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Conception

All women have the right to make their own choices around fertility, regardless of their HIV status. You should expect and receive the same level of support from doctors and healthcare workers as women who do not have HIV. Women should also expect to be closely involved in any decisions made about childbirth, during their pregnancy.

Although you have HIV, it is still possible for you to have a healthy pregnancy, and for your baby to be healthy and HIV negative. Effective HIV treatment, an undetectable viral load, careful planning about delivery and avoiding breastfeeding all ensure there is a very low risk of a woman with HIV passing it on to her baby.

You can find personalised information about becoming pregnant, about pregnancy and delivery, and about care for your new baby, by using NAM’s online tool HIV & pregnancy at www.aidsmap.com/pregnancy.

Planning to get pregnant

If you are pregnant, or planning to become pregnant, it's very important to find out how you can reduce the risk of passing HIV on to your baby and to ensure you have a healthy pregnancy. It’s a good idea to start discussing your options with your doctor or other members of your healthcare team as soon as you start thinking about having a baby. Your healthcare team will have experience of pregnancy in women with HIV and will be able to give you important information and support.

Talking to other women living with HIV who have been through the same experience can help you to make informed decisions about pregnancy, birth and looking after your baby’s health, such as having strategies in place for adhering to your treatment and for not breastfeeding.

You can prepare for pregnancy by making sure your viral load is low, that you and your partner are in good general health and neither of you has any opportunistic infections or sexually transmitted infections (STIs).

If you or your partner also have hepatitis C, talk to your healthcare team if you are thinking about becoming pregnant. Hepatitis C treatment currently often includes the drug pegylated interferon, with or without another anti-hepatitis C drug, ribavirin.

You must not become pregnant while you are taking ribavirin, nor for six months after finishing it, nor while your partner is taking ribavirin and for six months after he has finished it. It is a good idea to use at least two forms of contraception during this period. If you discover you are pregnant while taking treatment for hepatitis C, contact your doctor immediately to discuss stopping your hepatitis C treatment.

There are some things all women are advised to do when preparing to conceive. These include taking folic acid (a vitamin needed to make new cells in the body). If you are taking a drug called cotrimoxazole (Septrin) because of an opportunistic infection or as prophylaxis, you may need to take an increased dose if you are also taking folic acid. It is also best to avoid alcohol and tobacco while you are trying to become pregnant.

You are usually not able to join a clinical trial looking at the effectiveness of new HIV drugs if you are pregnant or thinking of becoming pregnant.

Conception for sero-different couples

In the past, getting pregnant through unprotected sex with a sero-different partner (where one partner is HIV positive and the other is HIV negative, often referred to as ‘serodiscordant’) was not recommended. There is now significant evidence that being on HIV treatment and having an undetectable viral load can prevent the transmission of HIV. You can find out more about treatment as prevention in the NAM factsheet HIV treatment and sexual transmission.

In certain situations, the risk of HIV transmission is low enough that it’s considered safe for a couple to have unprotected sex in order for the woman to become pregnant. This is the case when:

  • the partner who is HIV positive is on combination HIV treatment and is taking their treatment as prescribed, and
  • they have had an undetectable viral load for more than six months, and
  • neither of you has any sexually transmitted infections (STIs), and
  • you only have unprotected sex on the days when you are ovulating (and at your most fertile; see Knowing your fertile period, below). 
  • The HIV-negative partner may be offered anti-HIV drugs to take around the days you have unprotected sex as another preventive step (this is called pre-exposure prophylaxis, or PrEP).

There is now sufficient evidence for this to be the advice to couples (where the man is HIV positive and the woman HIV negative) in the 2013 fertility guidelines from the National Institute for Health and Care Excellence (NICE). It’s important that you and your partner discuss this option with your/his healthcare team before you have unprotected sex, so you can both make an informed decision.

If you and your healthcare team decide this is not the right option for you, there are other ways you can conceive, depending on whether you, your partner or both of you have HIV. These are explained below.

For an HIV-positive woman and an HIV-negative man

If you have HIV but your partner is HIV negative, you can become pregnant without risking HIV transmission to him through self-insemination, sometimes referred to as ‘DIY’. This is a simple process you can do at home. You will need to make sure that neither you nor your partner has a sexually transmitted infection before trying it.

This is best done when you are ovulating (your fertile period; see below). It’s best to try the technique several times during your fertile period.

