Restricting access of human immunodeficiency virus (HIV)–seropositive patients to infertility services: a legal analysis of the rights of reproductive endocrinologists and of HIV-seropositive patients

Phelps, John Y.

doi:10.1016/j.fertnstert.2007.09.018

Cited by 5 publications

(6 citation statements)

References 22 publications

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“…The American Society for Reproductive Medicine (ASRM) asserts that although HIV-infected patients may be referred to providers with more expertise in providing infertility services if their provider lacks that expertise, HIV-infected patients should not be denied access to health services solely based on their HIV status and that HIV antidiscrimination laws apply both to public or private settings [90]. …”

Section: Interventions For Women Wishing To Conceivementioning

confidence: 99%

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Preconception and Contraceptive Care for Women Living with HIV

Hoyt¹,

Storm²,

Aaron

et al. 2012

Infectious Diseases in Obstetrics and Gynecology

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Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.

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Section: Interventions For Women Wishing To Conceivementioning

confidence: 99%

“…Some states continue to have laws that ban assisted conception with semen from HIV-infected men [107] and some clinics may limit or deny services to HIV-infected couples [90]. In addition, most insurance plans (including Medicare/Medicaid) do not cover these services and the cost is usually prohibitive.…”

Section: Safer Conception With Serodiscordant Couplesmentioning

confidence: 99%

Preconception and Contraceptive Care for Women Living with HIV

Hoyt¹,

Storm²,

Aaron

et al. 2012

Infectious Diseases in Obstetrics and Gynecology

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“…Spermatozoa contaminated with HIV can transmit virus to the uninfected woman and to the child [2, 8]. Several states in the U.S. prohibit use of semen from HIV-infected individuals for insemination [9]. …”

Section: Introductionmentioning

confidence: 99%

“…Sperm washing has been advocated as a method to reduce HIV transmission, in which motile spermatozoa are separated from seminal plasma, nonsperm cells, and HIV [9, 10]. This method appears to be successful, with no reported infections in multiple procedures carried out in somewhat more than 2000 couples [11, 12].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Repurposing the Polyanionic Microbicide, PPCM, for Prophylaxis against HIV Transmission during ART

Anderson

Brown²,

Jackson

et al. 2011

ISRN Obstetrics and Gynecology

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HIV-serodiscordant couples wishing to conceive often seek assisted reproduction, during which spermatozoa from infected men are washed to minimize the risk of HIV transmission to partner and fetus. We sought to improve this method by adding a microbicide, PPCM, as an HIV prophylactic. HIV-1 (BaL) inhibition by PPCM appears irreversible and independent of added Ca2+. Without added Ca2+, PPCM (≤10 mg/mL, ≤90 min), a stimulus of Ca2+-dependent acrosomal loss, has no effect on sperm motility, forward progression, or acrosomal status. PPCM-treated (10 mg/mL) sperm retain their ability to acrosome react when Ca2+ is added. Sperm DNA integrity/function is unaffected by PPCM (≤10 mg/mL). Adding PPCM (5 mg/mL, 30 min) to washing media reduces infectivity (viral antigen p24 and RNA) of ex-vivo HIV-infected semen by 3-4 Logs compared with washing alone. Sperm washing with appropriate extracellular Ca2+ levels and PPCM is significantly more effective than washing alone at reducing HIV infectivity.

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“…These different conclusions from the courts are from non-infertility-related patientphysician relationships, but they highlight the legal importance of nondiscrimination in patients with chronic viral diseases such as HIV. 63 When it comes to fertility practices being accountable for treating virally positive patients, there are other considerable ethical dilemmas. If a physician refers an infected patient to another REI practice, the couple seeking fertility may not be able to feasibly receive services due to being geographically removed from those few locations that do treat infected individuals.…”

Section: Ethical and Legal Challengesmentioning

confidence: 99%

The Ethical Challenges of Providing Fertility Care to Patients with Chronic Illness or Terminal Disease

Hossain¹,

Phelps²

2010

Semin Reprod Med

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The field of fertility is rapidly evolving, bringing opportunities for improvement in our patients' quality of life as well as bringing new ethical dilemmas. As medical science continues to advance, significant numbers of the reproductive-aged population are living with chronic and/or terminal conditions but have reasonable odds of lengthy survival and wish to have children. Likewise, there are adolescents diagnosed with cancer who are increasingly expected to achieve an improved, if not normal, life expectancy after treatment. Oftentimes these children are told they must sacrifice their ability to later have genetically related offspring; however, technologies to preserve fertility are changing this prognosis. Patients with chronic infection are living longer, more normal lives and are increasingly seeking reproductive assistance. Moreover, there is an increasing number of patients' families desiring posthumous use of gametes, which also raises ethical and legal issues. This article discusses ethical principles of bioethics and then highlights specific ethical issues through four plausible cases that may be seen in a fertility practice providing medical care to patients with chronic illness or terminal disease. It concludes that prompt referral of patients to the reproductive endocrinologist, along with a multidisciplinary approach to care, provides increased chances of successful treatment of this group of patients.

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Restricting access of human immunodeficiency virus (HIV)–seropositive patients to infertility services: a legal analysis of the rights of reproductive endocrinologists and of HIV-seropositive patients

Cited by 5 publications

References 22 publications

Preconception and Contraceptive Care for Women Living with HIV

Preconception and Contraceptive Care for Women Living with HIV

Feasibility of Repurposing the Polyanionic Microbicide, PPCM, for Prophylaxis against HIV Transmission during ART

The Ethical Challenges of Providing Fertility Care to Patients with Chronic Illness or Terminal Disease

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