The high prevalence of the HIV virus in men of reproductive age and the advance of antiretroviral treatments, which improve the life quality and life expectancy of HIV-positive patients, mean that more and more couples who are serodiscordant (only one member is a carrier of the virus) want to have children of their own and have to resort to assisted reproduction to minimize the risk of transmission.
The different sections of this article have been assembled into the following table of contents.
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 resort 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 sperm sample to eliminate the viral particles of the seminal plasma and the cells that may be HIV carriers, separating the mobile spermatozoa to be used in an assisted reproduction technique.
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.
Sperm is mainly made up of three parts:
- Sperm plasma
- Other cells
By washing sperm before any reproduction treatment, we are able to separate these parts and obtain only the sperm.
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...
In order to separate the best sperm from the rest of the sample, a double washing process is the most common:
- Density Gradients
- several layers of different concentrations are added to separate the different cellular fractions of semen. The sample is added to the top and, after centrifugation, the motile sperm are 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 mobility will be found at the top of the sample, from where they will be retrieved.
The sample obtained after washing is analysed, usually using the PCR technique, to check that there is no viral particle. If the result is negative, i.e. there is no virus, this sample is suitable for use in assisted reproduction treatments.
These samples are usually free of the virus in a high percentage: 95 to 99% of the time. The success guarantee is very high, since so far no case of HIV transmission has been reported after semen washing.
Once it has been confirmed that the sample is free of viral particles, it can be used to perform the assisted reproduction technique indicated in each case, either artificial insemination or in vitro fertilization (IVF).
Some specialists prefer not to perform artificial inseminations because the risk of theoretical infection is higher. However, in many clinics this technique is carried out because there are no known cases of infected patients using samples from their seropositive partner for artificial insemination.
The problem with using these samples to perform artificial inseminations is that the initial seminal quality must be very good so that, once processed, it has sufficient concentration to achieve pregnancy with this technique.
In addition, in many cases, in order to avoid having to cancel the cycle or vitrify the oocytes in the event that the PCR is positive, the seminal sample is frozen once the washing has been carried out, which further reduces the quality.
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).
Moreover, if there are other fertility problems in the couple that make it difficult to achieve pregnancy through artificial insemination, IVF-ICSI will also be chosen. For example, if the woman's tubes are obstructed or she is of advanced age, IVF will be used.
FAQs from users
Is seminal washing in men with HIV effective in achieving a pregnancy without risks for the mother and the foetus?
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?
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.
Does the time it takes to do sperm washing to eliminate HIV affect the quality of the eggs?
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.
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If you'd like to know more about the management of patients with HIV who are trying to get pregnant, don't miss out on the following article: Fertility patients with HIV.
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