At present, the techniques used in serodiscordant couples are:
- Artificial Insemination (AI)
- In vitro fertilisation (IVF) with intracytoplasmic sperm injection techniques (ICSI)
The IVF-ICSI technique is the recommended insemination technique as it reduces oocyte-sperm contact and reduces the risk of HIV-1 transmission, as there is no interaction with other cell types.
The fertilisation and pregnancy rates are similar to those obtained after use of identical techniques in non-serodiscordant couples.
HIV + male
The first cases of pregnancies in serodiscordant couples (HIV+ male / HIV - female) were published in 1992. At present, the protocol used in cases where the male partner is seropositive was implemented in various Assisted Reproduction centres in Catalonia, where more than 1000 cycles have been conducted and to date there has been no case of HIV seroconversion in the mother or baby.
The protocol used to prepare the semen samples aims to substantially reduce the presence of the virus. With this technique seminal plasma, non-sperm cells and immobile sperm, principal fractions with confirmed viral presence, are eliminated.
This is a safe, effective and reproducible technique, bearing in mind that the primary aim of the technique is not to completely remove the risk but to reduce the risk when a pregnancy is desired.
The previous requirements that couples must meet are:
- The post-sperm washing PCR test of the semen samples should be negative in order to be able to use them in AIH or IVF-ICSI.
- The patient should undergo a HIV-1 PCR blood test to verify that she is seronegative before starting the cycle.
- Both partners should sign the informed consent form, which outlines the possible risks involved with the use of these techniques.
The technique used to minimise the risk of the transmission of HIV consists in repeated washings of the semen samples (by density gradient centrifugation followed by double washing and swim-up). Sperm collected via masturbation is used to conduct this technique.
The final sample is divided in two parts. One part is used to conduct the tests that show its viral load by means of double PCR (DNA and RNA). Once the result is obtained and the negative result confirmed, the other part of the sample is used to conduct the appropriate assisted reproduction technique.
In general, the rate of vertical transmission (VT) from mother to child of the HIV virus has dropped from 20% to 1% which has increased the desire of seropositive women to have children.
Various studies have been published regarding pregnancies in seropositive women using assisted reproduction techniques and there is no case of vertical transmission (VT). However, in these cases proper control of the pregnancy is essential in order to reduce this risk.