Can an HIV positive couple have children?

According to our specialists, people with HIV who receive antiretroviral treatment can lead the same lives as healthy people. However, can a woman with HIV get pregnant and have a healthy child, and can an HIV-positive man father a healthy child without infecting his partner?

Today, of the 35 million adults globally affected by this disease, some 15 million are women of childbearing age and are therefore capable of getting pregnant.

Thanks to medical and scientific advances, people with HIV are now able to have healthy children, provided they follow the treatment properly and have undetectable and controlled virus levels. In these cases, it is advisable to plan the pregnancy so that the strategy agreed upon with the doctor, and which is adapted to the couple’s situation, is followed as closely as possible. Depending on whether the woman is HIV positive, or the man is, or both of them are, different measures and precautions should be taken to avoid passing on the disease to the offspring.

We at Eugin care about our patients, and we want them to achieve their dream of motherhood, whatever the situation. This is why we are explaining below how we proceed in cases of couples with HIV so that they can have children without passing the disease on to them.

Thanks to scientific advances and the medicine available for HIV (Human Immunodeficiency Virus), seropositive people these days have a better quality of life, and that is why it is common for many couples in this situation to consider the possibility of starting a family.

A couple where the man has HIV antibodies is able to undergo artificial insemination if he wishes to have a child. This decreases the woman’s chances of contracting the infection.
This technique consists of separating the motile spermatozoa from the rest as the possible HIV virus is contained in the seminal liquid.

Over the last few years this technique has been carried out successfully by using washed sperm for HIV cases. Although there is a theoretical risk of infection, so far there has been no case of seroconversion in women or foetuses.

In order to maximize the efficiency of the procedure and minimize the number of insemination attempts, the woman’s cycle is controlled pharmacologically.

The chances of a resulting pregnancy after two or three attempts range between 50% and 60%.

It is important to bear in mind that when a pregnant woman is an HIV carrier and does not receive the appropriate treatment, the risk of the infection being transmitted to the child ranges between 15% and 20%.

Over the last few years this risk has been reduced to less than 1% as a result of the introduction of new effective medicine for AIDS and, later on, the use of combined antiretroviral pharmaceuticals as well as strict pregnancy and birth protocols. However, these drugs are potential teratogens (they can cause malformations in the newborn) and have to be administered under specialized control.

In order to reduce the risk during the pregnancy, the woman has to be in a stable condition in order to minimise the need for changes in medication (which are not advised) as well as to avoid any developing infections.

If there is no other infertility factor Artificial Insemination is recommended either with fresh or washed sperm, in cases where the male partner is also an HIV carrier.

Requirements for a minimal risk pregnancy
The infection of the male partner has to be stable with no other illnesses having been recently diagnosed in other words he has to be in good health. Both partners have to undergo a series of additional checks before the insemination to determine their general wellbeing and identify any possible unknown infertility problems.

In this case it may be necessary to apply another Assisted Reproduction Technique, such as In Vitro Fertilisation.

  • The woman should be in the best possible physical condition before deciding to become pregnant.
  • To know the associated risks of the medication and, if possible, to avoid those parts of the treatment which represent the most risk for the foetus.
  • Both partners have to be in good physical condition thus confirming the absence of any recent illness.
  • When the man is not infected with HIV, using Assisted Reproduction Techniques such as Artificial Insemination is recommended in order to avoid the transmission of the disease.

A couple in which one or both members are infected with HIV should be aware that if they would like to have a child, they must seek specialised care in order to preserve both their own health and that of the newborn. There are four aspects to this care:

  • Stabilization of the underlying disease and control by the specialist.
  • Reproductive counselling, in order to plan the pregnancy under the best possible conditions, or advise against it where appropriate.
  • Artificial Insemination with washed sperm for HIV cases.
  • Assisted Reproduction Techniques in cases where a sterility problem may exist.

There are very few centres offering experience and standard procedures to help HIV infected patients who want to have children. Barcelona and Milan are two pioneering cities in the development of this technique, which essentially consists of using the previously prepared sperm for Artificial Insemination.

Even though the artificial insemination procedure with previously prepared semen must be carried out by Eugin, in certain cases most of the previous study phase and the woman’s hormonal preparation can be undertaken effectively in the couple’s home town or area of residence.

