Unprotected sex: There is now significant evidence that HIV
treatment can be an effective prevention method. In some situations, it may
be considered safe to have unprotected sex in order to conceive. The 2013 NICE
fertility guidelines say the risk of HIV transmission is negligible when
the male partner is HIV positive and:
- he is on
highly active antiretroviral therapy (HAART) with good adherence
- he has had
an undetectable viral
load for more than six months
- there are
no other infections present
sex is limited to the days when the woman is ovulating (and at her most
In these circumstances,
sperm washing (see below) is unlikely to reduce the risk of infection further
and may reduce the likelihood of pregnancy.
PrEP: 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 to suggest this provides any extra protection to HIV-negative partner
if their HIV-positive partner is on HIV treatment and meets the criteria
Sperm washing: Where the conditions listed above are not met,
sperm washing is still the safest way for an HIV-positive man to biologically
father a child with his HIV-negative partner. Couples may also choose sperm
washing if they feel that any level of risk of transmission from unprotected
sex is unacceptable.
HIV is carried
primarily in the seminal fluid rather than in the sperm itself; this technique
separates the two. Once the sperm sample has been ‘washed’, it can be used in a
range of fertility treatments. The simplest of these is a technique called
intra-uterine insemination (IUI), where the washed sperm is placed into the
uterus (womb) of the woman. If there are any other fertility problems, it may be
necessary to combine sperm washing with more complex fertility
treatments such as in vitro fertilisation (IVF).
"It may be considered safe to have unprotected sex in order to conceive."
required to perform sperm washing are highly specialised and are
available at a few reproductive health clinics in the UK. These include the Assisted
Conception Unit at the Chelsea and Westminster Hospital and at King’s College Hospital in
London, and at the Hewitt
Centre for Reproductive Medicine at Liverpool Women’s Hospital.
The exact process will
vary depending on the unit. Generally, you will have consultations with a
doctor and other healthcare staff. You may have counselling to discuss
fertility and the treatment, or any complex health or social issues. You may be
required to have counselling if there are concerns about the potential welfare
of the child.
You will usually both
have a sexual health screen, including an HIV test (for the negative partner),
and tests to assess your fertility. The preliminary investigations and
appointments can take two to three months.
You will need to
provide a referral letter from your doctor (usually a GP or HIV doctor), and
current information on viral load and CD4 count. There may also be additional
eligibility criteria depending on which unit is providing the service. Sperm
washing is not always available on the NHS and you may have to pay
for this service, which is expensive. In some parts of the country, NHS policy recognises the HIV prevention role of sperm
washing and will fund one or several cycles of IUI with sperm washing. Even so,
only some of the costs of the treatment may be covered.