Assisted reproduction techniques in HIV serodiscordant couples (the man is HIV positive and the woman is HIV negative) with seminal lavage

What is meant by “serodiscordant couples”?

A serodiscordant couple is considered a couple in which one of the partners is seropositive for the human immunodeficiency ivrus (HIV) and the other is negative. Thereby, it is necessary the use of a condom during sexual relations to avoid viral transmission to the healthy member of the couple. Therefore, they cannot have children naturally because of the risk of transmiting the disease.

What can be done to prevent the transmission of the infection to the fetus and since when?

The first births of healthy children of HIV serodiscordant couples in which the man was positive and had undergone seminal lavage techniques were published about 15 years ago. This is currently a widely extended technique that aims to release the semen from the viral particles capable of transmitting the infection.

When is seminal lavage indicated?

This technique is indicated in couples who wish to have children in which the male has HIV infection but has a stable clinical course and is well monitored. A medical report confirming this requisite is necessary.

To be included in this reproduction program, both members of the couple must fulfill the same requirements as those patients that are candidates to assisted reproduction techniques. Therefore, the woman must undergo the complete study and the man must have his semen analysed so as to evaluate the minimum quantity and quality of the spermatozoids. It must be considered that the “lavage” always reduces drastically the number of habile spermatozoid of ejaculated semen.

 

What is insemination with seminal lavage?

Women of serodiscordant couples are submitted to an ovulation stimulation treatment, which is exactly the same as in seronegative couples who undergo artificial inseminations. Therefore, a clinical and an echographic monitoring need to be carried out to establish the maturation of the ovarian follicles (which contain the oocytes). In this follow up the women’s HIV negativity is also checked and sexual relations are discouraged until the day of the insemination.

The doctor will stablish the optimum day in which different lavages will be performed in the seminal samples of the ejaculate with the aim of releasing the cells contaminated by the virus, as well as any residual viral particle. If the laboratory of virology confirms the negativity of the detection of HIV by PCR techniques in the final sample, the insemination will begin. In doubtful or positive cases, the insemination will be cancelled with total destruction of the seminal sample.

 

How many inseminations with lavage may be performed?

Three to six inseminations may be performed in these couples, based on medical evaluation in each case. If the desired pregnancy is not achieved on these attempts, IVF by intracytoplasmatic spermatozoid injection (ICSI) will be recommended. See section on “In vitro fertilisation”.

What is IVF with intracytoplasmatic spermatozoid injection (IVF-ICSI) in HIV serodiscordant couples?

A cycle of IVF-ICSI with seminal lavage is indicated in couples who have not achieved gestation by insemination or in cases in which sperm collection following the “lavages” is insufficient for insemination but sufficient for the correct evaluation of viral PCR. It is also indicated in serodiscordant couples that also consult for sterility.

In these cases, the lavaged spermatozoids are used later, making cryopreservation necessary. This allows the accumulation of “lavaged” and virus negative spermatozoid from several ejaculates in patients with low sperm quality. The IVF cycle does not differ from the cycles carried out by HIV negative couples.

 

Is there any risk of transmitting HIV infection?

Seminal lavage minimizes the possibility of transmitting HIV infection. However, although the risk is minimum, the impossibility of transmitting the infection cannot be guaranteed.

Are there other risks or secondary effects attributable to the lavage techniques?

No, there are not. Complications may appear very occasionally due to the assisted reproduction techniques (insemination or IVF), however, there is no relationship with the fact of having performed a seminal lavage.