Safe Conception for People Living with HIV

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.