The world has come a long way in its attitude and approach towards people living with HIV. While there is still a lot of work to do especially in removing the stigma, the information concerning how to live a fulfilling life while living with HIV is far more readily available in the public domain. The wide spread use of antiretroviral therapy (ART) has seen a massive improvement in the quality of life for millions of people. Despite this, questions still linger about the options available for people living with HIV who also want to conceive. In years gone by, there was a lot of fear about the risk of transmission between partners during conception and to the baby conceived. I trust that by the end of this read, you will have a lot more insight about the options available to conceive in a manner that is safe for both partners.
According to UNAIDS (as of 2019), 19% of the South African population between the ages 15 and 49 are HIV positive. We highlight this because this is the reproductive age group. The first question we would like to answer is about what effect, if any, does HIV have on the fertility of an individual. Strictly speaking, the presence of HIV does not directly affect the fertility of an individual. However, the psychological impact of living with the virus can lead to stress for some people which in turn begins to affect the reproductive system. In addition to this, opportunistic Sexually Transmitted Infections (STIs) like gonorrhoea and chlamydia can also cause damage to the reproductive system. For the purpose of this article though, we wish to emphasize that HIV does not automatically make a person infertile.
There are basically two types of partners when it comes to HIV and conception. There are serodiscordant and seroconcordant couples. Serodiscordant means that one of the partners has HIV and the other does not. Seroconcordant means that both partners have HIV. As a general rule, no matter what category the partners fall in, it is recommended that all forms of other STIs be investigated and treated. This has been associated with a 40% reduction in HIV transmission for serodiscordant couples. For seroconcordant couples, the elimination of other STIs boosts the chance of fertility as other STIs can hinder fertility if passed from one partner to the other.
Now, for serodiscordant partners, there are a number of things which can be done to reduce the risk of HIV transmission while achieving conception. The list is not exhaustive but it will provide sufficient guidance and it goes without saying that professional consultation is necessary.
1) Male circumcision has proven that there can be a 66% reduction in transmission, so that is certainly worth implementation
2) Another way to reduce the risk of transmission is for the HIV negative partner to take pre-exposure ARVs before and during the period of trying to conceive. This needs to be combined with the HIV positive partner going on highly active ARVs to further reduce the risk of transmission. This has been associated with a 96% reduction in transmission especially if the HIV positive partner has been adhering to treatment and is virally suppressed. Virally suppressed in this instance means having less than 50 copies of HIV per millilitre of blood.
3) It is worth noting that if the positive partner is a woman, then the option of vaginal self-insemination is available. This means the semen can be collected from a condom and inserted by syringe into the vagina during the woman's ovulation period.
4) Serodiscordant couples can also have condom less sex during the time of ovulation if the positive partner is virally supressed and that too has been associated with up to 100% risk reduction in transmission.
5) If however, the male is HIV positive and there is fear about transmission through condom less sex, the sperm can be ‘washed’ in a fertility centre so that the sperm is ridden of cells containing the virus. The conception can then take place via intra uterine insemination (IUI) in a fertility clinic.
6) For couples that have other fertility challenges like ovulation problems or poor sperm quality and quantity or blocked tubes then the option of in vitro fertilization can work for them. They can go to a fertility centre where the eggs are retrieved from the woman and the sperm can be washed and then IVF be done or an intra intracytoplasmic sperm injection (ICSI) where the sperm and the egg are fertilized in the lab and the embryo gets transferred into the woman.
There was a study conducted in 2016 which proved that if the HIV positive partner is virally supressed (less 50 copies of HIV per millilitre of blood) and they are compliant with treatment, then there is not only a reduced risk but no risk at all of HIV transmission. This is known as the U=U theory which stands for Undetectable equals Untransmissible/Uninfectious. It is important to first be aware of your own status and that of your partner and then ensuring viral suppression should HIV be present by making certain that treatment is being complied with. Only after that can U=U be safely assumed.
In conclusion, there a number of options available and it is advisable that you consult your fertility specialist to find out which one is most appropriate for you. Safe conception is easily attainable with the correct support in place.
At Family Matters Fertility Centre, we have assisted multiple couples to start healthy families in the midst of HIV and you could be one of them if come through.
