Assisted Reproduction in Hiv and HCV Infected Men of Serodiscordant Couples

Abstract

In serodifferent couples, there is a significant risk of sexual transmission of HIV, while the risk of transmitting HCV is minor. That said, the whole of the ejaculate is not necessarily infected and, therefore, hazardous. A careful dissection of its components by which motile sperm is separated and subsequently analyzed to verify the absence of viral elements could allow these couples a safer access to the reproductive process. The development in the field of assisted reproduction of new laboratory techniques and reliable tests for confirming the presence of both viruses in semen have led to the achievement of pregnancies while avoiding the infection of the seronegative partner and offspring. The system of detection is often performed by means of RT-PCR methods. These protocols are sensitive, but the presence of polymerase inhibitors in semen interferes with the reactions, yielding a high number of false negatives or undetermined results. HIV affects sperm quality only in the most advanced stages of the disease, while the fertility of asymptomatic or mild symptomatic patients is not affected by the disease. This review explores the possibilities offered by assisted reproduction and molecular biology techniques to HIV and/or HCV serodiscordant couples by which they may conceive children with the minimum risk.

ICSI: Where We Have Been and Where We Are Going

“…Thus contamination presents potential challenges to a correct diagnosis. 63 Three quarters of individuals infected by human immunodeficiency virus (HIV) or hepatitis C virus (HCV) are in their reproductive ages. Male-to-female transmission of HIV is estimated to be 1 per 1000 acts of unprotected intercourse 64 and certainly higher than female-to-male transmission.…”

Decreased Semen Volume and Spermatozoa Motility in HIV‐1‐Infected Patients Under Antiretroviral Treatment

“…Several teams have developed medically assisted procreation (MAP) programs for serodiscordant couples with an HIV‐1‐infected male partner, which allow these couples to have children without infection of the female partner (Semprini, 1993; Marina et al, 1998; Gilling‐Smith, 2000; Guibert et al, 2001; Loutradis et al, 2001; Pena et al, 2002; Sauer and Chang, 2002; Marina et al, 2003; Ohl et al, 2003; Pena et al, 2003; Bujan et al, 2004; Garrido et al, 2004; Nicopoullos et al, 2004; Mencaglia et al, 2005). In these programs, spermatozoa are isolated from semen and usually tested for HIV‐1 nucleic acid before use in MAP.…”

Human immunodeficiency type-1 virus (HIV-1) infection in serodiscordant couples (SDCs) does not have an impact on embryo quality or intracytoplasmic sperm injection (ICSI) outcome

“…The small number of cases studied, compared with our previous studies regarding HIV-1 sperm washes (5,7,12), was due to the exclusion of those cases with severe male-factor infertility or those performed in other IVI centers. Moreover, women R37 years of age were also excluded, and oocyte donation cycles were also not considered.…”

“…In SDCs with the male infected, sperm wash has been demonstrated in both basic research (5,7,8) and subsequent clinical application (2-4, 6, 9-12) to be the most effective procedure to reduce semen HIV-1 load. Nevertheless, its efficiency is not absolute.…”

“…Success rates are considerably high, and consequently there is an important increase in the number of serodiscordant couples (SDCs) requiring assisted reproduction techniques (ART) (2)(3)(4)(5)(6).…”