HIV is a serious but manageable chronic disease that affects people of all ages, but the largest groups affected are people of reproductive age, many of whom express a desire to be biological parents. The potential for HIV-infected persons to live long and healthy lives, have uninfected children, and not transmit the virus to their partners has resulted in increasing numbers of individuals to seek out optimal means for creating biologic families. Transmission of the disease to the partner and offspring is a major concern. However, treatments for HIV can now limit the risk of viral transmission to the uninfected partner and baby.
So although you have HIV, it is still possible for you to have a healthy pregnancy, and for your baby to be healthy and HIV negative.
Planning to get pregnant
If you are planning to become pregnant, it’s very important to find out how you can reduce the risk of passing HIV on to your baby and to ensure you have a healthy pregnancy.
For an HIV-positive woman and an HIV-negative man: If the woman is HIV positive, but her partner is HIV negative it is possible to become pregnant without risking HIV transmission through intrauterine insemination/artificial insemination (IUI/AI).
For an HIV-positive man and an HIV-negative woman: HIV and antiretroviral therapy can cause some males to have sperm abnormalities, including low sperm count, low motility, and low volume. Sperm washing is the safest way for an HIV-positive man to biologically father a child with his HIV-negative partner. Sperm washing is used to separate the seminal fluid, which contains HIV, from the sperm, which do not contain HIV. Once the sperm sample has been ‘washed’, it can be used in a range of fertility treatments. The simplest of these is IUI/AI where the washed sperm is placed into the uterus around the time the woman is ovulating. If the woman has any difficulty in conceiving, or if her partner has a low sperm count, the washed sperm IVF (where the eggs are inseminated with washed sperm in a laboratory) or ICSI (where the sperm are injected directly into the egg) will be recommended.
The likelihood that you will become pregnant after sperm washing depends on many factors (including your age, your overall fertility and the technique used to implant the sperm), but the sperm washing itself does not reduce the chance of any technique working. Although it can’t be guaranteed that no HIV remains, sperm washing is considered very safe.
Risk of passing HIV to the baby
Without any treatment or care, the chance of a woman with HIV passing it on to her baby is between 35 and 40%. With the right treatment and care, this risk can be much reduced to a substantially lower number, in some cases to less than 2%.
HIV-infected women need to be actively treated with antiretroviral drugs to reduce the risk of transmission to the baby. Treatment reduces the viral load so that the baby is exposed to less of the virus while in the womb and during birth. Some anti-HIV drugs can also cross the placenta and enter your baby’s body where they can prevent the virus from taking hold. This is also why newborn babies whose mothers are HIV positive are given a short course of anti-HIV drugs (this is called infant post-exposure prophylaxis, or infant PEP) after they have been born.
To avoid passing HIV to your baby, your gynaecologist may recommend you have a pre-labour caesarean section. This is because there is an increased risk of you or your baby developing an infection after your waters have broken.
After your baby is born
For the best chance of preventing HIV, your baby will need to take HIV treatment for a short period after he or she is born. This is sometimes called infant post-exposure prophylaxis, or infant PEP. What sort of treatment your baby has will depend on the HIV treatment you have taken during your pregnancy.
Your baby will be tested for HIV several times in his/her first 18 months. The first time will be a few hours after your baby is born, and then again at six weeks old and at 12 weeks. These first tests are looking for the virus itself to see if it is present in the baby’s blood. If all these tests are negative, and you are not breastfeeding your baby, you will be told your baby is HIV negative (does not have HIV) at 12 weeks.
Finally, your baby will have an antibody test at 18 to 24 months. HIV antibodies (proteins that are produced by our body in response to infections) are passed from mother to baby via the umbilical cord during pregnancy. This is not the same as HIV being passed on, and does not mean your baby has HIV. These antibodies can last for up to 18 to 24 months, so testing the baby at 18 to 24 months is the final confirmation that your child does not have HIV.
If your baby is diagnosed with HIV, your baby will be referred to a specialist clinic for children with HIV, so he or she can receive the care they need. They will be given antibiotic treatment to stop them developing PCP, a type of pneumonia (this is often referred to as PCP prophylaxis).
To avoid passing HIV to your baby, it is safest to formula feed because breast milk can contain the virus.
HIV and Fertility Treatments at Medfem Fertility Clinics
All patients presenting at Medfem Fertility clinic are required to undergo HIV testing.
Medfem works with a limited number of external facilities that deal specifically with infertility treatments for HIV patients. The treatment of infertility in HIV affected people requires specialised laboratory facilities and as such we only work with clinics that adhere to international best practises.