HOUSTON » As summer approaches, anxiety about Zika is growing in states like Florida and Texas. The virus hasn’t spread to mosquitoes along the Gulf Coast, and it may not, but experts are preparing nonetheless.

And because Zika can cause birth defects in newborns, many women — and their doctors — are nervous. In the waiting room at Houston IVF, patients are handed a map of Zika-affected countries and asked to fill out a questionnaire.

“The first thing I’m discussing now is Zika,” said Dr. Jamie Nodler.

Public health officials said there have been 15 travel-related incidences of Zika in the Houston area. Nodler said at least a few couples have had to delay starting fertility treatment because the woman or her partner already may have been exposed to the virus while traveling south.

“Especially in Houston a lot of our patients and families are in the oil and gas industry,” Nodler said. “These aren’t people who are traveling to Mexico and Puerto Rico for fun or vacation. These are people who have to work in some of these offshore drilling areas.”

Even for patients who haven’t traveled, Nodler is advising they slather on repellant, just in case the virus is already here, but we don’t know it yet.

“No one wants to see an affected child,” he said.

Nodler says couples will need to manage Zika risk together. If his partner is already pregnant, a man should use condoms to avoid sexually transmitting the virus.

All over the city, parents and would-be parents have been absorbing the news about Zika.

“They’ve been saying Zika is coming to Houston, they don’t know when,” said Annie Tursi. She’s 35, owns four hair salons and her husband is a consultant. She said they were going to try for a third baby in 2016, but now they’re going to watch and wait.

“I think we’re really blessed to have two healthy boys, and if it does come this summer and it is a risk, then I probably just won’t even try for another one.”

Between their jobs and the toddler and the baby, there’s no way she can simply hunker inside all summer avoiding mosquitoes.

“Right now there’s just so many unknowns, and I think by the time they have a vaccine and know more that we’ll be done” with having children, she said, laughing. “We’ll be out of diapers and we’ll be done.”

Another Houston mom, Tracy Smith, couldn’t make that choice. She was already pregnant with twins when she heard about Zika. At a recent check-up, she learned she still had to be cautious even though her first trimester was over.

“She said it’s something to be concerned about your whole pregnancy you need to be in long sleeves, and long pants, wearing DEET,” said Smith, who was shocked to get that advice.

“My first thought was ‘I’m pregnant, I’m not going to put DEET all over myself!’ But I guess that’s what we do this summer,” she said.

She’s now wondering if she and her two other kids should move to her parent’s house for the summer, in a less buggy part of Houston.

“The probability is low,” that she’ll contract Zika, she said, “but the potential impact is so great and those are the kinds of threats that can be scary and disproportionately sort of taking up space in my brain.”

Health officials say because U.S. cities have a lot of closed spaces with air conditioning or screens, people are generally better shielded from mosquitoes than in some other countries.

Nonetheless, doctors in Houston have already opened a special clinic where women who have traveled to affected countries can get blood tests and counseling. A second clinic will open this summer.

Dr. Kjersti Aagaard, a professor at Baylor College of Medicine, said doctors are offering those clinic patients an ultrasound 15 weeks into pregnancy.

“We’ve actually developed a protocol around looking for very special views of the fetal brain and the eyes to look at for any evidence of fetal malformation with the Zika.”

Aagaard reminds her patients that Zika is just one of many possible risks during pregnancy — and risks can be managed, whether that’s through prenatal vitamins, genetic screening, or bug spray.

Zika is tough to talk about, though, because the studies are just not there yet.

“As much as we wish we could give them a very set of clear facts around ‘this is your risk, this is the time in pregnancy you’re at highest risk, or this is the time prior to planning a pregnancy you’re at highest risk.’ We simply don’t have that information,” she said. “We don’t know.”

Despite the unknowns, doctors in Houston aren’t telling people not to get pregnant.

What they are telling them is that they need to add mosquito bites to the list of cares and calculations that surround any pregnancy.

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(Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story is part of a reporting partnership with NPR, Houston Public Media and Kaiser Health News.)

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©2016 Kaiser Health News