HIV prevention. Assisted reproduction in HIV-discordant couples

Serodiscordant couples in whom the man is HIV-1-positive and the woman is negative have limited options if they wish to have children safely, because sexual intercourse carries a 1-in-500 risk of transmitting virus in semen to the female partner. Sperm washing is a risk-reduction option in which infected sperm are washed free of virus before insemination into the female partner at the time of ovulation. Absence of detectable HIV is verified before insemination using a polymerase chain reaction nucleic acid-based sequence amplification assay. Pregnancy rate per insemination is 14%, based on a European experience of more than 2000 inseminations; to date, there have been no seroconversions in either mother or child. Washed sperm have also been used in other assisted conception treatments, such as in vitro fertilization. In the United States, the CDC has recommended against insemination of women with semen from men infected with HIV. Current data from programs in Europe would suggest sperm washing to be a safe risk-reduction option for heterosexual couples wishing to bear a child. We suggest that sperm washing should only be carried out in dedicated units using a multidisciplinary approach to ensure that couples receive adequate preconceptual counseling, detailed sexual health and fertility assessment, and careful monitoring of the woman's HIV status during treatment and pregnancy.