The whole process is coordinated by post or via the internet. Therefore, many couples who do not reside in Barcelona can take advantage of Assisted Reproduction Techniques in a convenient way. This allows them to reduce the cost of treatment as they do not have to travel to the Clinic more often than is absolutely necessary.

Additional checks for men

  • Seminogram: This is not a routine seminogram, but it is especially geared towards knowing the male fertilising potential after the application of the semen washing process. In addition, part of this sample must be analysed using a PCR technique to ensure that the washing has been effective and that it is suitable to be used without risk of contagion. For this reason it is carried out at Eugin, following the same procedure for the preparation of the semen that will be performed on the day of the artificial insemination. A few years ago, the laboratory kits used to measure this PCR allowed us to obtain a result after a few hours, which made it possible to use the fresh sample on the day of insemination. Currently the use of this system is not possible and the result can take between 2 and 3 weeks. This technical detail means that insemination is not currently possible using fresh semen, so instead only frozen semen can be used. The long sperm washing process to clean it of viruses, along with the need to work with frozen samples, means that, on many occasions, the final sperm quality is not suitable for artificial insemination and it is directly advisable to conduct an IVF-ICSI.
  • Blood tests: These are required in order to be able to control the infection as well as a possible associated pathology. A complete hemogram, as well as hepatic and renal biochemical tests, serologies (HBsAg, anti-HC, lues) and HIV study (viral load levels and CD4 values) can be carried out in the couple’s hometown.
  • Infectious disease specialist’s report: It must be done by the specialist controlling the male’s underlying pathology and who has an in-depth knowledge of the clinical case. It is a report that assesses the current state of the disease and specifies the treatment being carried out. A standard form is used in order to facilitate the release of this information by the specialist.
  • Psychiatrist report: this report is necessary only if the male partner is undergoing a substitutive treatment with opiates or psychiatric drugs.

Extra checks for women

  • Gynaecological check-up: It will include an up-to-date cytology test and transvaginal ultrasound to assess ovarian reserve. It can be brought in or done at Eugin during the first visit.
  • Blood tests: These consist of a complete hemogram, as well as hepatic and renal biochemical tests, serologies (HBsAg, anti-HBs, anti-HC, rubella, lues, HIV), blood group and Rh. These tests are aimed at obtaining a correct preconception evaluation, which will be necessary if the outcome of the procedure is successful and the pregnancy does occur. These results can be brought to the clinic from the patient’s hometown given that they are recent.
  • Hormone analysis: This is done on the third day of the menstrual cycle and is made up of FSH, LH and 17 β-Estradiol. If the third day is a holiday, the test can be done between the second and fifth day of the cycle. The woman can bring the results from her hometown. It is not always indispensable.
  • Vaginal smear test. Sometimes requested to rule out STDs (gonococcus and chlamydia). It can also be provided by the patient.
  • Hysterosalpingography: The permeability of the uterus and the Fallopian tubes is checked by means of a contrast x-ray technique. It should be carried out between the eighth and twelfth day of the cycle and can be done in the patient’s hometown. This test is not always necessary.
  • Viral load determination via PCR: this has to be done before insemination takes place. If the pregnancy does occur, the HIV antibody determination has to be performed every three months until birth in order to control seronegativity.

Artificial Insemination requirements

The infection of the male partner has to be stable, in such a way that no other illness has been diagnosed recently and he is otherwise in good health. Moreover, an updated report from the patient’s specialist must be provided in order to have a professional opinion about his state of health at the given time. In addition to the above, the capacitated sperm sample must be suitable for insemination, with the proper sperm concentration and motility.

Regarding the woman, the basic requirement is a negative HIV result. If the woman is an HIV carrier too, she has to meet the same requirements as the man, and consider other Assisted Reproduction Techniques such as In Vitro Fertilisation.

In order to maximize the efficiency of the techniques and minimize the number of insemination attempts, the cycle of the woman is induced pharmacologically. The couple is also required to sign a consent form.

As far as we know and understand, couples with HIV who would like to become parents stand a better chance of having a healthy child if they undergo assisted reproduction treatment, rather than choosing natural reproductive methods because the transmission of the disease to their offspring is not yet fully understood.

At Eugin, we put all our expertise at your disposal in order to help you should this be your situation. Consult our experts so that they can provide you with all the information we have available and guide you in the best possible way.

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