Pregnancy following intracytoplasmic sperm injection from an HIV-1- seropositive man

Abstract

The first pregnancy achieved in a seronegative woman following in-vitro fecundation through intracytoplasmic sperm (ICSI) injection from a man with autoimmune deficiency syndrome (AIDS; HIV-1 carrier) is reported. The semen was prepared by PureSperm and swim-up techniques. Some of the motile spermatozoa obtained were used to detect the presence of HIV-1 using the polymerase chain reaction technique. HIV-1 in DNA or RNA form was not detected using this technique. The remaining spermatozoa were frozen. Ovarian stimulation in the woman was performed with long-protocol analogues and gonadotrophins. Thirteen mature oocytes were recovered, into which the thawed spermatozoa were microinjected. Nine embryos were obtained. Four were frozen, four transferred and one discarded. The woman became pregnant. Analyses for HIV-1 in the woman, performed in the first and third months of pregnancy, gave negative results. This case provides further experience with washed semen of sufficient quality for performing artificial insemination in HIV-1-serodiscordant couples (101 inseminations, 31 pregnancies, 28 deliveries, 37 babies, all healthy). In women with obstructed Fallopian tubes, or when the semen is not of sufficient quality for artificial insemination techniques to be performed, ICSI can be carried out using frozen, HIV-1-free semen.

Yes, It is Possible

“…The first pregnancy achieved in a seronegative woman following in vitro fecundation through intracytoplasmic sperm (ICSI) injection from a man with autoimmune deficiency syndrome (AIDS; HIV-1 carrier) was reported in 1998 [7]. The semen was prepared by PureSperm and swim-up techniques.…”

Detection of HIV and HCV RNA in semen from Brazilian coinfected men using multiplex PCR before and after semen washing

“…In contrast, both recent and earlier studies concluded that purification of motile spermatozoa by either the discontinuous gradient or swim-up method, or even by a combination of these techniques, reduces the number of HIV and/or HCV particles in semen to undetectable levels 8,14,17,18,24,28,32 , making it possible for serodiscordant couples to conceive a child by means of assisted reproduction techniques with minimum risk of seroconversion 14,15,32 .…”

“…As these couples cannot stop using condoms, lest they infect their seronegative partner or the newborn, it is essential to treat the infected semen with effective laboratory techniques that not only isolate the best spermatozoa, but also remove HIV and HCV infected cells from the semen. This is achieved in many studies by using the semen washing technique together with the swim up 26 method to purify the infected semen 17,18,24,32 .…”

Gynecologic issues in the HIV-infected woman

“…There was a trend toward shorter cycles and more cycle variability among seropositive women with high viral loads and low CD4 cell counts. A study comparing women with CD4 cell counts between 200 and 500 cells/µl to women with CD4 cell counts under 100 cells/µl demonstrated a prevalence of amenorrhea of 9% and 19% respectively, illustrating an association between immunosuppression and amenorrhea, at least at the more severe end of the spectrum (21).…”

“…The serodiscordant couple contemplating timed intercourse should be counseled against this, as transmission occurs in 1 of 500 to 1 of 1000 instances of unsafe sex, with a 4.3% horizontal transmission rate reported in couples using timed intercourse to conceive (200). If they do proceed with timed intercourse, they should be counseled not to start until the male's viral load is undetectable, to avoid sexual contact if either partner has any other untreated sexual infections, ulcers, or bleeding, and to use ovulation predictors to accurately time their sexual contacts.…”