Assisted reproduction in HIV and HCV infected men of serodiscordant couples

In serodifferent couples, there is a significant risk of sexual transmission of HIV, while the risk of transmitting HCV is minor. That said, the whole of the ejaculate is not necessarily infected and, therefore, hazardous. A careful dissection of its components by which motile sperm is separated and subsequently analyzed to verify the absence of viral elements could allow these couples a safer access to the reproductive process. The development in the field of assisted reproduction of new laboratory techniques and reliable tests for confirming the presence of both viruses in semen have led to the achievement of pregnancies while avoiding the infection of the seronegative partner and offspring. The system of detection is often performed by means of RT-PCR methods. These protocols are sensitive, but the presence of polymerase inhibitors in semen interferes with the reactions, yielding a high number of false negatives or undetermined results. HIV affects sperm quality only in the most advanced stages of the disease, while the fertility of asymptomatic or mild symptomatic patients is not affected by the disease. This review explores the possibilities offered by assisted reproduction and molecular biology techniques to HIV and/or HCV serodiscordant couples by which they may conceive children with the minimum risk.