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Preconception Counseling among HIV Serodiscordant Couples
Print [pdf 30kb] - Updated 8/2010
HIV positive woman with HIV negative male partner
Female-to-male HIV transmission likely occurs as a result of infection at either the base of the foreskin in uncircumcised men or via the urethra in circumcised men. Given the risk of HIV acquisition with unprotected vaginal sex, serodiscordant couples are encouraged to use safe sex and home insemination techniques in order to conceive.
Women who do not become pregnant within six months of this method may consider office intrauterine insemination (IUI) with either a known male donor/partner or a sperm donor (via sperm bank). If the sample is from a known male donor, the donor must undergo clinical evaluation and laboratory testing, including basic lab work and sperm analysis (number of viable sperm, motility, etc).
These services are available through University Reproductive Care (URC) at Roosevelt: Drs. Brenda Houmard and Kat Lin. The semen will be washed by the Male Fertility Laboratory under the direction of Dr. Charles Muller. They offer intra-uterine insemination (IUI), a procedure that should not be attempted without the assistance of an experienced clinician, given the risk of infection. The client meets with either Dr. Houmard or Dr. Lin, who conducts a general ob/gyn history and clinical exam that may includes some basic laboratory testing and further fertility testing and, depending on history, may include more extensive infertility assessment including serologic testing and a hysterosalpingogram.
For Natural Cycle IUIs, the client informs the URC staff of the first day of her menstrual cycle. On the day of her LH surge, the client calls the URC clinic to schedule an IUI the following day. Unlike intra-vaginal inseminations, IUIs are performed in a clinic setting with sperm that are prepared by the UW andrology lab from frozen samples or from a male partner.
The procedure is generally well tolerated. These services are available 365 days a year.
HIV positive man with HIV negative female partner
Male-to-female HIV transmission occurs via infection of endocervical or possibly vaginal epithelial cells. Women are thought to be at higher risk of acquiring HIV compared to men, possibly because of a larger vulnerable surface area and longer exposure to infectious semen. Unfortunately, there are no low-cost alternatives to allow for safer conception for these discordant couples.
We highly recommend close multi-clinic collaboration between: Madison HIV provider and University Reproductive Care physicians.
The most standard methods of attempting to conceive with an HIV-positive male partner include a few options that include:
A research study exploring more economical fertility options for HIV Discordance in male+/female- couples is ongoing at the University of Washington. This study is not enrolling human participants at this time but utilization of various separation procedures to yield a sperm specimen that is negative by PCR for the HIV virion. This specimen could theoretically be inseminated. This method, though theoretically ideal for discordant male+/female- couples, is not standard practice in the U.S. at this time.
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