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Assisted Reproduction Works for HIV+ Men

But Techniques Less Likely to Work in Women Who Have HIV
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WebMD Health News

May 28, 2003 -- Men with HIV infection have a good chance of fathering a baby via assisted reproduction. But assisted reproduction isn't nearly as likely to help HIV-positive women get pregnant, a French study suggests.

Can couples safely have a baby if one member has HIV infection and the other doesn't? It's very risky for such couples to have unprotected sex. But that doesn't mean they can't have a healthy baby -- at least if the man is the one who's carrying the AIDS virus.

"Sperm washing" techniques make it possible to get undetectable levels of HIV in sperm from a man. Using assisted-reproduction techniques, that safe sperm can be used to make his partner pregnant. Women risk passing HIV to their child in the late stages of pregnancy or during labor. But antiretroviral drugs and C-section make this risk very small.

How well does assisted reproduction work for such couples? Jeanine Ohl and colleagues at the Centre d'AMP de Strasbourg, France, took a look. They tried to help 57 couples -- 47 in which the man had HIV, and 10 in which the woman had HIV.

Intrauterine insemination (where the sperm is placed in the uterus) didn't work well for any of the couples. But in vitro fertilization (fertilization of the egg and sperm outside the body and then transferred into the woman) or intracytoplasmic sperm injection (injecting an egg with a single sperm) worked very well for couples where the male was HIV positive. These techniques resulted in pregnancy for half of all embryo transfers. None of the women acquired HIV infection from their infected male partners.

On the other hand, fewer than one in 10 embryo transfers involving HIV-positive women resulted in pregnancy with these assisted-reproduction techniques.

What's going on? None of the men had fertility problems. And their partners were younger than the HIV-positive women seeking pregnancy. Many of the women in the study waited years for reproductive assistance, which only recently became legal for HIV-positive women in France. Also, women with HIV infection are susceptible to genital infections that can cause fertility problems.

"Some research has found evidence of premature ovarian failure in [HIV] infected women, although this would need confirming in a larger study," Ohl says in a news release. "On the other hand, in developing countries, young infected women become pregnant easily. We have to determine whether the virus has created an additional negative factor. Perhaps 'at home' inseminations could be advised if the couple is very young."

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