About Abesha Care

Conception: When the man is HIV-positive and the woman HIV-negative.

Conception: when the woman is HIV-positive and the man HIV-negative.

Conception: When both partners are HIV-positive

A guide to HIV, pregnancy & women's health

When the man is HIV-positive and the woman HIV-negative

Sperm washing

When the man is HIV-positive and the woman is HIV-negative, it is possible to use a process
called sperm washing.

There have been no cases of HIV transmission to women from sperm washing.

It has led to the birth of over 600 HIV-negative babies

This is therefore the safest way for an HIV-negative woman to become pregnant from an HIV-positive man.

Sperm washing involves the man giving a semen sample to a clinic. A special machine then spins this
sample to separate the sperm cells from the seminal fluid. (Only the seminal fluid contains HIV-infected
white blood cells, sperm cells themselves do not.)

The washed sperm is then tested for HIV. Finally, a catheter is used to inject the sperm into the
woman's uterus. In vitro fertilisation (IVF) may also be used, especially if the man has a low sperm count

Limited conception attempts

A more controversial option is to have limited conception attempts during the most fertile
days in a woman's cycle.

		The risk of low level exposure from a person whose viral load is less than 50 copies/mL has
		been estimated as between 0.03% to 0.005%.

		This is a risk ratio of about 1 in 3,300 to 20,000. Some couples think that this is an acceptably
		low risk compared to the importance of trying for a baby.

For many women who want to have children, this risk may be acceptable, but it must be
something that she decides to do herself and is not pressurised into.

It is essential that an HIV-positive man uses HIV treatment to reduce his viral load to undetectable.
To make this even safer viral load should be checked in both blood and semen.

Approximately 10% of people with undetectable levels in blood, can have detectable levels in semen,
so this could offer additional safety. Viral load in semen can be tested using the same viral load tests
that are used for blood, and your clinic could advise on this.
Conception can either be naturally (having gentle sex) or with self insemination. Most doctors can
provide guidance on how to plan and identify which days would be appropriate.

Artificial or self-insemination would reduce the risk of trauma during sex where a small tear could
increase the risk of HIV transmission.

Continuing to use condoms at all other times is essential.

This approach is more controversial because there is still a small risk of transmitting HIV.
In one report around 60 couples conceived in this way without any HIV transmission BUT the study is
too small to draw conclusions safely – the risk of HIV transmission is already much less than 1 in 60.
There may be an additional safety benefit from the woman using 1-2 days of HIV drugs to reduce the
slight chance of infection even further. Several studies are looking at whether using tenofovir and FTC
(or 3TC) before exposure to HIV can reduce the risk of transmission.

When the woman is HIV-positive and the man is HIV-negative

The options are usually much simpler in this situation. Do-it-yourself artificial insemination
or 'self insemination' using a plastic syringe carries no risk to the man. This is the safest way
to protect the man from HIV.

Around the time of ovulation, you need to put the sperm of your partner as high as possible into your
vagina. Ovulation takes place in the middle of your cycle, about 14 days before your period.
Different clinics may recommend different methods. One way is to have protected intercourse with a
spermicide-free condom. Another is for your partner to ejaculate into a container. In both cases, you
then insert the sperm into your vagina with a syringe.
Your clinic can provide the container and syringe. They can also give detailed instructions on how to
do this, including advice on timing the process to coincide with your ovulation.

When both partners are HIV-positive

For couples in which both partners are HIV-positive, most doctors still recommend safer
sex. This is to limit the possibility of reinfection with a different strain of HIV.

It is likely that this risk is very low, but it is possible. This risk of reinfection is even less likely if you only
have unprotected sex a few times in order to conceive a baby. Here are some other things to consider
about the risk of reinfection:

The risk of reinfection between HIV-positive couples is likely to relate to their viral loads.
This risk is likely to be higher if one partner is doing well on treatment while the other partner is
untreated and/or has a high viral load.
The risk is more serious if one partner is resistant to HIV treatment.
If you routinely practice safer sex, you may be advised to limit unprotected sex to the fertile period. You
could also follow the advice for couples where one partner is HIV-positive and the other HIV-negative.
For HIV-positive couples who do not practice safer sex now, continuing to do so to conceive a baby will
carry no additional risk.
All these options involve very personal decisions. Knowing and judging the level of risk is also very
individual.
All methods of becoming pregnant carry varying degrees of risk, and chance of success (and sperm
washing and fertility treatment may involve a cost if you are unable to access it on the NHS).

If you are planning a pregnancy, take the time to talk about these options with your partner. This way
you can make decisions that you both are happy with.

--------------------------------------------------------------------------------------------------------------------------------

Information on this website is provided as a guide only. All treatment decisions should be taken in
consultation with your doctor or other healthcare professional.

REFERENCE:
!.1. Written by Polly Clayden and Simon Collins. Edited by Jeff Hoover. Drawings by Beth Higgins.
Produced by HIV i-Base.