Fertility treatments can be done safely and effectively in couples where the man is infected with the Aids virus and the women isn't, according to a new review of past studies.
Over the last 2 decades, researchers have improved methods of "washing" the semen of men infected with HIV.
"I think the procedure is getting safer and safer," said Dr Deborah Anderson of Boston University School of Medicine. She was not involved in the current research, but she said that washing the man's semen lowers the risk of transmission enough that "it's an acceptable ... procedure for couples that really want to have children."
In the new review, published in an issue of Fertility and Sterility, researchers from the Evandro Chagas Clinical Research Institute in Rio de Janeiro, Brazil, looked at 17 earlier studies involving a total of about 1,800 couples in which only the male partner had HIV.
In each of the studies, researchers performed either intrauterine insemination (IUI) or in vitro fertilisation (IVF)/intracytoplasmic injection (ICSI) after washing the semen. Then they recorded pregnancy rates per cycle after the procedures. They also monitored the women and any babies for seroconversion.
About a third of the women had IVF/ICSI. Ultimately, roughly half the women became pregnant, and about 80 to 85% of the pregnancies resulted in the birth of a baby.
The success rates for pregnancy were comparable to that shown in other studies of fertility treatment in couples without HIV. If anything, couples in the current study may have been more likely to get pregnant using fertility treatments because many of them had no underlying fertility problems, the authors say.
None tested positive
None of the women in the study, or babies that were born after fertility treatments, tested positive for HIV. However, in a few of the studies in which researchers tested semen after it was washed, between two and eight of every 100 samples tested positive for HIV - indicating that it still may be possible, if unlikely, for the virus to be passed either to the woman or to the foetus.
However, the findings are "very reassuring," according to Dr Elizabeth Ginsburg of the Brigham and Women's Hospital Centre for Reproductive Medicine in Boston.
Dr Ginsburg, who was not involved in the study, said that even if some of the samples did test positive for HIV, the amount of the virus was probably so small that it wasn't likely to be passed to the mother or baby.
Not a common procedure
Despite mounting evidence of its safety, fertility procedures are not very common in HIV serodiscordant couples. In part that's because the procedures aren't often covered by insurance, Dr Ginsburg said. Although some fertility procedures may be as inexpensive as $1,000 (about R6,800), others run many times higher.
"One of the things that is a shame is that when couples can't afford fertility treatment, they're stuck with the other option, which is having timed intercourse, and that puts the woman at risk," Dr Ginsburg said.
Dr Anderson said a new option for these couples might become available in the future -- medications that the woman can take to avoid getting the virus from her partner who has HIV. And "if the mom doesn't get it, the baby's not going to get it," she said. "I think that's going to be the future of this field."
So far, only a couple of early studies have been done on the drugs' effectiveness at preventing transmission of the virus, and for now, Dr Anderson said, fertility treatment is the safest possible option for these couples.
(Reuters Health, Genevra Pittman, March 2011)
Fertility and pregnancy