Management of infertility in HIV infected couples: a review (original) (raw)
Related papers
2016
The HIV epidemic has continued to grow and remains a major challenge to mankind. In the past, ethical considerations about the resulting child and risks of sexual, vertical and nosocomial transmission of HIV prevented practitioners from offering fertility services to people living with HIV. In recent times however, the use of highly active antiretroviral therapy (HAART), has not only improved the life expectancy and quality of life of those infected but also reduced the risk of HIV transmission. The need for fertility services in the HIV-positive population has thus increased and may be employed for management of infertility and protection from transmission or acquisition of HIV infection. As such, preconception counseling, sexual health and fertility screening have become routine in the management of HIV-positive couples. The option of care include adoption, self insemination with husband sperm, embryo donation from couples who have been verified to be HIV negative, insemination wi...
Reproductive assistance in HIV serodiscordant couples
Human Reproduction Update, 2013
Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.
HIV and reproductive care—a review of current practice
BJOG: An International Journal of Obstetrics and Gynaecology, 2006
In developed countries, antiretroviral treatment has increased life quality and expectancy of HIV-infected individuals and led to a drop in mother-to-child transmission (MCT) risk to below 1%. Fertility has been shown to be reduced in both men and women with HIV. As a result of these factors, the demand for reproductive care in this population is rising. In discordant couples where the man is positive, sperm washing significantly reduces viral transmission risk to the uninfected female partner over unprotected intercourse. Positive women do not necessarily need specialised fertility treatment but should be monitored closely during pregnancy to minimise MCT risk.
Consultations of HIV-infected women who wish to become pregnant
Archives of Gynecology and Obstetrics, 2011
Purpose The aim of this study was to determine the impact and outcome of consultations of HIV-infected women if a pregnancy is planned. Methods This study was performed retrospectively based on patient's records of HIV-infected women with the desire to become pregnant between 2000 and 2008. Relevant data regarding HIV infection, obstetrical history, diagnostic procedures and medical interventions related to conception, as well as pregnancy outcomes, were evaluated. Results A total of 57 HIV-infected women (and their partner) were included; 38% (n = 22) of the couples showed a reduced fertility and 24 women (42%) became pregnant once or several times during the study period. Conception resulted from unprotected intercourse (n = 11), self-insemination (n = 10), assisted insemination (n = 2) or in vitro fertilization (n = 1). The outcome of all pregnancies was: 26 live births, 1 intrauterine fetal demise (38 weeks), 1 miscarriage, 1 cervical pregnancy and 1 legal abortion. No horizontal transmission occurred in serodiscordant couples. Seven (12%) women were lost to followup, 12 couples (21%) abandoned the attempt to get pregnant, and 14 couples (25%) reported an ongoing wish for a child.
THE USE OF ASSISTED REPRODUCTION FOR HIV-INFECTED SERUM DISCORDANT COUPLES (Atena Editora)
THE USE OF ASSISTED REPRODUCTION FOR HIV-INFECTED SERUM DISCORDANT COUPLES (Atena Editora), 2022
The increase in longevity and quality of life has led serodiscordant couples to seek help in assisted reproduction, avoiding putting their partner at risk of infection or acquiring a new viral strain, being evaluated and treated on a case-by-case basis. There are inadequate data to prove that one therapy is safer than any other. In addition, the choice of treatment is based on available resources and the results of standard infertility tests, which are also part of the decision-making process. The general consensus in the legal and medical community is that HIV-infected couples or individuals must be counseled and have access to infertility treatment or treatment to decrease the risk of infection in an uninfected partner when attempting natural conception. HIV-infected patients seeking assisted reproduction services must be highly motivated to have children, well-controlled HIV with a stable CD4 count, undetectable virus in serum and semen (90 percent. When the woman is not HIV-infected and the If a man is infected with HIV, the risk of transmission is substantially reduced with the use of medically assisted reproduction. In women with a normal fertility assessment, intrauterine insemination (IUI) with doubly processed sperm as a first-line therapy is one of the options of choice. If unsuccessful or for couples diagnosed with known female factor infertility, in vitro fertilization (IVF) with intracytoplasmic sperm injection may be performed. Donated sperm is an additional option. When the woman is HIV-infected and the man is not is infected with HIV, IUI using the partner's sperm will prevent female-to-male transmission in an attempt to conceive Natural.
Nederlands tijdschrift voor geneeskunde
The desire to have children is more and more common in HIV serodiscordant couples. The Academic Medical Centre Amsterdam has developed a new treatment protocol for couples in whom the man is HIV positive. Semen is processed to obtain HIV-1 free spermatozoa. These spermatozoa are used for IUI treatment. Thus far, 20 serodiscordant couples underwent 76 IUI cycles. An insemination was performed in 50 cycles (66%). The insemination was cancelled in 26 cycles, because of too many follicles (risk for multiple pregnancy), weekend (no possibilities for virological testing), not enough spermatazoa after preparation, a positive HIV-1 RNA test and other reasons. 10 out of 20 women became pregnant (50%), 8 women were on-going pregnant. The clinical and ongoing pregnancy rate per started cycle was 13% and 11% respectively. 7 babies have thus far been born and none of the mothers or babies seroconverted within this study period. Larger numbers of patients are necessary to support the safety of th...
MMWR. Morbidity and mortality weekly report, 2017
By the end of 2014, a total of 955,081 persons in the United States (299.5 per 100,000 population) had received a diagnosis of human immunodeficiency virus type 1 (HIV-1) infection (1). The annual estimated number of HIV infections and incidence rate in the United States decreased from 2010 to 2014, and the survival rate has increased over time (1). Effective highly active antiretroviral therapy (HAART) is helping persons with HIV to live longer, healthier lives. Many of these persons, including an unknown percentage in discordant relationships (i.e., one partner is HIV-infected, and the other is HIV-uninfected), might wish to have their own biologic children. When the female partner is HIV-infected and the male partner is not, a discordant couple can undergo autologous sperm intrauterine inseminations to achieve conception without placing the man at risk for infection. However, for HIV-discordant couples in which the man is HIV-infected and the woman is not, strategies to minimize ...
PLoS ONE, 2011
The success of combination antiretroviral therapies for the treatment of human immunodeficiency virus (HIV) has resulted in prolonged life expectancy (over 40 years from diagnosis) and an improved quality of life for people living with HIV. The risk of vertical HIV transmission during pregnancy has been reduced to less than 1%. As a result of these breakthroughs and as many of these individuals are of reproductive age, fertility issues are becoming increasingly important for this population.