Using methods of reproductive technology, pregnancy can be safely achieved in HIV serodiscordant couples - couples in which one member is HIV-positive and the other is not, according to findings from a study at Columbia University in New York.
For couples having trouble conceiving, in vitro fertilization (IVF) is often undertaken, a process the joins the woman’s egg with the man’s sperm in a laboratory dish, so that conception is performed “in vitro,” or “outside the body.” This may include intracytoplasmic sperm infection (ICSI), a process in which the sperm is treated to remove all HIV and then directly injected into a fertilized egg.
“Although sperm washing techniques for assisting HIV serodiscordant couples wishing to have children have been utilized for almost 20 years, the US healthcare system has been slow to embrace the methodology,” lead author Dr. Mark V. Sauer told Reuters Health. Sauer directs Columbia’s Division of Reproductive Endocrinology, whose 12 years of experience providing services for such couples provides the basis for the report.
“Our center uses IVF with ICSI of prepared sperm to separate cellular and fluid components known to harbor virus from the virus-free sperm fraction,” Sauer said. “Our findings failed to detect any transmission to patients or their offspring.”
The study, reported in the current issue of Fertility and Sterility, included 181 couples in whom the man was HIV-infected and the women was not. The woman underwent 355 fresh IVF-ICSI cycles and 65 frozen-embryo transfer cycles. Sixteen percent of stimulations were canceled due to poor ovarian response.
On average, 15.0 eggs were retrieved from the ovaries, resulting in 12.1 mature eggs suitable for ICSI, yielding 9.0 embryos per couple, the report indicates.
The overall clinical pregnancy rate/embryo transfer was 45 percent and the ongoing/delivery pregnancy rate/embryo transfer was 37 percent, the author’s state.
Multiple pregnancies was the most frequent obstetrical complication, at a rate (41 percent) similar to that reported for the general population of patients undergoing IVF-ICSI, and high-order multiple birth was seen in 5 percent. Preterm delivery was also common (43 percent). There was no evidence of maternal or neonatal HIV transmission and no deaths occurred.
“We feel (IVF-ICSI) is a reasonable alternative to insemination methods currently touted in Europe, and at least as safe,” Sauer concluded.
“Finally, IVF/ICSI does not specifically violate recommendations against ‘insemination’ of HIV discordant couples as stated by the Centers for Disease Control and Prevention and many state laws in this country.”
SOURCE: Fertility and Sterility, June 2009.