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Reproductive Options for People who are HIV Positive

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HIV-positive couples are increasingly looking to expand their family. When this happens, the health status of both parties is a top priority. For partners who are both HIV-positive, conception can occur normally, but there is a risk of transmitting a drug-resistant strain of HIV between partners. This risk can be minimized if both partners are rigorously adhering to treatment and their viral load is undetectable. Timing unprotected intercourse when the woman is ovulating is critical for success.

When only one partner is HIV-positive there are considerations that should be made. First, the partner that is HIV-positive should be rigorously following their treatment plan to achieve an undetectable viral load. This will not eliminate the possibility of transmitting the virus, but will reduce it. It is estimated that the risk of unprotected intercourse is 1:500-1000. There is still the possibility that a single act of unprotected sex will lead to transmission of the virus to the non-positive person. If electing this method of conception is most desirable, it is advised that both people attend counselling on the precise timing needed for conception and how to detect ovulation. The Center for Disease Control and Prevention (CDC) does not recommend post-exposure prophylactic use of anti-retrovirals in the case of repeated sexual intercourse between partners of varying status.

An option available for serodiscordant couples (couples that are not both HIV-positive) is intrauterine insemination with sperm that has been washed free of the seminal fluids which is most likely to carry the virus. Sperm are placed directly into the uterus of the woman when she is ovulating. This is a cost effective treatment at approximately $400 per insemination. In Europe sperm washing is widely used and they have performed over 2000 intrauterine inseminations without seroconverting the female to an HIV-positive status. However, due to a single transmission in 1990 in the United States, the technology was advised against by the American Society of Reproductive Medicine. Over 20 years has passed and sperm washing is being much more widely used without transmission of the disease.

Insemination with donor sperm eliminates the risk of transmitting the virus from the HIV-positive man to the HIV-negative woman and the resulting infant. This adds the benefit of eliminating the risk of virus transmission, but it also removes the genetic link the child has with the HIV-positive partner. Additional consideration should be given to the use of donor sperm when the potential infected parents' life is threatened by disease.

In vitro fertilization is commonly performed in the United States when intrauterine insemination is unsuccessful, or the risk of intrauterine insemination is not feasible. During this, the woman's eggs are retrieved from her body after taking medication to stimulate a mass number of eggs at the same time. Sperm is isolated from a semen sample through washing, then either placed with the eggs for natural fertilization or a technique called intracytoplasmic sperm injection (ICSI) is used. ICSI fertilizes by injecting one sperm directly into the egg. This reduced the chance of eggs coming in contact with multiple sperm. Once the eggs are fertilized they are allowed to grow into embryos and transferred back to the woman. This method reduces the chance that virus will come in contact with sperm and eggs, thus hopefully producing a healthy embryo.

Adoption is the final option presented for couples that do not want to risk the transmission of the virus during unprotected sex and choose not to undergo any of the medical procedures listed.

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