By Cristina Mestre Ferrer BSc, MSc (embryologist) and Aitziber Domingo Bilbao BSc, MSc (embryologist).
Last Update: 10/06/2014

One of the main worries of infected people is when they decide to have a baby: men with HIV virus, as well as women, can have biological babies with no fear of transmitting the illness to their offspring. In the same way, assisted reproduction techniques have to be used to avoid the transmission to the partner.

It is necessary to follow a number of recommendation, so that the risk of a vertical transmission of HIV is almost non-existent, with an infection’s rate lower than 1%. If no further action is taken, the vertical transmission’s rate varies between 15 and 30%.

The different sections of this article have been assembled into the following table of contents.

Women with HIV

If the mother has HIV, the most adequate treatment is advisable, either artificial insemination or in vitro fecundation (IVF), according to different factors, such as: fertility alteration in the woman, the mother’s age and the sperm quality of her partner.

When is ART required?

This special indications are also to be followed:

  • The viral load has to be low or undetectable.
  • The counting of CD4 lymphocytes must be more than 300.
  • Administration of drugs that decrease the risk of infection from HIV of the future baby, as well as stop the progress of the infection during the pregnancy.
  • Adequate and specialised follow-up during all the pregnancy.

The labour must be carried out through cesarean, because it is a critical moment for a possible transmission. Cesarean must have been scheduled with anticipation, in order to avoid the labour contractions: the breaking of the sack can make the baby drink infective secretions. The possibility of an infection exists during all the pregnancy, but the most delicate period for the transmission is during the labour: they calculate that 2/3 of the babies with HIV have been infected in that moment.

They also suggest the labour assistants clean with special care the newborn’s mouth and nose. An artificial breastfeeding is required, because the virus can be transmitted through the mother’s milk.

Men with HIV

In men’s case, avoiding the risk of transmission is easier: you can be a father without knowing the viral load, because a sperm washing will be carried out. HIV virus isn’t within the sperm, but rather in the seminal plasma, which is the fluid sperms need to move.

When is ART required?

In this case, in order to avoid the transmission, artificial reproduction techniques have to be used, either artificial insemination or in vitro fecundation (IVF) – in both cases, they will use frozen sperm.

Seminal samples of men with HIV have to be processed through sperm washing: it consists of separating the sperm with a higher quality from plasma or seminal fluid.

Once completed the washing, the sample is frozen and a small quantity of washed sperm is extracted to verify if the virus was completely eliminated from the sample. In order to carry out this checking, a PCR is made to verify if there is the slightest amount of HIV.

This test can last between several days and a week. For this reason, this can’t be done with fresh sperm: it has to be frozen to maintain the sperm quality, while verifying if it is a good sample to be used in fertility treatments, with no risk of HIV transmission.

FAQs from users

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

By Aitziber Domingo Bilbao BSc, MSc (embryologist).

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.

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Authors and contributors

 Cristina Mestre Ferrer
BSc, MSc
Embryologist
Bachelor's Degree in Biological Sciences, Genetics & Human Reproduction from the University of Valencia (UV). Master's Degree in Biotechnology of Human Assisted Reproduction from the UV and the Valencian Infertility Institute (IVI). Embryologist at IVI Barcelona. More information
 Aitziber Domingo Bilbao
BSc, MSc
Embryologist
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
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