Today, people affected by the human immunodeficiency virus (HIV) are able to have a better quality of life thanks to advances in medicine and the drugs available to treat the disease.
However, couples in which one or both members are HIV-positive should take several precautions when having a child, both to avoid contagion and not to transmit the infection to their offspring.
In any case, it is important for the couple to ask for medical advice when trying to get pregnant, to have all the necessary tests and pregnancy follow-ups done once pregnancy has been achieved.
The different sections of this article have been assembled into the following table of contents.
How is HIV transmitted?
HIV is a retrovirus that affects the immune system of infected people by binding to and destroying CD4 lymphocytes, a type of immune system cell responsible for making antibodies.
HIV is not able to reproduce on its own once it has infected a person. To do this, it targets CD4 lymphocytes and uses its internal machinery to multiply. The number of copies of the virus in the blood of those affected is what is known as viral load.
The most important routes of HIV infection are the following:
- Unprotected sex
- Needle exchange between drug-dependent persons
- Blood contact through wounds
- Vertical transmission: from mother to fetus during pregnancy or childbirth
It should be noted that HIV is not the same as AIDS (acquired immunodeficiency syndrome). Specifically, AIDS is the most serious stage of those affected by HIV, in which the immune system is severely weakened and unable to defend the body.
As a result, opportunistic diseases, infections or neoplasms may appear that seriously threaten the lives of those affected.
An HIV-positive person does not have to develop AIDS, though. These people are able control their viral load thanks to antiretroviral drugs and lead a completely normal life, even consider the option of having children.
Pregnancy through ART
Serodiscordant couples in which only one partner is HIV-positive can become parents through assisted reproduction techniques.
Both artificial insemination (AI) and in vitro fertilization (IVF) are appropriate techniques for achieving pregnancy without the man and woman having physical contact through sexual intercourse. In this way, the risk of contagion from one to the other can be avoided.
Chosing one technique or another will also depend on the fertility status of each one, the age of the woman and the sperm quality of the man.
Once pregnancy is achieved, the woman should take special care and follow a special treatment in order to avoid the transmission of HIV to the future baby, if she is the one affected.
Men with HIV
If the man is HIV-positive, there is a risk of semen transmission if he has unprotected sex with his partner. Specifically, HIV is not found in sperm, but in seminal plasma, which is the mixture of fluids that make up semen.
Therefore, the best way to achieve pregnancy is to separate the sperm from the seminal fluid where the viral particles are found. This is achieved thanks to sperm washing that's done in fertility clinic labs.
After this washing, the sperm sample is frozen and a small amount is analysed to check that the HIV has been completely eliminated. This test, called PCR, involves looking for genetic material of the virus in the washed sample.
Once proven that the sperm sample is suitable and free of HIV, an AI or IVF is carried out depending on the characteristics of each couple. However, there are specialists who prefer IVF with ICSIinstead of AI, since the sperm is introduced directly into the egg and any risk of contagion is avoided.
It doesn't matter what the male's viral load is. Sperm washing is a very effective technique that removes all HIV particles. If you want to know all the details of the procedure, you can read more here: Sperm washing with HIV.
Women with HIV
If the HIV carrier is the woman, the assisted reproduction treatment will be focused on avoiding the risk of contagion from the woman to the man.
Therefore, artificial insemination is a good option if the following requirements for it are met: good ovarian reserve, women’s age under 36 years, permeable fallopian tubes and optimal sperm quality.
Sperm is introduced directly into the uterus and fertilization occurs in the fallopian tubes. The eggs do not contain viral particles and implantation will take place without problems.
However, before initating fertility treatments, it’s neccessary for the woman to have a bood test done in order to assess her viral load. If it is very high, antiretroviral treatment should be followed and the risk of transmission to the fetus should be reduced by waiting until it decreases.
The risk of vertical or perinatal transmission (from mother to fetus) occurs during gestation, as the fetus feeds on nutrients that come from the mother's blood through the placenta, as well as during delivery and breastfeeding.
On the other hand, in the event of suffering fertility problems in which IVF is requiered, the fertility clinic will carry out the process under the maximum safety conditions, both for the clinic staff and for the rest of the patients.
The most common procedure is to separate HIV patients spatially and temporally from the rest: use of different operating rooms and / or at different times of day, use of double glove and discard of all material used.
Natural Pregnancy with HIV
Today, a serodiscordant couple can have a child naturally and safely, without the risk of HIV infection, following a specific protocol of controlled natural pregnancy care and follow-up.
In fact, more than 120 babies have already been born to serodiscordant couples having unprotected sex. In addition, the risk of vertical transmission has been reduced from 30 per cent to 1 per cent in recent years thanks to antiretroviral treatments.
In order to attempt a natural pregnancy with HIV, the following requirements must be met:
- The viral load of the affected person must be very low or undetectable (<50 copies/mL).
- No other sexually transmitted disease.
- Not having any fertility problems that make pregnancy difficult.
- Having unprotected sex only on a woman's fertile days.
It is best to monitor a woman's menstrual cycle and use ovulation tests to increase the likelihood of pregnancy and reduce the risk of infection. On non-fertile days, it is advisable to continue to use a condom.
Pregnancy and childbirth
Once the pregnancy has been achieved, the woman will have to carry out an exhaustive and specialised follow-up throughout the entire pregnancy, which will vary depending on whether she is the HIV-positive person or if it is her partner.
When the man the HIV-infected partner, the undetectability of the virus in semen must be confirmed before attempting pregnancy.
After obtaining a positive pregnancy test, the woman should be tested for HIV at the beginning of pregnancy. The serological checks will then be repeated in the third and sixth month of gestation.
At first, the pregnancy of a serodiscordant couple is always considered high risk. However, if all the controls are negative and the woman does not suffer any complications, the last months of pregnancy are followed normally.
Finally, it is important to have safe sex throughout pregnancy, as transmission from the mother during pregnancy significantly increases the risk of infection of the fetus.
Pregnancy follow-up protocol changes when a woman is HIV-positive. Serologic checks should also be done every 3 months to confirm that the viral load remains undetectable.
Also, the woman will continue her antiretroviral treatment, as long as the drugs do not contain teratogenic components.
The delivery of an HIV-positive woman will be performed by scheduled cesarean section to avoid labor contractions and rupture of the amniotic sac. In this way, the possibility of HIV transmission to the baby is minimized.
After delivery, the baby will be tested for viral load after delivery and at months 1, 3, 6, 12, and 18 of life.
It is also important to know that babies born to HIV-positive mothers should be breastfed artificially, as breast milk can transmit HIV.
FAQs from users
Which one do you recommend in patients with HIV? IUI or IVF?
When a man is affected by HIV, the first thing we would do is washing the semen sample, which removes the seminal plasma, so that the sample contains spermatozoa only. Thanks to this technique, we are able to remove the virus from semen samples. After the washing, we examine the sample to detect copies of the virus using the PCR (Polymerase Chain Reaction) test. If the PCR is negative or the number of copies is low, the sample can be used for a fertility treatment. In this cases, we recommend patients to choose ICSI, as a sperm washing affects the sperm count and motility.
Suggested for you
We have mentioned sperm washing in the course of the article. If you are interested in how the procedure takes place, read on here: Sperm washing in HIV-positive men.
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FAQs from users: 'Which one do you recommend in patients with HIV? IUI or IVF?'.