As life expectancy among people with HIV is increasing significantly due to the introduction of HAART in the UK, heterosexual couples are increasingly interested in the possibility of beginning a family. Consequentially, HIV-positive people will need access to fertility treatments, and calls have been made for HIV-positive people to be treated in the same way as others with chronic medical conditions.
Two groups of people with HIV have been identified as being likely to want or need access to infertility treatment; serodiscordant couples (where only one partner has HIV) who wish to avoid the transmission of HIV to the partner (infertility may not be an issue here) and serodiscordant and seroconcordant (where both partners have HIV) couples who have tried unsuccessfully to conceive.
The results of a questionnaire survey sent to each of the 75 clinics in the UK providing assisted conception, concerning access to infertility treatment by HIV-positive people were published last week in the British Medical Journal.
The survey highlighted a serious inequity in the availability of both infertility investigation and access to infertility treatment.
In total 57 of the 75 UK clinics (76%) responded to the questionnaire. The majority (25/57) of these clinics had not seen an HIV-positive person in the past year. Units that had seen an HIV-positive person in the past year were more likely to than units that had not to offer infertility investigation and treatment to couples where the male partner was HIV-positive. The same trend was not observed where the female partner was HIV-positive or both partners were HIV-positive.
Only 44% of units would treat a couple where only the man was HIV-positive. This is hugely disappointing since donor insemination in such circumstances is completely safe and sperm washing could be used by couples wishing to have a child that is biologically theirs.
The wider availability of interventions to prevent the transmission of HIV to the child in couples where both partners have HIV does not appear to have influenced infertility treatment centres approach to HIV-positive people at all; a total of 38 of the 57 clinics (67%) that responded to the survey said that they would not offer infertility treatment to couples where both partners are HIV-positive.
Whilst the Human Fertilisation and Embryology Act 1990 states that the welfare of the child should be considered before any course of treatment starts, no category of women (including women with HIV) are excluded from consideration for infertility treatment. The authors cautioned that “a blanket refusal to provide infertility investigations and treatment to couples infected with HIV may lead to an increase in seroconversion of the uninfected partners of serodiscordant couples trying to conceive naturally”.
Apoola A et al. Access to infertility investigations and treatment in couples infected with HIV: questionnaire survey. BMJ 2001; 323: 1285 (1 December).