Sperm washing for assisted reproduction in HIV positive patients

By (embryologist), (gynecologist), (embryologist), (embryologist) and (biochemist).
Last Update: 08/11/2022

The prevalence of the human immunodeficiency virus HIV in people of childbearing age, and the progress of antiretroviral treatments which improve the quality of life of HIV-positive patients, mean that more and more serodiscordant couples wish to have children of their own.

A serodiscordant couple is one in which only one partner is a carrier of the virus. In the case of the male partner, seminal lavage and assisted reproduction can be used to minimize the risk of transmitting the virus to his partner.

What is HIV and how is it transmitted?

The human immunodeficiency virus (HIV) is a retrovirus that is transmitted through blood, sexual fluids, and by vertical transmission (through mothers to children).

It is important not to confuse it with AIDS (Acquired Immune Deficiency Syndrome), which is the most serious manifestation of a series of alterations affecting people infected with HIV because their immune system is strongly affected by the virus.

The fact that it is sexually transmitted makes it advisable to turn to assisted reproduction techniques to minimize the risk of transmission of the virus from one partner to the other in the case of being serodiscordant.

If both partners are HIV-positive, re-infection with different strains can also be harmful, as it can worsen the state of the disease. Therefore, it is also recommended to opt for assisted reproduction if children are desired.

If the man is the carrier of HIV, there is the option of performing a sperm washing to avoid the transmission of the infection to the mother and even to the future baby when trying to get pregnant.

What is sperm washing?

Sperm washing consists of processing the semen sample to eliminate the viral particles of the seminal plasma and the cells that may be HIV carriers. Thus, separating the mobile spermatozoa to be used in an assisted reproduction technique.

Semen is mainly made up of three fractions or parts: seminal plasma, spermatozoa and other cells.

Despite being a controversial issue, the most widely accepted theory today is that sperm do not transmit the retrovirus. Therefore, by washing the sample, the risk of the woman becoming infected is practically zero.

How will sperm washing be done?

To perform the washing, the patient must leave a semen sample in the andrology laboratory. Using different techniques, sperm with better mobility are separated from the rest of the semen components: seminal plasma, lymphocytes, epithelial cells, weak sperm...

The most common way to separate the best spermatozoa from the rest of the semen sample is to apply a double washing process. Therefore, a density gradient is performed followed by a swim-up.

Density Gradients
several layers of different concentrations are added to separate the different cellular fractions of semen. The sample is added to the top. After centrifugation the motile sperm are found at the bottom of the tube.
sperm recovered from the density gradients are added to a tube with semen preparation medium and incubated under controlled conditions. The sperm with the best motility will be found at the top of the sample, from where they will be retrieved.

Once the best quality sperms have been isolated, it is important to confirm the absence of the virus in the sample. This must be done before use in artificial insemination or in vitro fertilization (IVF).

Confirmation of the absence of the virus

After performing the seminal lavage, half of the sample obtained is analyzed, usually by PCR, to verify that no viral particles are present. The other half of the sample is then frozen, awaiting the results.

If the test result is negative, i.e. there is no virus, the part of the sample that remains frozen is considered suitable for assisted reproduction treatment. On the contrary, if the presence of virus is confirmed, the frozen sample is discarded. In the latter case, it will be necessary to start the entire seminal lavage procedure with a new semen sample.

However, these samples are usually virus-free in a high percentage of cases. Moreover, it can be said that the guarantee of success is very high. So far, no case of HIV transmission after seminal lavage has been described.

Sperm washing and assisted reproduction tecniques

Once it has been confirmed that the sample is free of viral particles, it can be used to perform the assisted reproduction technique indicated. This could be either artificial insemination or in vitro fertilization (IVF).

However, some specialists prefer not to perform artificial inseminations because the risk of theoretical infection is higher. Furthermore, the initial seminal quality must be very good so that, once processed, it has sufficient concentration to achieve pregnancy with this technique.

For all these reasons, the chosen technique after sperm washing is usually IVF with ICSI (intracytoplasmic sperm injection).

It should also be kept in mind that HIV-positive patients may have the quality of semen affected by the infection itself or by antiretroviral treatments. Therefore, in cases where the initial quality of the seminal sample is not very good, the chosen technique will be IVF-ICSI (intracytoplasmic sperm injection).

