FREQUENTLY ASKED Questions
- What is the history of using sperm from an HIV-positive man in assisted reproduction?
- Can Intended Parents live a life with the same longevity as other non-HIV positive parents?
- Has there ever been a transmission of HIV in assisted reproduction?
- What steps are taken to ensure safety for the baby and person carrying the pregnancy (surrogate or intended mother)?
- What types of reproductive procedures are possible using HART tested sperm?
- Can I use my doctor for my reproductive procedures?
- I’m a physician and I have a patient who I’d like to refer but I have questions. Who do I contact?
What is the history of using sperm from an HIV-positive man in assisted reproduction?
The technique of washing the semen from an HIV positive man for the purpose of artificially inseminating an HIV-negative woman began in 1992, at a time there were no fully suppressive HIV regimens or the ability to measure HIV in the blood. Since then, there have been many advances in sperm washing and assisted reproduction techniques beyond basic intrauterine insemination to in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In 1996 the ability to measure the amount of HIV in the blood – the viral load – was developed. At the same time, the first three-drug regimens became available which could suppress HIV to undetectable levels. This drug regimen allowed for the selection of sperm donors with the lowest risk of having HIV in their semen.
Can Intended Parents live a life with the same longevity as other non-HIV positive parents?
Yes. HIV is now a long-term manageable disease with current medications able to completely control the virus for a full lifetime. National studies now calculate the life expectancy of those with and without HIV to be nearly identical.
All of the intended parents who participate in our program go through an extensive health screening process before being admitted to the program. This is designed to ensure that their HIV viral load is undetectable and that their health status is acceptable.
Bringing a child into the loving home of an individual or couple with HIV is essentially no different than bringing a child into any other loving home
Has there ever been a transmission of HIV in assisted reproduction?
In the reported medical literature to date, there has not been one case of HIV transmission involving 3700 cases of intrauterine insemination and 800 cases of either IVF or ICSI, including data from those early days of inadequate HIV therapy and monitoring.
Independent of assisted reproduction, studies have looked at the risk of HIV transmission through intercourse between serodiscordant couples (one HIV positive and one HIV negative) when the positive partner has an undetectable the viral load. The conclusion is that the risk is extremely small – so small that the Swiss Federal Commission for HIV/AIDS issued the following formal statement in 2008. It said that an HIV-infected person on antiretroviral therapy with an undetectable viral load is not sexually infectious, i.e. cannot transmit HIV through sexual contact.
What steps are taken to ensure safety for the baby and person carrying the pregnancy (surrogate or intended mother)?
To meet these criteria the following steps are required:
- The Intended Parent(s) must provide records from his HIV physician to document at least six months of an undetectable viral load (<48) on a stable regimen which has not been changed during that time period.
- The Intended Parent must undergo complete infectious disease screening and it will be repeated if more than seven days have elapsed before semen donation.
- The Intended Parent must provide 2 to 3 semen samples over five days that are washed in a two-step process, a small portion of which will be sent to an HIV specialty lab to test for any residual virus. Although most men with undetectable viral loads in their blood also have undetectable HIV viral loads in their semen, sometimes a very low amount of HIV is found. If any HIV is detected, the specimen will be discarded, even though studies have shown that this low level of HIV is not infectious.
- As an additional precaution, the person carrying the pregnancy will be prescribed a medication to further reduce the chances of any viral transmission. This is called pre-exposure prophylaxis.Very recent studies show that giving the antiretroviral medication Truvada (tenofovir plus emtricitabine) to an HIV-uninfected partner prior to exposure reduces the risk of transmission through unprotected intercourse with an HIV-positive partner by about 70-90%. An FDA advisory panel has recommended the approval of Truvada for HIV serodiscordant couples, which is what, in essence, a surrogate and an intended parent are. This medication is safe to give during the first trimester of pregnancy and will start just prior to your embryo transfer through one month after your embryo transfer.Truvada is one of the more frequently prescribed HIV medications during the last ten years and is extremely well tolerated.
What types of reproductive procedures are possible using HART tested sperm?
Both IVF and insemination are possible. Dr. Kolb strongly recommends IVF procedures with HART tested sperm because of the sperm loss that occurs in the washing and testing process. Because of the costs associated with additional semen collection and testing, it usually does not make financial sense to choose insemination.
Can I use my doctor for my reproductive procedures?
Yes. After your specimen has been tested and cleared HRC Pasadena is happy to ship your samples to the doctor of your choice. We’ll need to connect with your doctor to ensure they are able to work with HART patients.
I’m a physician and I have a patient who I’d like to refer but I have questions. Who do I contact?