Author: DrDurga G Rao, Co-Founder and Medical Director, Oasis Fertility
The immense joy and satisfaction of parenthood should not be denied to anyone. But in some couples, ethical issues arise and kill the desire to have a biological child.In the case of couples who are seroconcordant (both partners are seropositive) or serodifferent (one partner is seropositive and the other is not), the yearning for a childgets loaded with guilt, fear, uncertainty and hopelessness. The dream of parenthood is brought under control by the fears of infected women occurring during the process of conception or vertical transmission (of transfer of HIV from mother to child) ie during the period of delivery orduring the period of breastfeeding . So, should couples infected with HIV give up their dreams of having a biological child? Not necessary in today’s era of advanced medical care. New treatments and assisted reproduction techniques can help these couples become happy parents with healthy children.
Does HIV have an impact on fertility?
Globally, around 37 million people are infected with HIV, and nearly 80% of them are of childbearing age. Women with HIV are prone to gynecological diseases like pelvic inflammatory disease and cervical dysplasia, which can impact fertility or increase the risk of complications during pregnancy. Sperm motility, morphology is affected in the case of HIV positive men. In addition, hypogonadism, impotence, erectile dysfunction are observed more frequently in these men.
Can HIV positive couples conceive naturally?
Yes of course. Preconception counseling plays a crucial role as it helps the couple get a clear picture of the risks involved as well as the possible outcomes. If the male partner is HIV positive while the female partner is unaffected, the male partner would be advised to take antiretroviral therapy to reduce the viral load, and the female partner may opt for PrEP (pre-exposure prophylaxis) for protect against transmission. The couple are advised to have unprotected sex only at the time of ovulation.This method will help many couples who have normal ovarian reserve without tubal pathology and normal sperm setting to conceive naturally. In addition, children born to them have a very high chance of being HIV negative. PrEP is another new treatment process that may be of benefit, but we must wait and watch. If only the woman is HIV-positive and her husband is HIV-negative and his viral load is undetectable, she may attempt a pregnancy by self-insemination at the time of ovulation. Elective cesarean delivery, neonatal prophylaxis and breastfeeding avoidance have been shown to reduce mother-to-child transmission. If the pregnancy is not achieved, the couple can opt for assisted reproduction techniques.
Fertility treatment options for HIV positive couples:
Medical advances have resulted in a significant increase in the life expectancy of HIV-positive patients and, therefore, their desire for children must be supported.
The assisted reproduction technique is the best and safest method that can prevent the sexual transmission of the disease. If a man is HIV positive, a sperm washing technique is used which largely eliminates the risk of transmission, after which IUI (Intrauterine Insemination) or IVF (In Vitro Fertilization) / ICSI (Intracytoplasmic Sperm Injection) is done. Seroconversion was not observed in the female partner and neonatal transmission was absent when viral loads in HIV-positive men were undetectable. The HIV -1 RNA test on the semen sample can also detect very low viral loads which may be undetectable in the blood sample. The importance of the presence of viral RNA in a semen sample on the risk of transmission is not very clear.
Fertility treatments help minimize the risk of transmitting HIV, thereby helping couples to become parents. But several obstacles prevent HIV-positive couples from accessing reproductive health technologies. The main intention of advanced fertility treatment is to provide safer pregnancy and childbirth options for couples with HIV.
fertility centers must follow strict guidelines when handling specimens from HIV couples through laboratory decontamination, waste disposal, and taking all necessary precautions, such as handling and storage of specimens from infected individuals in a dedicated area.
As the saying goes, “Knowledge is power”, people infected with HIV have a right to know about possible treatment options, the risks involved, and so on. that can help them make informed decisions about their reproductive desires. Adoption is also one of the options that can bring the joy of parenthood into their life!