taking suppressive therapy while you are trying to conceive.
How Genital Herpes Affects Reproduction
The following important facts from the Centers for Disease Control and Prevention (CDC) will give you an additional perspective on genital herpes as you consider your options to get pregnant:
- Genital herpes is common in the United States, affecting one in 16 people ages 14 to 49.
- Herpes simplex type 2 causes most cases of genital herpes, while type 1 mostly infects the mouth and is responsible for "fever blisters."
- More women are infected than men, and men pass the disease to women more frequently than vice versa.
- Most of those infected with herpes simplex have had minor or no active symptoms.
- People infected with genital herpes only shed the virus 10% of the time when there are no lesions.
In the absence of lesions, a doctor can swab your genital area and send it to test for herpes simplex DNA to see if you are shedding the virus. However, because the virus only sheds 10% of the time, a negative test doesn't mean you don't ever shed virus.
Can Herpes Cause Infertility?
Herpes simplex does not adversely affect egg production or ovulation. However, a couple of studies did show a possible correlation with fertility challenges:
- Infertility in people with uteruses - One small study from 2016 found that there was a link between a certain strain of herpes (not the traditional genital herpes strain) and unexplained infertility in people with uteruses. This study showed that 43% of 30 participants with unexplained infertility had a uterine lining that was infected with this specific herpes strain (HHV-6A). However, the 36 participants in the study who had no problems conceiving were not found to have the herpes strain in their uterine lining.
- Infertility in people with penises - Other studies have focused on the effect of genital herpes on infertility in people with penises. It was determined that having genital herpes may lower sperm count, which, in turn, may affect your chances of getting pregnant. Herpes may actually be a significant factor in unexplained infertility for these individuals.
- Reduced fertility in a couple - A common complication that may also occur is if it is time to try to conceive and you have a herpes outbreak. This could delay intercourse and therefore interfere with potential conception and pregnancy.
How Herpes May Affect Infant Health
In many cases, you can have a healthy baby despite a herpes infection. However, the Institute for Quality and Efficacy in Healthcare conducted an analysis of factors affecting herpes transmissions during pregnancy and found the following:
- A baby can get sick if they acquire herpes from their infected mother during vaginal birth.
- A doctor might also suggest a mother take daily herpes suppressive therapy starting at 36 weeks to reduce the chance of passing the virus to the fetus.
- Herpes does not pass through breast milk, so you can safely breastfeed your baby. However, do not breastfeed if you have open herpes sores on your breasts or anywhere your baby can touch.
- If a mother has an active infection or is shedding the virus near term, a cesarean section is recommended to avoid the risk of newborn infection.
- Rarely, a fetus will acquire the herpes simplex virus from placental transmission from the mother during pregnancy. This can increase the risk of miscarriage or preterm delivery, and it's much more common in the last trimester of pregnancy.
Pregnancy Alternatives When You Have Genital Herpes
If you prefer not take a risk of sharing the virus through unprotected sex, you and your partner might want to consider alternate ways to have a family. These options include the following:
- Artificial insemination - You can work with a doctor to get with your partner's or donor's sperm without skin-to-skin sexual contact.
- In vitro fertilization - In vitro fertilization, which can be complex and expensive, involves combining the egg and sperm outside the body and then transferring fertilized embryos to the uterus.
- Surrogacy - If you have the virus and your partner doesn't and you want to avoid the concerns of transmitting herpes to your baby during pregnancy, you might want to consider using a surrogate to carry the baby. The cost of surrogacy can also be expensive.
For most people, having a diagnosis of genital herpes can be stressful and life-changing. Because there is no cure, trying to get pregnant can be challenging but not impossible. And other options are available.
Knowing the essentials about the virus and how to decrease the chance of infecting your partner (and vice versa), and how and when to time intercourse can help you get pregnant safely. Talk to your doctor for more help and insight.