All women have the right to make their own choices about fertility and childbirth, regardless of their HIV status, and you should expect and receive the same level of support from doctors and healthcare workers as anyone else.

With effective HIV treatment, reducing viral load to an undetectable level and a managed delivery, the risk of an HIV-positive woman passing HIV on to her baby is very low.

HIV treatment can reduce the risk of transmitting HIV to your baby. If you are pregnant, or planning pregnancy, it's very important to find out how you can reduce the risk of your baby being infected with HIV and to ensure your drugs are the best ones for pregnancy. Discuss your concerns and options with your doctor.

Talking to other HIV-positive women who have been through the 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 and that you and your partner are in good general health with no other infections or STIs. If you are thinking of becoming pregnant, you may be advised to try to conceive at a time when your viral load is likely to be low, or easily controlled by HIV treatment. If you have an opportunistic infection, you should wait until it has been treated or until you no longer need treatment to prevent you getting such an infection (sometimes called prophylaxis).

UK guidelines on managing HIV infection in pregnant women suggest some things HIV-positive women can do when preparing to conceive, including 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.

Talk to your doctor if you are planning on getting pregnant to ensure that you are taking or starting the most suitable HIV medication for pregnant women.

You cannot join a clinical trial looking at the effectiveness of new HIV drugs if you are pregnant or thinking of becoming pregnant. See NAM’s booklet Clinical trials for more information.

Getting pregnant through unprotected sex with a sero-different partner (where one partner is HIV-positive and the other is not) is not generally recommended because there is still a risk of transmission of HIV to the negative partner, even when your viral load is undetectable.

You can become pregnant safely if your partner is HIV-negative. This can be done 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). 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.
7. The area to aim for is high up in the vagina, towards the cervix.
8. Slowly squirt out the contents of the syringe. Gently remove the syringe.
9. 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 information on how to calculate and recognise when you are ovulating.

Sperm washing can be used to separate the seminal fluid, which contains HIV, from the sperm, which do not contain HIV. The remaining sperm are placed in a substitute fluid and inserted into your vagina when you are ovulating, the time when you are most fertile.

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. Your doctor or GP can give you more information or answer any queries you may have regarding sperm washing.

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. You may be asked to show that you are in a stable heterosexual relationship.

If you have difficulty in conceiving or if your partner has a low sperm count, you may want to investigate IVF (in vitro fertilisation) together with sperm washing. 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 success rate for sperm washing varies depending on how the sperm is implanted.

You could also consider the option of using donor sperm.

If you are both HIV-positive and have unprotected sex, it may result in one or both of you getting reinfected with a different strain of the virus, or a drug-resistant strain, especially if one of you is on treatment and the other one is not.

Sperm washing could be used by couples where both partners have HIV, and want to avoid reinfection.

However, if you are both taking HIV treatment and have an undetectable viral load and no other STIs, and neither of you are having sex with other partners, the risk of transmission is further reduced, but not eliminated. It is therefore extremely important for you and your partner to discuss your options and the risks with your doctor and healthcare team before you make a decision to have unprotected sex.

Talk to your healthcare team about your situation and other possibilities.

Fertility treatment funded by the NHS currently varies across the UK. The criteria that you must meet to be eligible for treatment can also vary, and in some cases it may depend on what your local health trust will fund. You may want to find out more about your options at a private fertility clinic, but there will be costs associated with this.

Adoption might be another option. Having HIV does not automatically mean you can’t adopt, but your health and circumstances would be assessed before you could apply.