Can HIV positive patient plan for pregnancy?
Yes, HIV positive couple can plan pregnancy. With the current advances in fertility and antiretroviral treatment available for HIV, it is possible to conceive and carry forward a pregnancy. With the right treatment HIV positive people can enjoy parenthood.
It is important that you consult your doctor or visit an infertility clinic before trying for pregnancy, so that they can ensure that you and your partner are at minimum risk for transmission of HIV. Screening for other sexually transmitted infections is also important as cumulative risk of other infections can alter the plan of treatment and conception.
Is there any risk while planning pregnancy if one of the partners is HIV positive?
If your partner has undetectable viral load (the amount of virus in an infected person’s blood) then there is minimal risk for HIV transmission, and you can try to become pregnant by natural conception via unprotected sexual intercourse during the fertile period of the woman’s cycle and using condom for the rest of the cycle. But if your partner does not fulfill the above criteria, then you need to consult your doctor for advice on measures to reduce the transmission risk and achieve successful pregnancy.
Should we plan for IUI or IVF treatment for HIV positive couple?
There are ways to reduce transmission of HIV in couples who want to become pregnant. Before embarking on pregnancy planning, it is very important that you visit an infertility specialist.
An IVF specialist will assess your current situation, the HIV positive partner’s health and will advise the best possible method based on that. It is recommended to be compliant with antiretroviral treatment (medicines for HIV positive people) or start treatment if not already started in the infected partner to bring the viral load (amount of virus in the infected person’s blood) to a minimum, preferably to undetectable levels. Pre-exposure prophylaxis (medicine taken to prevent getting HIV, before getting exposed to the virus) in form of antiretroviral drugs is also a practice, in which the HIV negative partner is given antiretroviral drugs before attempting to get pregnant to reduce the risk of getting infected.
A very efficient method is sperm washing, which separates sperm from the seminal fluid and is then used for intrauterine insemination or in vitro fertilization. Sperm washing can be used for various assisted conception techniques. Of all currently available methods of assisted conception IVF/ICSI is the ideal and safe choice for HIV sero-discordant couples to fulfil their wish of having a baby.
If the couple does not want to go through above treatment, then doctors can recommend using donor semen from a suitable healthy donor, which will remove the risk of HIV transmission.
What does the term sero-discordant mean?
Sero-discordant means only one of the partners is HIV positive and the other is not HIV positive. According to WHO Nearly 50% couples with HIV are sero-discordant.
When is IUI advised to a HIV positive / infected couple?
When sperm washing is used for reducing the risk of HIV transmission from the male to the female or if couple wants to avoid unprotected intercourse altogether, then IUI can be used in those cases.
Can IUI be done when wife is HIV positive?
IUI treatment can be done if wife is HIV positive in a sero-discordant couple, but it will only reduce the risk of transmission of HIV to the husband, which does protect the husband, but has no effect on the pregnancy or the baby, because the mother would be already HIV positive.
Can IUI be done when husband is HIV positive?
IUI can be done if the husband is HIV positive and it will protect the wife as well as the baby from HIV.
Is IUI safe for HIV Positive patients?
IUI is one of the methods for getting pregnant in sero-discordant couples. It is useful in both cases when either partner is HIV positive, but it still has some risk of HIV transmission to the female because of high concentration of sperm used to impregnate the woman, IVF on the other hand uses fever sperms for achieving pregnancy and only one sperm is used if ICSI is done, which makes ICSI the safest method. Also, the success rate of IUI is less (10%) compared to IVF-ICSI (45%)
What sperm washing technique is used for HIV positive patient/couple?
The method of choice for sperm washing for HIV or any infective disease like Hepatitis B would be double density gradient followed by swim up. During this method the semen sample is layered over a chemical density gradient which acts as a fine sieve, filtering out only motile sperm and leaving behind the semen plasma and other unwanted cells behind.
It is called double density as the chemical component is layered in two densities with the heavier density at bottom of tube and lighter density on top of the heavier density.
Is there any safe sperm wash method to avoid HIV infection?
Double density gradient followed by swim up is a safe method for washing HIV positive semen. It is a standard protocol for handling all semen samples that are infectious in nature. However, the procedure should be performed with perfection in order to avoid any chance of HIV virus in the prepared semen sample.
There are a few do’s and don’t that should be followed by technician while handling sero positive sample. Make sure you get the semen sample prepared from a standard Andrology lab where you trust the abilities of the technician handling your sample.
What is the cost of sperm washing for IUI when patient is HIV positive?
The cost is same as any IUI sample preparation and HIV patients are not charged additionally. The cost of semen preparation by double density gradient method in Indore ranges from 2000 to 5000 rupees.
What is the effect of HIV during pregnancy?
Being HIV positive poses multiple problems in a pregnancy and is harmful for the mother as well as the baby. Though HIV does not alter the baby’s development or the course of pregnancy, but there are complications which develop more in HIV positive mothers and they can negatively impact the pregnancy outcome.
What are the complications due to HIV in pregnancy?
There are various complications due to HIV in pregnancy, following is a list of such complications:
- Higher rates of spontaneous abortion
- Higher rates of ectopic pregnancy
- Higher rates of various infections
- Preterm labor
- Preterm rupture of membranes
- Increased risk of stillbirth
Can HIV be transmitted to baby if couple is HIV positive?
Yes, HIV can be transmitted to the baby if the couple is HIV positive, or if at least one partner is positive, as in sero-discordant couples. Without any medical intervention the transfer rate in a sero-discordant couple where male is HIV positive and female is negative would be around 1 case per thousand acts of unprotected intercourse.
If the mother gets infected then without any intervention mother to child transmission of HIV is around 15-45%.
But with right treatment with antiretroviral drugs in the infected partner, use of sperm washing and IVF/ICSI/IUI, risk is reduced to nearly zero.
Is IVF/ICSI safer option compared to IUI when planning pregnancy for HIV positive couple?
Yes IVF/ICSI is the safest option for getting pregnant in HIV positive sero-discordant couples. According to various studies done about the safety of different methods of achieving pregnancy in a sero-discordant couple, it was found that IVF/ICSI was not only the safest option, but also the most cost effective of all available options for pregnancy.
What is the chance of transmitting HIV by IVF ICSI to the baby?
The process of IVF ICSI after sperm washing, reduces the transmission rate of HIV to nearly zero. Even with IUI after sperm washing no cases of HIV transmission have been reported so far.
Is there any advance sperm selection technique that will guarantee HIV virus free sperms during IUI or IVF?
Unfortunately no. The best sperm selection method for infectious samples like HIV or Hepatitis is Double density gradient. Advance sperm selection methods like microfluidics are not recommended for HIV sample as they cannot clearly separate sperm from infected sample.
Is there any difference in IUI success rate for HIV positive patients?
No, there is no difference in IUI success rate for HIV positive versus non infected people. IUI success rate is around 10%. It declines with the woman’s age.
Is there any difference in IVF success rate for HIV positive patients?
No, IVF success rates are same for HIV and non-infected people. IVF success rate is around 60% per embryo transfer. It also depends on the person’s age.
Are the embryos tested for HIV before placing them to uterus?
No, embryos are not tested for HIV before placing them in the uterus. At present testing of embryos is available for genetic diseases only.