  1. Your partner will need to ejaculate into a container. The container doesn’t need to be sterile, but it should be clean and dry.
  2. Next you’ll need a plastic syringe. Your HIV clinic can provide them, or you can buy the kind used to give medicine to babies at a chemist.
  3. Wait up to 30 minutes for the semen to become more liquid.
  4. Draw back on the syringe once with nothing but air, then push the air out again. Now point the syringe into the liquid and slowly draw it back to suck in the semen.
  5. Get into a comfortable position lying on the bed with your bottom raised on a cushion.
  6. Either you or your partner can now slowly insert the syringe as far into the vagina as possible. The area to aim for is high up in the vagina, towards the cervix.
  7. Slowly squirt out the contents of the syringe. Gently remove the syringe.
  8. Try to remain lying down for the next 30 minutes while the sperm makes its way through the cervix. Some semen may leak out but this is normal, and doesn’t mean it won’t have worked.

An alternative method is for you and your partner to have sex together, using a male condom. After sex, withdraw the penis from the vagina with the condom still on. Then take it off, and use a syringe to transfer the semen to your vagina. If you use this technique, make sure that the condom doesn’t contain a spermicide.

The healthcare team at your clinic will be able to provide syringes and other equipment, and information on how to calculate and recognise when you are ovulating.

For an HIV-positive man and an HIV-negative woman

Where you and your partner can’t meet all the conditions that make having unprotected sex a safe option, a technique called sperm washing is the safest way for an HIV-positive man to biologically father a child with his HIV-negative partner.

Bear in mind that, where you can meet all the conditions, sperm washing is unlikely to reduce the risk of infection further. You may also be less likely to conceive through the insemination processes used in sperm washing than you are through unprotected sex.  

Sperm washing is used to separate the seminal fluid, which contains HIV, from the sperm, which do not contain HIV. Once the sperm sample has been ‘washed’, it can be used in a range of fertility treatments. The simplest of these is called intra-uterine insemination (IUI). The washed sperm is placed into your uterus (womb) around the time you are ovulating. 

If you have difficulty in conceiving or if your partner has a low sperm count, you may want to investigate sperm washing combined with other fertility treatments. These include in vitro fertilisation (IVF, where the eggs are inseminated with washed sperm in a laboratory) or intra-cytoplasmic sperm injection (ICSI, where the sperm are injected directly into the egg).

You can ask your doctor for a referral to an assisted conception unit where you should receive the same service as couples who are not HIV positive.

The likelihood that you will become pregnant after sperm washing depends on many factors (including your age, your overall fertility and the technique used to implant the sperm), but the sperm washing itself does not reduce the chance of any technique working. 

Although it can’t be absolutely guaranteed that no HIV remains, sperm washing is considered very safe.

Sperm washing is not widely available and you may have to pay for this service, which is expensive. To be eligible for sperm washing you will need a referral from your partner’s doctor with details of his viral load and CD4 count. There may be other eligibility criteria, depending on where you are having the treatment.

Knowing your fertile period

If you are having unprotected sex or using self-insemination to become pregnant, you need to try these on the days when you are most fertile, and more likely to become pregnant. This is at the time of ovulation (when an egg is released from one of the ovaries). Getting to know your body and your menstrual cycle will allow you to estimate and recognise when ovulation happens and increase the chances of getting pregnant.

If you note down the dates of the beginning of each period, you will find out how long your menstrual cycle is. The average length is 28 days, but many women have a cycle that is shorter or longer.

To get a rough idea of your fertile time:

  1. Work out the date you are expecting your next period to begin.
  2. Count back 16 days before this date.
  3. Your fertile time begins around now and lasts five or six days. For example, if you expect your period to begin on May 26th, your fertile time should begin around May 10th.

You can also learn to identify your fertile time by noting the changes in your vaginal secretions. At the beginning and end of your cycle vaginal secretions are creamy, sticky and thick. As your body prepares for ovulation, they become wetter, thinner, clearer and stretchy like raw egg white. Your breasts may feel tender. Mild stomach pain and feeling bloated can be other signs that you are ovulating. You can buy ovulation prediction kits over the counter at chemists or supermarkets, or online. They can be useful if you have a very irregular cycle and find it hard to know when you might be ovulating, but they can be expensive.

Other options

Talk to your healthcare team about your situation and other possibilities for having a baby.

A short course of anti-HIV drugs (pre-exposure prophylaxis, or PrEP) can also be used to protect a negative partner from HIV transmission. (There is no evidence that this provides any extra protection if you are on effective HIV treatment.)

There’s some evidence that fertility problems are more common in people with HIV than in people who don’t have HIV. If you are not pregnant after six months of trying, it would be a good idea to talk to your doctor about it. They may be able to give you advice or there may be treatment that can help.

Adoption might be another option for you. As with any potential adoptive parents, your health and circumstances would be assessed before you could apply.

HIV & women

Published July 2014

Last reviewed July 2014

Next review July 2017

Contact NAM to find out more about the scientific research and information used to produce this booklet.

This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.