Furthermore, if there are other fertility problems in the couple that hinder pregnancy by artificial insemination, IVF-ICSI will also be chosen. For example, if the woman has blocked fallopian tubes or is of advanced age.

Fertility treatments, like any other medical treatment, require that you trust the fertility specialists that will be by your side during your journey. Logically, each clinic has a different work methodology. Our Fertility Report will offer you a selection of recommended clinics, that is, fertility centers that have passed our rigorous selection process. Moreover, our system is capable of comparing the costs and conditions of each one so that you can make a well-informed decision.

FAQs from users

Is seminal washing in men with HIV effective in achieving a pregnancy without risks for the mother and the foetus?

By Marita Espejo Catena M.D., M.Sc., Ph.D. (gynecologist).

One of the ways of transmission of the human immunodeficiency virus is sexual and, indeed, the seminal sample of an HIV+ male may contain a viral load that allows infection of his partner.
Seminal washing is a laboratory technique that is applied to couples in which the male may be affected by an HIV infection and also by hepatitis B or C virus. It is based on the fact that viruses are located in seminal plasma and non-sperm cells, but not in sperm.
When the spermatozoa are separated from both seminal components, we are sure that the risk of viral transmission has been reduced to the maximum and this is confirmed by the determination of the negative viral load in the treated sample in the laboratory, which shall be used for assisted reproduction.

Which one do you recommend in patients with HIV? IUI or IVF?

By Aitziber Domingo Bilbao B.Sc., M.Sc. (embryologist).

When a man is affected by HIV, the first thing we would do is wash 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.

Does the time it takes to do sperm washing to eliminate HIV affect the quality of the eggs?

By Rebeca Reus BSc, MSc (embryologist).

No, because it is taken into account when programming the woman's follicular puncture. In addition, the sperm sample is often frozen to ensure that on the day the eggs are obtained, a sample free of viral particles will be available.

Is sperm washing only performed in patients with HIV infection?

By Silvia Azaña Gutiérrez B.Sc., M.Sc. (embryologist).

No. sperm washing can be performed in HIV serodiscordant couples in which the male partner is the carrier of the virus, but also when the male partner is infected with hepatitis B or C virus.

In any case, the purpose of seminal lavage is to minimize the risk of transmitting the infection to the partner in the search for pregnancy.

As we have already mentioned, HIV can be transmitted sexually. In the following article we discuss other sexually transmitted diseases in case you need more information: Sexually transmitted diseases - STDs.

In the following article you can find more information about the management of seropositive patients when trying for a baby: Pregnancy with HIV.

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FAQs from users: 'Is seminal washing in men with HIV effective in achieving a pregnancy without risks for the mother and the foetus?', 'Which one do you recommend in patients with HIV? IUI or IVF?', 'Does the time it takes to do sperm washing to eliminate HIV affect the quality of the eggs?' and 'Is sperm washing only performed in patients with HIV infection?'.

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Authors and contributors

 Aitziber Domingo Bilbao
Aitziber Domingo Bilbao
B.Sc., M.Sc.
Bachelor's Degree in Biology from the University of the Basque Country. Master's Degree in Human Assisted Reproduction from the Complutense University of Madrid, and Master's Degree in Biomedical Research from the University of the Basque Country. Wide experience as an Embryologist specialized in Assisted Procreation. More information about Aitziber Domingo Bilbao
 Marita Espejo Catena
Marita Espejo Catena
M.D., M.Sc., Ph.D.
Graduated in Medicine and Surgery from the University of Valencia in 1992. Specialist in Gynaecology and Obstetrics. Doctor in Medicine from the University of Valencia in 2000. Master in Assisted Human Reproduction by the Rey Juan Carlos University and IVI in 2008. Currently, she is the director of Instituto FIVIR. More information about Marita Espejo Catena
License: 464616497
 Rebeca Reus
Rebeca Reus
BSc, MSc
Degree in Human Biology (Biochemistry) from the Pompeu Fabra University (UPF). Official Master's Degree in Clinical Analysis Laboratory from the UPF and Master’s Degree about the Theoretical Basis and Laboratory Procedures in Assisted Reproduction from the University of Valencia (UV). More information about Rebeca Reus
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV
Adapted into english by:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

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