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 carry out 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 a 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 a 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.
When in a couple one or both partners are infected with HIV, they should be aware that if they want to have a child they need specialised help and attention in order not to risk their health and that of the newborn. This help involves four aspects:
- Base illness stability and control by a specialist.
- Reproductive advice in order to programme the pregnancy under the best possible conditions or to rule it out in some cases.
- 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.
Although the Artificial Insemination procedure with previously prepared sperm has to be carried out in Barcelona, in some cases most of the fertility study and the hormone preparation of the woman can be effectively carried out in the couple’s hometown or area.
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
- Spermogram: This spermogram focuses on the fertilisation potential of the male partner’s sperm after having undergone sperm washing, furthermore, this part of the sample should be studied through the PCR technique, to make sure that the washing procedure has been effective. This would mean that the sample would be apt to use without risk of infection. For this reason it has to be performed in Barcelona following the same procedure that will be carried out on the day of Artificial Insemination. Some years ago, we were able to obtain results just a few hours after egg retrieval through the PCR laboratory KITS, which meant we could use a fresh sperm sample on the day of insemination. It is currently not possible to use this system, so results can take 2 to 3 weeks to arrive after retrieval. This technical detail means we can no longer use a fresh sample to inseminate, and must use a frozen one.The long washing procedure to separate the virus from the sperm sample, together with having to use a frozen sample, may cause the final sample to be NON APT to use. So an IVF-ICSI cycle will be recommended.
- Blood tests: These are required in order to be able to control the infection as well as a possible associated pathology. A complete hemogram, 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.
- Urethral smear: Sometimes this is required in order to rule out STD’s (sexually transmitted diseases) such as Gonococcus and Chlamydia. These tests can either be carried out in the patient’s home town or in Barcelona.
- The report from the specialist in infectious diseases has to be done by the specialist who attends to the male partner’s case and controls his base pathology. This report evaluates the current condition of the illness and specifies the treatment that the patient is undergoing. The specialist fills in a standard form to simplify the information provided.
- 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: This consists of an updated cytology. It can be brought with you or carried out in Barcelona on your first visit.
- Blood tests: These consist of a complete hemogram, hepatic and renal biochemical tests, serologies (HBsAg, anti-HBs, anti-HC, rubella, lues, HIV), blood group and Rh. These tests intend to obtain 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.
- Smear test: This is necessary in order to rule out STD’s (Gonococcus and Chlamydia). The results can be brought to the clinic.
- 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 PC: 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 has to be provided in order to have a professional opinion about his state of health at the given time.
Regarding the woman, the basic requirement is a negative HIV result. If the woman is a 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.