Fertility Road Issue 03

FERTILITY ROAD | |IRTSA
NEW SCIENCE
REPRODUCTIVE
OPTIONS FOR
HIV-POSTIVE
PARENTS
By Lyudmyla Smahina, CEO
of International Reproductive
Technologies Support Agency.
The Invention of antiretroviral therapy has allowed
HIV-infected people to enjoy an active lifestyle for a
longer time and think about having children. Up-to-date
reproductive medicine has also highlighted this group
of patients. On top of that, long-awaited parenthood is now
possible not only for HIV-positive couples (one partner infected)
but for concordant parents (both partners infected) as well.
For an infected man, insemination or IVF with a donor sperm
is considered the safest. However, there is a problem of legal
limitations imposed on such practices in many European countries.
Also, it is often more intolerable for a man to recognize the absence
of genetic relation to a child than it is for a woman. If to consider
adoption as an alternative option then HIV infection complicates
the procedure or in some cases can make it absolutely impossible.
Other more reasonable ways tend to include various methods of
artificial fertilization depending on the reproductive health of a
couple. These cover intrauterine insemination (IUI), in-vitro fertilization
(IVF) or ICSI. The latter two methods are considered more
efficient as they eliminate close contact between an egg and a sperm.
Techniques for sperm clean-up represent distinctive feature of
the programmes. First inseminations using cleaned sperm cells
were performed in Italy (1989) and Germany (1991). From 1991
to 2003 application of these methods gave birth to 500 children.
Sperm washing is a term used to describe the process of cleaning
masculine germ cells from the virus as it is only the surface of the
sperm and not the sperm itself that is affected. Research has shown
that virus infects only plasma sperm, core cells and immobile
sperm cells. Mobile vital sperm cells are not infected. To detect
such sperm cells, sperm Is mixed with a special liquid with
high density. Then, it is divided into three elements and place
into a medical centrifuge. Adding salt solution results in the
emerging of active sperm cells on the surface which is then taken for
fertilization preceded by tests on the presence of the virus applying
high-sensitive methods (sensitivity threshold is 10 pattern/ml).
However, there is a possibility that HIV content in the material
can be lower than the sensitivity threshold. Therefore, one can
not guarantee that this method is 100% safe.
Unfortunately, the sperm washing method is not accessible in every
country. In Great Britain, there are only a few clinics that deal with
this, while France has recently approved the right of HIV-infected
people for IVF. The same law has been introduced in Italy
and Spain as well. In Germany this service is even included in
medical insurance while in Sweden it is completely controlled
and sponsored by the government.
As far as a HIV positive woman is concerned, there is a chance
of a so-called vertical virus transference from mother to a child
which is possible during pregnancy child delivery, and breast
feeding. In 25-40% of such cases HIV is transferred during gestation.
This becomes possible because of vulnerability of the placental
barrier in the result of which the virus can penetrate from
the mothers blood into that if the child.
According to the World Health Organisation a chance of vertical
transference amounts to 20-30%. Under conditions of special
nursing and feeding with milk mixtures the risk decreases to
2-5%. Less continual delivery as well as C-section operations are
also recommended for such obstetric patients.
Thus, the success of the programme depends on three factors:
antiretrovirus therapy, planned cesarean operation and artificial
feeding. However, such medical services are normally difficult to
receive. Many European medical centers offer IVF services only
for those couples where a man is an infected person. Significant
challenges are also faced by concordant couples.
It would be appropriate to note ethical, psychological and social
aspects of implementation and outcomes of highly mentioned
reproductive programs. Many people are curious how living with
one or two HIV-positive parents can influence the child. There
is no doubt that such couples will be very careful in their daily
routine doing their best to avoid any chance of infection.
For more information about
IRTSA’s services, please contact:
Phone: +38 (044) 223-51-13
E-mail: info@irtsa.com.ua
www.irtsa.com.ua/en
www.fertilityroad.com
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