Should HIV discordant couples have access to assisted reproductive technologies?

Spriggs, Merle; Charles, T

doi:10.1136/jme.29.6.325

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…With optimal management, the prospect for child rearing appears realistic. Given the recent statements that HIV-1 infection should not serve as a sole contraindication to assisted reproduction, 1,2 in addition to mounting opinion in the field favoring fertility treatment for HIV-1-infected patients, 10,24,25 biases against providing assisted reproduction to HIV-1-seropositive patients appear to be gradually weakening. A permissive attitude toward providing reproductive care to HIV-1-seropositive patients recognizes the autonomy of infected individuals, some of whom would assume risks to attempt to conceive naturally in the absence of reproductive assistance 13 ; additionally, it protects the welfare of the uninfected partner and the offspring, who may be at a higher risk of infection if assisted reproductive services were not available.…”

Section: Discussionmentioning

confidence: 99%

Deaths of HIV-Positive Men in the Context of Assisted Reproduction: Five Case Studies from a Single Center

Nakhuda

Peña²,

Sauer³

2005

AIDS Patient Care and STDs

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Provision of reproductive services to individuals infected with HIV-1 is gaining popular acceptance and is generally endorsed by specialists in reproductive medicine. In the situation in which the male is HIV positive and the female partner is not infected, a large body of evidence has demonstrated that the use of assisted reproductive technology is effective for achieving pregnancy, while eliminating the risk of viral transmission to the mother and fetus. No reports have documented the well-being of the HIV-infected partners subsequent to seeking fertility services. In the current report, we document the cases of five HIV-positive men who died secondary to complications of HIV infection shortly after participating in the assisted reproduction program for HIV-1-serodiscordant couples at Columbia University. Three of these couples successfully achieved pregnancy and live birth, including one set of triplets, and one case of posthumous conception; the fourth case resulted in the cryopreservation of all embryos after the sudden death of the male before the time of embryo transfer; the fifth couple failed to conceive. None of the deaths, which occurred within a few months to 2 years from initial consultation, were related to infertility treatment. The demographic and social statuses of these patients were not different from the general population of men seeking assisted reproduction in our clinic. Regarding the HIV infection status of these cases, three patients had a longer duration of infection compared to the general population of men in our cohort, and one had a significantly lower CD4 cell count. All five men had stable HIV viral loads, and were determined by their primary care providers to be clinically healthy at the time of entry into the program for assisted reproduction. The untimely deaths of these patients underscores the importance of the thoughtful consideration of the complex issues involved in family planning for these individuals, including advanced directives for the use of cryopreserved gametes and embryos, and the social, emotional, and practical issues for the children and surviving partners subsequent to the death of the HIV-positive parent.

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Section: Discussionmentioning

confidence: 99%

Deaths of HIV-Positive Men in the Context of Assisted Reproduction: Five Case Studies from a Single Center

Nakhuda

Peña²,

Sauer³

2005

AIDS Patient Care and STDs

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“…In 2003, Spriggs published a study that identified and evaluated arguments for and against offering ART, specifically IVF, to HIV‐discordant couples (male partner HIV positive, female partner HIV negative) 20…”

Section: Human Immunodeficiency Virusmentioning

confidence: 99%

“…In 2003, Spriggs published a study that identified and evaluated arguments for and against offering ART, specifically IVF, to HIV-discordant couples (male partner HIV positive, female partner HIV negative). 20 The idea of offering ART to HIV-discordant couples generates concern about safety and public health and raises questions about the acceptable level of risk to offspring as well as the necessity for couples who want this assistance to be subject to selection criteria (in particular, the question of whether they should undergo exams for their suitability as parents when those who are able to conceive naturally face no such scrutiny and people with other illnesses are given access to ART).…”

Section: Hiv and Ivfmentioning

confidence: 99%

Role of Infection in In Vitro Fertilization Treatment

Coccia¹,

Cammilli²,

Ginocchioni³

et al. 2004

Annals of the New York Academy of Sciences

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With the increasing demand for assisted reproductive techniques (ARTs), it is important to consider how to manage infection. Three main positive factors that contribute to successful in vitro fertilization (IVF) cycles are maternal age, the ovarian hyperstimulation protocol used, and the number and quality of transferred embryos. Negative factors include contamination and infection. This paper describes the issues relating to infection during IVF and proposes guidelines to control infection and to increase laboratory safety.

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“…The usefulness of the concept of the 'welfare of the child' has been the subject of much debate since the Act (Blyth, 1995;Blyth & Cameron, 1998;Cannold & Gillam, 2002;Devlin & Parkin, 2003;Dower, 2001;Landgridge, 2000;Pennings, 1999;Spriggs & Charles, 2003;Stern, Cramer, Green, Garrod, & De Vries, 2003). In this paper I explore ways in which it might be coherent to talk about the welfare of the child at all in relation to 'potential children' and their implications for practice.…”

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confidence: 96%

The welfare of the child

Parker

2005

Human Fertility

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Should HIV discordant couples have access to assisted reproductive technologies?

Cited by 21 publications

References 28 publications

Deaths of HIV-Positive Men in the Context of Assisted Reproduction: Five Case Studies from a Single Center

Deaths of HIV-Positive Men in the Context of Assisted Reproduction: Five Case Studies from a Single Center

Role of Infection in In Vitro Fertilization Treatment

The welfare of the child

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