HIV sperm wash (for HIV discordant couple)

The development of highly active antiretroviral therapy has transformed the prognosis of patients infected with human immunodeficiency virus type 1 (HIV) living in the developed world and increased the demand for reproductive care for these patients. The primary aim is to ensure that infected individuals do not put their uninfected partner or unborn child at risk. Centres offering assisted-conception treatment to HIV couples need to provide risk-reduction options such as sperm-washing, and reproductive counselling, and ensure the safety of uninfected patients and healthcare workers in the centre. Where the man is HIV-1 positive and the women HIV-1 negative, sperm-washing is a well-established, effective means of reducing HIV transmission risk compared with timed, unprotected intercourse. If a couple have additional fertility issues, sperm-washing can be combined with ovulation induction, in vitro fertilization or intracytoplasmic sperm injection. In HIV-positive women trying to conceive, reducing risk lies primarily after conception in preventing mother-to-child transmission, achieved through the use of antiretroviral medication during pregnancy and delivery, caesarean or managed vaginal delivery and an avoidance of breast-feeding.

Sperm washing is a process which has been developed for couples who wish to have a child, where the male is HIV-positive and the female is HIV-negative. The procedure reduces the risk of HIV transmission to the female partner and subsequently the unborn child.
Sperm washing rests on the premise that HIV infected material is carried primarily in the seminal fluid rather than in the sperm itself. The technique involves purifying sperm from seminal fluid. The sperm is then used for insemination into the female partner when she is ovulating and most likely to become pregnant (called Intra-Uterine Insemination or IUI), or for in vitro fertilisation, (IVF).
There remains a very small theoretical risk to the woman of HIV transmission. Sperm washing is however, considerably safer than having unprotected sex, but if a couple is certain that they don’t want to take any risk, no matter how minimal, sperm washing would not be a suitable method for them. These couples may prefer to find out more about artificial insemination by donor which is a risk free alternative.

A sperm-washing service is available at Womens Hospital International. A couple’s first step on this programme is to visit our counselor, to get further information and support, and to explore some of the issues involved. Partners are seen individually and together. Deciding to embark on this treatment may not be a easy decision. Although the risk of the female partner becoming infected is minimal, it still exists, and for one or both partners it may be felt that this risk is too much. There is also an opportunity to discuss issues concerning parenting itself, coping with a child when one parent is HIV-positive and facing the reality that treatment does not guarantee pregnancy. Counseling is available on an individual and couple basis.

During the first visit, couples will also need to have a full sexual health screen which includes an HIV test for both partners. Following these tests, an appointment is made with our experts who will assess the fertility of each couple. Over the following few weeks, tests including various blood tests along with an ultra-sound scan and an x-ray for the female partner, and a semen analysis for the male partner will be performed. These tests indicate whether insemination would be a realistic option. If either partner was to have sub-optimal fertility, IVF may be a consideration after all avenues have been explored. All preliminary investigations and appointments can take two to three months.