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IVF & IUI FOR HIV PATIENTS


Many HIV-serodiscordant couples desire children and physician-assisted techniques can help individuals achieve pregnancy while reducing the risk of seroconversion in their seronegative partner. For HIV-seropositive males, sperm washing with intrauterine insemination (SW-IUI) was introduced.


In vitrofertilization with intracytoplasmic sperm injection (IVF-ICSI) has been primarily used to reduce the risk of viral transmission. When properly applied to well-selected populations, no seroconversion has been reported with either of these methods. Within the last 5 years, randomized controlled studies have demonstrated the efficacy of daily pre-exposure prophylaxis in reducing the risk of seroconversion in couples having intercourse when an HIV-seropositive male has undetectable viral loads. In both the USA and Europe, favorable reproductive outcomes have been reported for HIV-seropositive females undergoing IUI and IVF-ICSI. Herein, we review the use of various contemporary reproductive techniques available to HIV-serodiscordant couples interested in having children, including new data on cumulative clinical pregnancy rates and cumulative live-birth rates after IVF-ICSI for male serodiscordant couples. We conclude by proposing that pre-exposure prophylaxis with SW-IUI may be a safe, economical and effective alternative for achieving pregnancy in well-selected, monogamous HIV-serodiscordant couples where the male partner is seropositive.


We propose the following guidelines for use of PrEP with SW-IUI in well-selected, monogamous couples:

  • The male partner is under active surveillance by an infectious disease specialist, is adherent to HAART, demonstrates stable disease with CD4 counts >250 cells/mm3 and has undetectable HIV-RNA in the plasma (<50 copies/ml) for at least 6 months;
  • Both partners undergo a fertility evaluation to determine appropriateness of SW-IUI based on the presence of tubal patency and adequate sperm counts and sperm motility;
  • Semen samples from HIV-seropositive males will be processed in a separate laboratory identified for this purpose using a class II biologic safety cabinet. The following steps will be taken:
  • Filtration of unfractionated semen to remove fibers, microcalculus and mucinous debris
  • Centrifugation through a discontinuous density gradient
  • Washing of the pellet from the gradient
  • Repeat washing of the pellet with centrifugation
  • Sperm 'swim-up' procedure
  • Motile sperm from the supernatant will be used for insemination
  • Female partners have medical clearance including hepatic and renal function testing prior to initiating PrEP;
  • Use of urine luteinizing hormone (LH) tests to determine the optimal timing of IUI, typically within 24 h of the LH surge;
  • Female partner takes PrEP with 300 mg TDF-FTC on the day of the LH surge and continues for 2 additional days (total of 3 days);
  • After six unsuccessful attempts, the evaluation for infertility would be repeated.


CAN HIV COUPLES HAVE THEIR OWN CHILD?


​​Really, thanks to the medicine available for HIV (Human Immunodeficiency Virus). These days, seropositive people have a better quality of life, and therefore it is common for many couples in this situation to consider the possibility of having a family.

A couple in which a man has HIV antibodies has the possibility of performing an artificial insemination if he wishes to have a child. This diminishes the woman’s chances of getting the infection. Yes, this technique consists of separating the motile spermatozoa from the rest of ejaculation as the possible HIV virus is contained in the seminal liquid.


WHAT IS THE RESULT OF IVF FOR HIV PATIENTS?


Pregnancy rate per intrauterine insemination cycle differs between 10.8% and 18.6%. Yes, this gets itself similar to the results attained in HIV-negative patients. As for IVF treatment, it has been stated that HIV-positive women have the lower pregnancy rates than HIV-negative women 11-21% evaluated to 26% in matched control. The reduced pregnancy rates after IVF has been viewed in HIV infected women when they brought into apply their own eggs. On the other hand, no major decrease in the pregnancy rates was found when donated eggs went used.

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AFFORDABLE IVF TREATMENT FOR HIV PATIENTS : BUILD YOUR FAMILY