Unfortunately, as women age, their fertility declines. The biological clock is REAL. I’ve seen many women focused on climbing the corporate ladder to reach financial independence but, as they attend their routine gynae checks - a chat on starting a family reveals that many of them would love to be moms one day when circumstances allow. As I assess them, some of their sonars show that their eggs are depleting. My advice for them is to do a blood test (AMH) to check-in on their ovarian reserve. I explain this test to be like a petrol gauge that indicates to you the mileage you can cover. For a woman whose sonar reveals fewer follicles and AMH levels on the decline, it may be an indicator to focus the attention on plans of motherhood earlier than anticipated. Where fertility is concerned, ignorance is not bliss, but pain. A poor ovarian reserve means missing out on the chance of having a biological child. However, all hope is not lost as there is the option of egg donation as an alternative and others. So what do you do if you’re not ready to be a mom but would love to be one day? Either you haven’t met your Prince in shining armour yet, your career has just begun to skyrocket, or, your financial situation needs to add up first (as babies don’t come cheap they say). Then BANK your eggs - something I refer to as your FERTILITY INSURANCE or FERTILITY BACK-UP. As your eggs are aging or wasting away each month it slowly reduces chances of future motherhood. Since you’re not spending on nappies and the formula yet, why not invest in such a change towards your fertility insurance and freeze your eggs? This would ensure that in the case you run into a situation of delayed motherhood readiness for whatever reason and your eggs are depleted, there’s a viable plan B for your own biological child. Freezing eggs offers the advantage that after the age of 35 years of age the quality of your eggs would not be compromised and their age would remain not a day or a second older than the day you froze them. This means that even if you’re only ready for a baby at the age of 42, your fertility investment can be cashed in to give you the opportunity of the family you desire. At Family Matters Fertility Centre this is achieved with 3 components:
1. Our world-class technology in the fertility lab.
2. Highly skilled Team of Fertility Specialist doctor, embryologist, God Almighty and of course.
3. You and your lovely self.
For more information book a consultation with us today!
February is Fertility Awareness month. The month to answer a very intimidating question - am I fertile? Before reaching this conclusion there are several factors to consider. First and foremost, it's important to note that before you allow your imagination to run wild with the fear that you may be, you need to have been trying to conceive for at least 12 months. If after a year you and your partner have not conceived, don't fret there are a few other points to keep in mind:1. Are you over the age of 35? If so, as I'm sure you're well aware, your biological clock could be a possible reason for infertility. Studies have shown that women over 35 have a more difficult time falling pregnant compared to younger women due to the fewer production of eggs.
2. As the saying goes, it takes two to tango and, when it comes to infertility both partners should be tested in order to determine the cause. For men, it may be a sperm disorder that has gone undetected. We recommend giving you and your partner peace of mind by booking an appointment with us for a semen analysis. For R1200, we can confirm whether your sperm has the strength to swim upriver or, if they need a little boost. Either way, we're here to help you!
3. Babies are made in fallopian tubes. That said, if you're a female under the age of 35, that hasn't conceived after 12 months of trying to, an HSG test (an X-ray that can determine if your fallopian tubes need to be opened) can be done. Although this is not done at our centre, we can assist you to the best of our ability once you have received your results.
Finally, a word of encouragement - fear not! Here at the Family Matters Fertility Centre, we are capable and compassionate to walk this journey of conception with you offering you the option of IVF that we do at our on-site laboratory. If you'd like to book an appointment, please click the link below.
IVF stands for In-vitro fertilization. This means that instead of the meeting of egg and sperm (Fertilization)in the fallopian tube of the woman, the meeting is done in the laboratory where the woman's eggs are removed from the ovary and fertilized with the sperm from the man. The embryo then develops in the lab and is transferred into the woman’s womb after 3-5 days.
Naturally, the body releases one mature egg per month for fertilization. Ovarian stimulation involves the administration of medication to the woman which stimulates the ovaries to instead produce about 5 - 10 eggs during the menstruation cycle. The process takes about 8 - 12 days on average depending on the body's response.
During the process of stimulation with drugs, the ovarian response is checked/monitored by transvaginal sonar to confirm follicular growth by measuring the size of the ovarian follicles, the thickness of the lining of the womb and blood tests. Expected follicular growth is 18mm on average and the womb lining thickness of 8mm.
This is the process that involves harvesting the eggs from the woman’s ovaries into a petri-dish of the lab for assessment and fertilization. The woman is sedated with medication that makes her not to feel pain during the procedure. A sonar is done transvaginally to view the ovarian follicles well and a needle inserted with sonar guidance into the ovary. Suction is then applied to draw out as many eggs as available. The procedure takes anything between 10 - 30 minutes, depending on the number of eggs available and the position of the ovaries.
This is the fun part that takes place in the laboratory. If the quality of the sperm is good, then natural fertilization (IVF) is left to take place overnight where the sperm is poured over the eggs and courtship takes place between the two and the egg naturally selects the best sperm for itself. If there is abnormality in the sperm quantity or quality, then our very skilled embryologist is the one who analyzes (under a microscope) the sperm sample produced, then chooses the best looking, fittest, fastest guy to inject into the egg for fertilization. This process is called ICSI (Intracytoplasmic sperm injection).
All of the above procedures can be done here at Family Matters Fertility Centre, with staff that are competent and compassionate to assist you along the way.
Give us a call to book an appointment and begin your fertility journey.