San Francisco, California – Many of the estimated six million people in the US infected with HIV, Hepatitis B (HBV) or Hepatitis C (HCV) are of reproductive age. Those desiring to have children and minimize the possibility of passing their virus to their offspring need access to specialized advanced reproductive technologies.
Researchers at Texas Tech University Health Sciences Center found that while services are available, they are most likely to be delivered at larger clinics. To gauge availability, they sent a survey to 370 assisted reproductive technology (ART) programs listed on the website of the Centers for Disease Control. Forty-seven programs responded, with 13 reporting that they offered no services for patients infected with HIB, HBV, and HCV. Seven more clinics did not treat patients with HIV. Generally, the clinics which did not offer treatment options for virally-infected patients were smaller and cited a lack of appropriate equipment.
In Canada, HIV positive couples and individuals have access to advanced reproductive technologies at more than half of fertility clinics; but the more technically demanding the service, the more difficult it is to obtain.
Mark Yudin, MD and his colleagues in Toronto sent surveys to all 28 fertility clinics in Canada. Twenty responded, with 16 clinics being willing to serve HIV-positive patients, four unwilling.
Of the 16 clinics, 12 had seen one or more HIV-positive male or female in the previous year. Sixty percent of clinics responding (12/20) offered intrauterine insemination (IUI) when the woman was HIV-positive and donor sperm for HIV-positive females – 30% (6/20) offered sperm washing for HIV-positive males – and 20% (4/20) offered IVF for couples with an HIV-positive female.
In New York, doctors at Columbia University report on their successful multidisciplinary approach to providing IVF for HIV-positive women. Before starting ovulation induction, patients are required to go through an extensive evaluation of their disease and overall health, a psychosocial evaluation, and a consultation with a specialist in Maternal Fetal Medicine who has a special interest in HIV. The program has also adapted its surgical and lab protocols to isolate potentially infectious tissues, using a separate operating room for retrievals, and removing granulosa cells that surround the eggs which can harbor blood.
Forty patients, from 27 to 42 years old, who had been diagnosed with HIV an average of 7 years earlier, were evaluated – 25 were treated. Most were on highly active antiretroviral therapy and their HIV levels were undetectable prior to starting fertility treatment. Of the eight women who had ovulation induction and IUI, four became pregnant and delivered babies. Seventeen women had IVF with 10 becoming pregnant and seven delivering; three of the IVF pregnancies ended in miscarriage. All of the babies, tested at birth, three months and six months are HIV-negative.
David Adamson, MD, President of ASRM remarked, “For most patients HIV is a manageable, chronic disease and HIV- positive men and women live full lives which can include the joys of parenthood. The Columbia program is a good example of what can be achieved when reproductive specialists partner with their colleagues in maternal-fetal medicine and infectious disease specialists. With the participation of all of these specialties, we can help patients become parents and prevent the transmission of virus to infants.”
The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 8,000 physicians, researchers, nurses, technicians, and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, The Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, and the Society of Reproductive Surgeons.