ART May Allow HIV-Infected Men to Father Children Without Infecting Their Partners

Laurie Barclay, MD

May 30, 2003

May 30, 2003 — Assisted reproductive technology (ART) may allow HIV-infected men to father children without risking infecting their partners, according to the results of a study published in the June issue of Human Reproduction. But in this study, ART was rarely effective in HIV-positive women.

"I was very pleased by the good results for men, but surprised at the poor results for women, which I did not expect," lead author Jeanine Ohl, from Centre d'AMP de Strasbourg in France, says in a news release. "One explanation may be that the men did not have any fertility problems but the women did. The women were significantly older than the partners of the seropositive men and some had waited a long time for this treatment, which only became possible because of changes in the law in France two years ago."

This French decree extended permission to offer ART to serodiscordant couples in which the woman is infected with HIV. Although rules on treating HIV-positive patients differ in different countries, several countries allow ART for HIV-positive men, but few allow it in infected women.

For HIV-positive men with HIV-negative partners, Dr. Ohl's group washed the sperm using two successive techniques to separate motile sperm from semen, and they inseminated the women only with sperm that tested negative.

Among 57 serodiscordant couples, 12 of 39 in which the male was infected parented a total of 14 children, and none of the women partners converted to HIV-seropositivity. Injection of the egg with a single sperm (ICSI) was the most successful ART technique, resulting in pregnancies in 48.8% of all transferred embryos. In-vitro fertilization was less successful, and eight attempts at intrauterine insemination (IUI) did not result in any pregnancies.

Of the 10 HIV-positive women treated, only one became pregnant, which Dr. Ohl attributed to possible premature ovarian failure. Treatment is ongoing for 37 couples, and her group is planning an observational study of ovarian function in HIV-positive women. Although some studies provide evidence for premature ovarian failure in HIV-infected women, young infected women in developing countries become pregnant easily.

Dr. Ohl points out that more than half of those infected with HIV are of child-bearing age, and that thanks to progress in treatment, infection often does not progress beyond a chronic stage.

"Patients can thus make life plans and even envisage having children. This pressing desire for children is legitimate and any other conclusion would discriminate against these patients," she says. "A cultural revolution is taking place, especially in the medical profession."

Hum Reprod. 2003;18:1244-1249

Reviewed by Gary D. Vogin, MD

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