Oct. 26, 2000 -- Should doctors help people with HIV have babies -- even if there is a slight risk that the infected man's sperm could infect the woman and child with the AIDS virus? Washing the sperm of a partner to prevent HIV transmission is gaining acceptance in Europe, but not typically in the U.S.
Sophisticated tests now show that there is no detectable HIV in the processed sperm, according to studies reported at this week's annual meeting of the American Society for Reproductive Medicine. Sperm washing was first performed in 1989, and the oldest child conceived via the procedure is now more than 11 years old. That child, his mother, and more than 350 other similarly conceived children and their mothers all remain free of HIV. So far, not one person has become infected in more than 3,000 sperm-washing procedures.
But there is a difference between no detectable HIV and absolutely no HIV at all. Thus the controversy: Should a doctor perform a procedure that carries even a small risk of infecting a patient with HIV?
Louis Bujan, MD, presenter of one of the studies, argues that it is wrong to refuse. "It is very important to offer these patients help to conceive a child, because if they choose to conceive without medical help, they are at high risk of HIV transmission," he tells WebMD. "If the physician refuses to help the patient, he is perhaps responsible for this transmission."
Augusto E. Semprini, MD, presenter of another study, was the first physician to offer sperm washing. "It has been a big, big fight," he tells WebMD. "Even someone with a very compromised status can try on his own to have a child -- so I think I have a duty to intervene. I don't have the right to refuse assistance. I see it as highly ethical," says Semprini, professor at Italy's University of Milan.
The principle behind the procedure is simple: HIV infects some of the cells found in semen, but it can't infect sperm itself. So a semen sample from an infected man undergoes two processes: first, the semen is spun in a centrifuge to separate out the sperm. Then the concentrated sperm is forced to swim through a gel, effectively washing them and leaving all HIV-contaminated material behind. Half the sperm is then tested for traces of HIV. If it tests negative, the other half is inseminated into the woman.
In the U.S., Semprini's group has worked with Deborah Jean Anderson's team at Brigham and Women's Hospital in Boston, which first raised the question of whether sperm could carry HIV. Anderson colleague Alison Jane Quayle, PhD, tells WebMD that she advocates the procedure for HIV-discordant couples -- in which the man has HIV but the woman doesn't -- who very much want to have children.
"I would say go ahead," Quayle says. "I have talked to discordant couples who are desperate to have children, and you can't say 'no' to everything. You have to give them something that is practical. If I know they are going to go out and have unsafe sex, it would be a very good idea to offer them sperm washing."
The assisted-pregnancy procedure is now available to some in England, France, and Spain. It soon will be available in Switzerland -- but not in the U.S. because of concerns that HIV could theoretically escape attempts to flush it away.
"In science, you can never say 'never' -- sometimes a bit of HIV might stick to the sperm, but we have never seen it," Quayle says. "In culture work, molecular work, and microscopy, we have not been able to find an association between HIV and sperm."