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Options for conception

Selina Corkery
Published: 23 October 2013

For many people with HIV, having a healthy, HIV-negative child is an achievable goal. For women with HIV, effective HIV treatment and care reduce the risk of mother-to-child transmission (MTCT) to very low levels.

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. It is particularly important for you both to discuss the options and risks with your healthcare team before you make a decision to have unprotected sex in order to become pregnant.

When the man is HIV positive and the woman HIV negative

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
  • there are no other infections present
  • unprotected sex is limited to the days when the woman is ovulating (and at her most fertile). 

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 outlined above.

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). 

The facilities 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.

When the woman is HIV positive and the man HIV negative

Unprotected sex: It may be considered safe to have unprotected sex in order to conceive if:

  • the woman is on highly active antiretroviral therapy (HAART) with good adherence
  • there are no other infections present
  • unprotected sex is limited to the days when the woman is ovulating (and at her most fertile).

Self-insemination: HIV-positive women can use a simple self-insemination technique, using semen from their HIV-negative male partner. This is completely safe. It is most likely to be successful when the woman is ovulating. It’s best to try several times during the fertile period.

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’s some evidence that fertility problems are more common in women with HIV than in women 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. There may be some treatment that can help.

When both partners are HIV positive

If both you and your partner are on HIV treatment, have had an undetectable viral load for some time, have no other STIs, and neither of you is having sex with other partners, the risk of transmission of different strains of HIV to the other partner is very low.

Calculating the fertile period

Women are most fertile, and more likely to become pregnant, 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.

More information

Serodiscordant couples and couples who are both HIV positive may have insemination using donor sperm. This is completely safe.

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

Staff at your HIV clinic can give you more advice about all these options so you can decide if they might work for you.

NAM’s online tool HIV & pregnancy can provide personalised information about the options available to you and your partner.

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

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.