Amidst the continuous rise of global HIV/AIDS patients, its treatment and transmission prevention has become pivotal in medical science. And with the advancement in HIV treatment and prevention facilities, couples or individuals with HIV have started realizing their dream of becoming parents without transmitting the disease to the child as well as to their partners.
Different treatment approaches are available for serodiscordant (one partner has HIV) or seroconcordant (both partners have HIV) patients to achieve pregnancy and live birth without transmission of HIV/AIDS to the child and their partners. For example, HIV medications (antiretroviral drugs) or PrEP can help to get pregnant through natural conception without spreading the infection to the other partner. Furthermore, fertility treatments are paired with HIV treatment for HIV-positive infertile couples to achieve pregnancy.
What is HIV or AIDS?
HIV, short for Human Immunodeficiency Viruses, is an infection that attacks the body’s immune system, enabling other life-threatening diseases or infections easy access to the body. It is also known as AIDS (acquired Immune Deficiency Syndrome). It can be transmitted from one person to another through blood, semen or semen fluid, vaginal fluid, rectal fluid, and breast milk.
Nearly 2.4 million people in India are living with HIV, and approx. Forty million people have HIV worldwide; among these, 2-3 million are young children.
HIV is less commonly known for infertility, but it indeed causes infertility in many HIV-positive individuals.
Is it possible for HIV patients to have children without HIV transmission?
Yes, HIV-positive patients can have children without the transmission of infection. In the past, HIV patients struggled with HIV without any viable treatment. At one point, they can’t even have unprotected sex without transmitting the infection to their partners, and they can’t even dream of a normal life, let alone dream of having their own children. However, in recent years the advancement in preventive measures for HIV has made it possible for HIV patients to live an ordinary life.
Antiretroviral therapy (HAART) has improved the life expectancy of HIV patients and also reduced the risk of transmission. Thus, fertility and HIV treatments can assist HIV patients in managing infertility to get pregnant and deliver an HIV-free child, respectively.
Fertility treatments for HIV-positive infertile couples
If an HIV-positive couple plans to have a child, they must keep the risk of transmission in mind. Almost Half of the HIV-positive couples are serodiscordant. Therefore during fertility treatment, the risk of transmission of infection to the HIV-negative partner should be minimized, and infection in the HIV-positive partner should also be reduced or controlled for preventive measures.
There are two scenarios for treatment;
- If one partner is HIV positive
- If both partners are HIV positive
Transmission Preventive Measures
When one partner has HIV, treatment such as HIV PrEP (pre-exposure prophylaxis) and TasP (treatment as prevention) can help prevent transmission of infection from HIV negative to HIV positive partner, respectively.
If both partners are HIV-positive, they have to have an undetectable viral load to avoid reinfection if they are trying for natural conception. For female HIV-positive partners, sustaining an undetectable viral load before and during pregnancy lowers the risk of transmission to the child upto 0%.
Now, couples can have scheduled unprotected intercourse during ovulation to maximize the chances of conception. This also means they can have condomless sex only during ovulation and not any other time because that’ll risk the HIV-negative partner for transmission.
If HIV-positive couples also struggle with infertility, effective fertility treatment can be planned according to the patient’s needs. Sometimes, HIV can cause fertility problems in both male and female partners. Before pursuing any fertility treatment, it is vital to diagnose the underlying infertility in both partners.
Fertility Drugs and Ovulation Induction
If a female partner has ovulatory dysfunction, ovulation induction with fertility drugs can stimulate and regulate ovulation in female partners. However, ovulation induction does not address all infertility issues in the couples, such as male factor infertility, tubal damage, poor egg quality, etc.
In case of complicated infertility, IUI and assisted reproductive techniques (ARTs) – IVF and ICSI with sperm washing are recommended for HIV-positive couples. ART fertility treatments are more secure in preventing the transmission of infection between partners as these fertility techniques do not involve natural methods of conception.
Intrauterine Insemination or Artificial Insemination (IUI)
In intrauterine insemination, the sperm sample is collected from the male partner and washed before transferring it inside the uterus. If an HIV-positive couple does not want to try natural conception and the male partner has mild male infertility (low sperm count and motility), then IUI treatment is best suited.
IUI treatment can entirely prevent transmission of HIV from one partner to another, whether one or both partners have HIV. If the male partner is HIV positive, the sperms are separated from the infected seminal fluid before artificially inseminating it inside the female uterus. If a female partner is HIV positive, she must maintain undetectable viral loads before and after conception.
In Vitro Fertilization (IVF)
In the cases where HIV-positive couples suffer from severe infertility, namely blocked or damaged fallopian tubes, low ovarian reserve, oligospermia, azoospermia, asthenozoospermia, etc., low-complexity fertility treatments IUI and ovulation induction are often not successful. In that case, more complex and advanced ART treatments, such as IVF, ICSI, IMSI, PGS, etc., are suggested to the patients.
In IVF, sperm and eggs are collected from the parents and fertilized in the laboratory, then the fertilized eggs (embryos) are placed inside the uterus for implantation. IVF is a more effective fertility treatment than IUI and helps with several infertility factors. In vitro fertilization is beneficial if one or both partners are HIV positive and the couple struggle with infertility. It completely prevents HIV transmission and also ensures pregnancy.
Donor Consideration
Assisted reproductive technologies allow HIV patients to opt for donor eggs, sperm or donor embryos to achieve pregnancy. HIV positive couples can also elect surrogacy with self gametes (eggs and sperm) as an alternative to completely omit transmission of infection from mother to the child.
Fertility Help for HIV-Positive couples at Risaa IVF
Risaa IVF has helped several infertile couples to achieve parenthood. We are proud to behold the highest IVF success rate of 40-58%. At Risaa IVF, we manage a multidisciplinary treatment approach for different patients and their medical needs. For HIV-positive couples, it is crucial to overcome infertility while also preventing transmission of HIV infection between partners and mother-infant. If you or your partner are HIV positive and want to be parents, it’s non-negotiable to consult HIV and fertility specialists in order to conceive cautiously without the transmission. Consult our experienced fertility experts regarding any fertility help.
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