Multicentre European study finds that sperm washing has a zero risk of HIV transmission

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Sperm washing is a safe option for HIV serodiscordant couples wishing to conceive, according to a retrospective study involving eight European clinics published in the September edition of AIDS.

The study involved 1036 couples where the man was HIV-positive and the women HIV-negative. These couples had over 3000 cycles of assisted reproduction using washed sperm. Not a single case of HIV transmission occurred. On the basis of this finding the investigators write, “it is neither ethically nor legally justifiable to exclude individuals from infertility services on the basis of male HIV-infection.”

Thanks to potent anti-HIV therapy many HIV infected individuals can look forward to a more or less normal lifespan. Because of this improvement in prognosis, many people with HIV are thinking about parenthood.

Glossary

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

serodiscordant

A serodiscordant couple is one in which one partner has HIV and the other has not. Many people dislike this word as it implies disagreement or conflict. Alternative terms include mixed status, magnetic or serodifferent.

prognosis

The prospect of survival and/or recovery from a disease as anticipated from the usual course of that disease or indicated by the characteristics of the patient.

Significant numbers of serodiscordant couples – where one partner is HIV-positive and the other HIV negative – have unprotected sex because of a wish to conceive. This can involve a risk of HIV transmission.

An option for couples where the man is HIV-positive is sperm washing. This involves the removal of infectious HIV from semen and the artificial insemination of the HIV-negative partner.

The risk of HIV transmission per act of unprotected penile – vaginal intercourse is thought to be in the region of 0.1%. But no study has compared this risk to that involved with sperm washing. The eight European centres that provide sperm washing have created the Centre for REproductive Assisted Techniques for HIV Europe (CREAThE) network. Investigators from these centres performed a retrospective analysis to determine the efficacy and safety of sperm washing.

The centres provided 3390 assisted reproduction cycles using washed sperm to 1036 couples. The number of cycles per couple varied from one to 19. Intra-uterine insemination was the most frequently used procedure (84%). The average age of the female partners at the time was treatment was 32 years and the men had an average age of 35 years. Data from 1989 to 2003 were included in the study.

Treatment resulted in pregnancy on at least one occasion in 499 (48%) women, with the total number of pregnancies being 533.

There were 410 deliveries involving 468 live births (this included 29 sets of twins and 13 sets of triplets). There were two neonatal deaths, 112 miscarriages, eight extra-uterine pregnancies, two terminations, and one intrauterine death.

HIV antibody tests were performed on 97% of the women within six months of receiving an assisted reproductive cycle involved washed sperm. None of the women test HIV-positive. This allowed the investigators to calculate the probability of HIV transmission of sperm washing to be zero (95% confidence interval, 0 – 0.09%). The 3% of women who were not tested for HIV within six months of their cycles all came from the same Italian centre.

The investigators comment, “the present study is the first multicentre study of the use of sperm washing in HIV-1-serodiscordant couples…it is the largest series published to date and the first with sufficient case numbers to confirm the safety and efficacy of assisted reproduction where sperm washing was used as the primary means of avoiding HIV infection in the female partner.”

References

Bujan L et al. Safety and efficacy of sperm washing in HIV-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS 21: 1909 – 1914, 2007.