Aide médicale à la procréation chez les personnes infectées par le VIH

Prevention of HIV transmission with sperm washing within fertile serodiscordant couples undergoing non-stimulated intrauterine insemination

The purpose of this prospective non-randomized study was to study the effectiveness of semen washing followed by intrauterine insemination (IUI) in Human Immune Deficiency Virus (HIV)-discordant couples in which the male partner was infected, in preventing HIV transmission to uninfected partner and offspring. The study was performed in a private assisted reproductive center specialized in couples with infectious diseases and enrolled sixty-nine fertile couples in which male partner tested positive for HIV, seeking for reproductive treatment. Triple sperm washing followed by viral RNA purification and real-time polymerase chain reaction was performed prior to IUI intervention. HIV transmission to female partner and newborns, and clinical pregnancy rate were the main outcome measures. A total of 180 IUI treatment cycles were performed in 69 couples. There were 16 clinical pregnancies (clinical pregnancy rate/cycle 9.0%, clinical pregnancy rate/patient 23.2%), one of which resulted in miscarriage (6.3%). No seroconversion was detected in the 69 women treated with sperm washing followed by IUI or in any of the newborns (tested at birth and at 3 months of age). Sperm washing followed by IUI is a safe and effective treatment option for serodiscordant couples wishing to conceive and to prevent HIV virus transmission to the mothers and newborns.

Safe conception for HIV-discordant couples: insemination with processed semen from the HIV-infected partner

OBJECTIVE

The objective of the study was to evaluate the safety of semen washing with intrauterine insemination (SW-IUI) for achieving pregnancy when the man is human immunodeficiency virus (HIV) infected and the woman is HIV negative.

STUDY DESIGN

We conducted a retrospective analysis of 635 HIV-discordant couples enrolled in a SW-IUI program and followed up 367 Italian women. We computed pregnancy, live birth, and multiple delivery rates and assessed the women's postinsemination HIV status.

RESULTS

The retrospective analysis included 635 couples (2113 SW-IUI cycles): 41% of the women (95% confidence interval [CI], 37-45%) had a live birth (per-cycle live birth rate 13%; 95% CI, 11-14%). HIV status after SW-IUI was negative when available but unknown for 26% of the women: missing HIV status was not associated with correlates of HIV risk. The follow-up study included 367 couples (1365 cycles): 47% of the women (95% CI, 42-52%) had a live birth (per-cycle rate 14%; 95% CI, 12-16%). Ascertainment of postinsemination HIV status was complete and confirmed no HIV transmission attributable to SW-IUI. The upper 95% confidence limit of the HIV transmission rate was 1.8 per 1000 cycles in the retrospective analysis and 2.7 per 1000 cycles in the follow-up study.

CONCLUSION

SW-IUI appears to be a safe and effective method for achieving pregnancy in HIV-discordant couples in which the man is HIV infected.

Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada

The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.