HIV-positive intended parents

After the invention of antiretroviral therapy HIV-positive people can lead a long active life. Naturally, lots of them do not consider having children, but modern reproductive medicine does not leave this category of patients aside. Moreover, nowadays not only discordant couples (one of the partners is infected), but also concordant ones can make their dream of the child come true. 

In case of infectious male partner, the safest method is the IVF with donor`s oocytes. But here the legal problem occurs in many European countries. Needless to say, that men usually percept the absence of genetic relation to the child more acute. Regarding the variant of adoption as a possible option, the disease of even one of the couple makes it often impossible. 

The other more acceptable methods are different methods of artificial insemination, the usage of which depends on the state of the couple`s health. IVF + ICSI and the further transfer of the embryos to the uterus, while the sperm is preliminary cleared, is the safest method. The first insemination using the cleared sperm was conducted in Italy in 1989 and in 1991 in Germany. From 1991 till 2003 500 children were born by means of using such technique. No cases of contamination were detected.

The clearance of sperm involves the clearance of the male sex cell from virus, as only the surface of the sperm is lesioned. In fact, ejaculate consists of spermoplasm, nuclear cells and the sperms themselves. During research, it has been stated that only the first two components as well as inactive sperms are contaminated. Movable active sperms never have the virus. In order to derive such sperms, the ejaculate is mixed with special high-density solution and is placed in a sedimentator, where the sperms, nuclear cells and testicular fluid lay down in 3 layers. Afterwards the natrium solution is added that causes the lift of the active sperms to the surface. 

This layer is taken for the insemination and still tested before. There is no possibility to exclude, that the level of HIV virus can be under sensitivity level, so the method is still not 100% safe, but reduces risk almost to zero. One extra condition of safety is low level of the virus in sperm in general. Cryopreservation is not recommended as well because of the quality of sperm which leaves much to be desired. 

Unfortunately, this method is available not in every country. In Great Britain, for example, only several clinics deal with it, France has recently consolidated the right of HIV-infected patients for the artificial insemination, the same is in Italy and Spain. In Germany, such service is included in medical insurance policies of several companies, in Sweden these programmes are totally controlled and financed by the government. 

The main issue with the HIV-positive woman is the possible decrease in fertility. But if this factor is excluded, the woman can conceive with the help of sperm injecting to the reproductive tracts. If the problems exist, (according to the research data, reproductive decrease occurs much more often with HIV-positive women), it is more effective to conduct the IVF with ICSI. The stimulation of the ovaries is highly recommended as well. 

Speaking about pregnancy of such patients, there is a risk of vertical transmission from a mother to a child, that is probable during the pregnancy (through the placenta), delivery (during labour) and breastfeeding.  In 25-40% of cases the virus is transmitted in the period of gestation. The risk is growing with the presence of other infections, because of malnutrition, harmful diet, smoking, taking drugs. During the labour, the contamination takes place in 60-75% of cases, when mother`s blood contacts with the skin and mucous coat of the baby, especially because the obstetric interference. 

According to figures from the World Health Organisation, the probability of vertical transmission makes 20-30%. Under the conditions of proper care and feeding with milk formula, this risk decreases in 2-5%. Oxytocia and caesarean section are also recommended to such patients.
If the HIV is detected during the pregnancy, the retroviral therapy is prescribed. Due to the presence of mother`s antibodies, it is sometimes difficult to detect the virus of the child at an early stage, that is why the test is done in 3, 9, 12 and 18 months after the baby`s birth. Therefore, the successful outcome of this program depends on 3 factors: antiretroviral therapy, planned caesarean section and formula feeding. 

Thus, these medical services are not easy to get. Lots of medical centres offer the service of extra corporal fertilization for discordant couples, but unfortunately HIV-positive women not always can get help in the reproductive clinic. So, the services of the oocyte donor and a surrogate are mainly the only reasonable options for such intended parents, as despite of such successful results, even the thorough care after the HIV infected pregnant woman does not guaranty complete safety. Moreover, high prices do not contribute to their usage as well.