Semen specimens are analyzed for detectable viral burden.
WASHINGTON, D.C.—HIV infection in men need not be a barrier to fatherhood, according to new findings presented here at the American Society for Reproductive Medicine annual meeting.
Testing semen for HIV can eliminate specimens with a detectable viral burden and allow couples to proceed to assisted reproductive technology (ART) without transmitting HIV infection to mothers or infants, researchers at Harvard Medical School in Boston conclude.
Anne Kiessling, PhD, and her colleagues looked at pregnancy outcomes using sperm from HIV-infected men. Their study included 668 semen specimens from 262 HIV-infected men. A total of 107 semen samples tested positive for HIV and were discarded. Men with two consecutive positive specimens were further evaluated for prostatitis or for modification in their anti-retroviral therapy.
Specimens with undetectable viral loads were washed, frozen, and shipped to the patients’ infertility centers for use in ART procedures. Most couples underwent in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI), but some conceived following insemination with the Oligospermia Cup (Milex). A total of 151 couples proceeded to ART. By the end of 2006, 69 pregnancies had resulted. Sixty-two babies were born—10 sets of twins and 42 singletons. All mothers and babies tested negative for HIV antibodies.
“The goal of this program was to prove the principal that HIV disease should be treated as any other male factor infertility,” said Dr. Kiessling, an associate professor in the department of urology. “We found that you can safely eliminate the specimens that have virus in them and just use sperm from specimens that are undetectable for virus.”
HIV blood test is not a reliable predictor of viral burden in semen, she said. Studies have shown that, in HIV-infected men, semen-producing tissues are a separate compartment of HIV infections. As a result, semen viral burden is different from that of blood.
“The trick is in the testing,” she said. “We have found that men who have been on successful antiviral therapy may have an undetectable burden in blood, but from time to time they still shed some virus in semen specimens. It is very inconsistent.”
Steven Ory, MD, immediate past president of ASRM, said these findings show that HIV infection need not prevent fatherhood. “Assisted reproduction for patients living with HIV has been shown to be safe when the correct protocols are followed. It is very encouraging to see also that HIV does not cause damage to sperm’s DNA,” said Dr. Ory, who is with IVF Florida Reproductive Associates, Margate, Fla.